• Giammauro Berardi, Tommy Ivanics, Gonzalo Sapisochin, Francesca Ratti, Carlo Sposito, Martina Nebbia, Daniel M D'Souza, Franco Pascual, Samer Tohme, Francesco Enrico D'Amico, Remo Alessandris, Valentina Panetta, Ilaria Simonelli, Celeste Del Basso, Nadia Russolillo, Guido Fiorentini, Matteo Serenari, Fernando Rotellar, Giuseppe Zimitti, Simone Famularo, Daniel Hoffman, Edwin Onkendi, Santiago Lopez-Ben, Celia Caula, Gianluca Rompianesi, Asmita Chopra, Mohammed Abu Hilal, Guido Torzilli, Carlos Corvera, Adnan Alseidi, Scott Helton, Roberto I Troisi, Kerri Simo, Claudius Conrad, Matteo Cescon, Sean Cleary, KwonChoon H DCHDDepartment of Surgery, Cleveland Clinic, Cleveland, OH., Alessandro Ferrero, Giuseppe M Ettorre, Umberto Cillo, David Geller, Daniel Cherqui, Pablo E Serrano, Cristina Ferrone, Vincenzo Mazzaferro, Luca Aldrighetti, and T Peter Kingham.
• Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
• Ann. Surg. 2023 Nov 1; 278 (5): e1041e1047e1041-e1047.

ObjectiveTo compare minimally invasive (MILR) and open liver resections (OLRs) for hepatocellular carcinoma (HCC) in patients with metabolic syndrome (MS).BackgroundLiver resections for HCC on MS are associated with high perioperative morbidity and mortality. No data on the minimally invasive approach in this setting exist.Material And MethodsA multicenter study involving 24 institutions was conducted. Propensity scores were calculated, and inverse probability weighting was used to weight comparisons. Short-term and long-term outcomes were investigated.ResultsA total of 996 patients were included: 580 in OLR and 416 in MILR. After weighing, groups were well matched. Blood loss was similar between groups (OLR 275.9±3.1 vs MILR 226±4.0, P =0.146). There were no significant differences in 90-day morbidity (38.9% vs 31.9% OLRs and MILRs, P =0.08) and mortality (2.4% vs 2.2% OLRs and MILRs, P =0.84). MILRs were associated with lower rates of major complications (9.3% vs 15.3%, P =0.015), posthepatectomy liver failure (0.6% vs 4.3%, P =0.008), and bile leaks (2.2% vs 6.4%, P =0.003); ascites was significantly lower at postoperative day 1 (2.7% vs 8.1%, P =0.002) and day 3 (3.1% vs 11.4%, P <0.001); hospital stay was significantly shorter (5.8±1.9 vs 7.5±1.7, P <0.001). There was no significant difference in overall survival and disease-free survival.ConclusionsMILR for HCC on MS is associated with equivalent perioperative and oncological outcomes to OLRs. Fewer major complications, posthepatectomy liver failures, ascites, and bile leaks can be obtained, with a shorter hospital stay. The combination of lower short-term severe morbidity and equivalent oncologic outcomes favor MILR for MS when feasible.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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