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Ratti et al. Hepatoma Res 2016;2:271-8 Hepatoma Research
DOI: 10.20517/2394-5079.2016.20
www.hrjournal.net
Topic: Advances in Minimally Invasive Cirrhotic Surgery Open Access

Liver resection for hepatocellular

carcinoma within a fast-track management:

a propensity-score matched analysis

between open and laparoscopic approach

Francesca Ratti , Federica Cipriani , Raffaella Reineke , Marco Catena , Michele Paganelli , Luigi Beretta , Luca
2
1
1
1
1
2
Aldrighetti 1
1 Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milano, Italy.
2 Department of Anaesthesiology and Intensive Care, IRCCS San Raffaele Hospital, 20132 Milano, Italy.
Correspondence to: Dr. Francesca Ratti, Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milano, Italy.
E-mail: ratti.francesca@hsr.it
How to cite this article: Ratti F, Cipriani F, Reineke R, Catena M, Paganelli M, Beretta L, Aldrighetti L. Liver resection for hepatocellular
carcinoma within a fast-track management: a propensity-score matched analysis between open and laparoscopic approach. Hepatoma Res
2016;2:271-8.
ABSTRACT

Article history: Aim: The study was designed to assess the implications of enhanced recovery after surgery
Received: 08-06-2016 (ERAS) approach in patients submitted to open liver resection for hepatocellular carcinoma
Accepted: 20-09-2016 (HCC) comparing their short term outcome with patients treated by laparoscopic approach,
Published: 30-09-2016 in a case-matched design. Methods: The open-group (n = 60) was matched in a ratio of 1:1
with patients undergoing laparoscopic liver resection for HCC (Lap-group, n = 60), with a
matching achieved on a basis of propensity scores including 6 covariates representing patients
characteristics and severity of the disease. Primary outcome analysis was performed in
Key words: terms of ERAS-specific items and postoperative morbidity and mortality. Results: Overall
Hepatocellular carcinoma, morbidity and mortality were comparable between groups. Incidence of ascites was slightly
fast track, higher in the open- compared with the Lap-group (respectively 11.7% and 13.3%), without
laparoscopy, statistical significance. The need for introduction or increase of chronic diuretic therapy was
liver surgery, significantly higher in the open-compared with the Lap-group (16.7% vs. 11.7%, P = 0.046).
enhanced recovery after surgery, Furthermore, ascites more frequently required percutaneous drainage in the open-compared
liver failure with the Lap-group (5% vs. 1.7% respectively, P = 0.041). Conclusion: In patients who
can’t benefit from minimally-invasive approach because of disease characteristics, ERAS
management seems to be associated with an improved postoperative functional recovery and
postoperative outcomes, comparable to those of the minimally invasive approach.

INTRODUCTION a significant improvement that was widen to encompass
even patients management. [1-3] Indeed, this innovative
Thanks to the widespread diffusion of laparoscopic trend included the application of multimodal perioperative
surgery of the liver, surgical technique has experienced care protocols, called fast track or enhanced recovery
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