Alexandra W Elias, MD, Tariq Almerey, MD, Riccardo Lemini, MD, Emmanuel M Gabriel, MD, PhD. Mayo Clinic FL
Introduction: The application of minimally invasive surgery (MIS) using laparoscopic or robotic approaches for the treatment of hepatocellular carcinoma (HCC) has increased in the last decade. Many studies have identified that a multiple disparities exist in the care for patients with HCC, and that these disparities can have a significant impact on oncologic outcomes. The purpose of this study was to investigate the demographic factors associated with surgical approach and outcomes for patients with T1/T2 HCC.
Methods and Procedures: This was a retrospective analysis of the National Cancer Data Base, 2006-2012, who had undergone open or minimally invasive liver surgery with T1 or T2 HCC. Patients who had pathologic T3/T4 tumors that were clinically staged as T1/T2 were excluded in order to minimize the effects of stage migration on OS. Patients offered MIS but then converted to open were analyzed in their respective minimally invasive group, either laparoscopic or robotic. Primary outcomes included overall survival (OS), and secondary outcomes included margin status, post-operative length of stay (LOS), and the unplanned readmission rate. A multivariable logistic regression model was used to identify patient characteristics that were significantly associated with MIS and the primary/secondary outcomes.
Results: A total of 3,351 patients were identified. The initial surgical approach included 82.7% open (2,770) and 17.3% MIS (581). Patients with T1 tumors were more likely to have MIS than T2 tumors. Patient with private insurance or Medicare were more likely to undergo open surgery as compared to uninsured patients. Patients with higher levels of education were more likely to undergo MIS. No other demographic factors were identified with respect to increased likelihood of undergoing MIS. MIS had superior short-term outcomes, including shorter post-operative LOS (OR=-2.80 days, 95% CI -3.41 – -2.15, p<0.001) and a lower rate of unplanned readmissions (OR=0.50, 95% CI 0.30–0.084, p=0.007). However, the risk of margin positivity was higher in the MIS group (OR=1.63, 95% CI 1.04–2.56, p=0.32). No difference in overall survival was observed based on surgical approach (HR=0.94, 95% CI 0.74–1.20, p=0.63).
Conclusion: MIS offers significant surgical benefits for early clinical stage T1/T2 HCC. OS was equivalent regardless of surgical approach. This study identified unique disparities in surgical approach for early stage HCC. As MIS becomes increasingly applied to HCC and further study validates long-term equivalency of MIS compared to open surgery with the added short-term benefits, disparities in surgical approach may become more relevant to patient care.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93539
Program Number: S164
Presentation Session: Disparities
Presentation Type: Podium