Influence of Child–Pugh B7 and B8/9 cirrhosis on laparoscopic liver resection for hepatocellular carcinoma: a retrospective cohort study

BACKGROUND: Laparoscopic liver resection for hepatocellular carcinoma (HCC) in patients with Child–Pugh A cirrhosis has been shown to be beneficial. However, less is known regarding the outcomes of such treatment in patients with Child–Pugh B cirrhosis. We conducted a retrospective study to evaluate the outcomes of laparoscopic liver resection for HCC in patients with Child–Pugh B cirrhosis, focusing on surgical risks, recurrence, and survival. METHODS: 357 patients with HCC who underwent laparoscopic liver resection from 2007 to 2021 were identified from our single-institute database. The patients were divided into three groups by their Child–Pugh score: the Child–Pugh A (n = 280), Child–Pugh B7 (n = 42), and Child–Pugh B8/9 groups (n = 35). Multivariable Cox regression models for recurrence-free survival (RFS) and overall survival (OS) were constructed with adjustment for preoperative and postoperative clinicopathological factors. RESULTS: The Child–Pugh B8/9 group had a significantly higher complication rate, but the complication rates were comparable between the Child–Pugh B7 and Child–Pugh A groups (Child–Pugh A vs. B7 vs. B8/9: 8.2% vs. 9.6% vs. 26%, respectively; P = 0.010). Compared with the Child–Pugh A group, the risk-adjusted hazard ratios (95% confidence intervals) in the Child–Pugh B7 and B8/9 groups for RFS were 1.39 (0.77–2.50) and 3.15 (1.87–5.31), respectively, and those for OS were 0.60 (0.21–1.73) and 1.80 (0.86–3.74), respectively. There were no significant differences in major morbidities (Clavien–Dindo grade > II) (P = 0.117) or the proportion of retreatment after HCC recurrence (P = 0.367) among the three groups. CONCLUSION: Among patients with HCC, those with Child–Pugh A and B7 cirrhosis can be good candidates for laparoscopic liver resection in terms of complications and recurrence. Despite poor postoperative outcomes in patients with Child–Pugh B8/9 cirrhosis, laparoscopic liver resection is less likely to interfere with retreatment and can be performed as part of multidisciplinary treatment. GRAPHICAL ABSTRACT: [Image: see text]