Introduction
Hepatocellular carcinoma (HCC) is the most common
type of primary liver malignancy and a major cause of
cancer-related mortality worldwide. According to GLOBOCAN 2022,
liver cancer remains a major oncological burden globally, and
Vietnam remains among the countries with a high disease burden
(1). The burden is particularly
high in Asia, where chronic hepatitis B virus infection and
underlying cirrhosis remain dominant etiological factors. Since
early-stage HCC is often asymptomatic and surveillance is
inconsistently implemented, numerous patients present with
intermediate or advanced disease, requiring treatment decisions
that balance oncological control with preservation of hepatic
functional reserve (1-4).
Surgical resection is potentially curative and
remains a cornerstone treatment for patients with adequate liver
function and resectable tumors. However, hepatectomy is technically
demanding and may be complicated by substantial postoperative
morbidity, particularly in patients with chronic liver disease.
Post-hepatectomy liver failure (PHLF) and bile leakage are among
the most clinically relevant adverse events, as they are associated
with prolonged hospitalization, increased resource utilization and
impaired short-term recovery. Standardized definitions from the
International Study Group of Liver Surgery (ISGLS) (5,6)
facilitate comparisons across studies, yet complication rates still
vary widely according to patient selection, extent of resection,
perioperative management and institutional experience (3,4,7,8).
Although outcomes have improved in high-volume
centers, data from Vietnam and other low- and middle-income
countries remain limited. Local evidence is required to benchmark
early surgical safety and to describe pathological, as well as
operative findings, and to identify potentially modifiable risk
factors that can inform clinical decision-making. Therefore, the
present study aimed to describe the clinical, laboratory, imaging,
pathological and operative characteristics of patients undergoing
hepatectomy for HCC at Da Nang Oncology Hospital (Da Nang,
Vietnam), and to explore factors associated with early
post-operative complications.
Patients and methods
Study design and setting
The present retrospective observational cohort study
was conducted at Da Nang Oncology Hospital, a tertiary referral
hospital in the central zone of Vietnam. The medical records of
consecutive patients who underwent hepatectomy for HCC between
January, 2021 and May, 2023 were reviewed. The present cohort study
has been reported in line with the STROCSS guidelines (9).
Study population
Consecutive adult patients (≥18 years of age) who
underwent open hepatectomy with curative intent for primary HCC at
Da Nang Oncology Hospital during the aforementioned study period
were eligible. HCC was diagnosed according to institutional
practice based on clinical assessment, serum α-fetoprotein levels
when available, and contrast-enhanced computed tomography (CT) scan
or magnetic resonance imaging (MRI). Patients were excluded if they
underwent non-resectional procedures only (such as exploration or
biopsy without hepatectomy), required re-operation for recurrent
HCC during the same admission, or had incomplete records for key
operative variables or postoperative outcomes.
A total of 60 patients were screened during the
study period (from January, 2023 to June, 2023). Following the
application of the eligibility criteria, 3 patients were excluded,
including 1 patient who underwent exploratory laparotomy without
hepatectomy as the tumor was found to be unresectable
intraoperatively, 1 patient who underwent re-operation for
recurrent HCC during the same admission, and 1 patient who had
incomplete medical records for key operative and post-operative
outcome variables. The final study cohort therefore included 57
patients who underwent open hepatectomy for HCC.
Diagnosis and preoperative
evaluation
Pre-operative evaluation included demographics,
presenting symptoms or reason for admission, medical history, viral
hepatitis markers (HBsAg and anti-HCV) and routine laboratory tests
(complete blood count, liver biochemistry and coagulation profile).
Tumor characteristics were assessed on a contrast-enhanced CT scan
or MRI, including typical arterial hyperenhancement and washout
when present.
Liver functional reserve was assessed using the
Child-Pugh classification. Tumors were staged using the Barcelona
Clinic Liver Cancer (BCLC) system based on tumor burden, liver
function and performance status at diagnosis (8).
All hepatectomies were performed using an open
approach. Operative reports were reviewed to determine the type of
resection (right hepatectomy, left hepatectomy, sectionectomy or
segmentectomy) and the incision used. For analysis, hepatectomy was
categorized as major (resection of ≥3 Couinaud segments) or minor
(resection of ≤3 segments).
Perioperative management followed institutional
protocols, including standardized anesthesia monitoring,
intraoperative antibiotic prophylaxis and postoperative supportive
care. Post-operative analgesic use and duration of hospitalization
were recorded from the medical charts.
Outcomes and definitions
The primary outcome was the occurrence of any early
post-operative complication during the index hospitalization or
within 30 days post-surgery, as documented in the medical records.
Patients could experience ≥1 complications.
PHLF and bile leak were defined and graded according
to ISGLS criteria. PHLF was defined as post-operative deterioration
in liver function requiring a change in clinical management, while
bile leak was defined as bilious drainage with elevated bilirubin
concentration in the drain fluid and/or the need for intervention
(5,6).
Other post-operative events recorded included
post-operative hemorrhage, ascites, surgical site infection,
pleural effusion and other clinically significant adverse events.
When sufficient documentation was available, complications were
graded using the Clavien-Dindo classification (10).
Secondary outcomes included operative time,
estimated blood loss, intraoperative adverse events, postoperative
analgesic duration, post-operative length of stay and
in-hospital/30-day mortality.
Ethics
The present study was conducted in accordance with
ethical standards and the principles of the Declaration of
Helsinki. The study protocol was approved by the Academic and
Ethics Committee in Biomedical Research of Da Nang University of
Medical Technology and Pharmacy (Approval No. 11/CT-HDDD, dated
January 12, 2023). Permission to access patient medical records was
granted by Da Nang Oncology Hospital. As this was a retrospective
study using de-identified data, the requirement for informed
patient consent was waived.
Statistical analysis
Data were analyzed using SPSS version 20.0 (IBM
Corp.). Categorical variables were compared using χ2 or
Fisher's exact test, as appropriate. Continuous variables are
presented as the mean ± standard deviation or median (interquartile
range), depending on their distribution. A two-sided P-value
<0.05 was considered to indicate a statistically significant
difference.
Results
The baseline characteristics of the patients are
summarized in Tables I and
II. The cohort was predominantly
male (78.9%), with a mean age of 57.0±12.1 years. The majority of
the patients had a normal BMI (18.5-24.9 kg/m2, 77.2%)
and preserved liver function (Child-Pugh A, 100%). Chronic
hepatitis B virus infection was the predominant viral background,
and 42.1% of patients had an α-fetoprotein level ≥400 ng/ml.
 | Table IBaseline demographic and clinical
characteristics of the present study population (n=57). |
Table I
Baseline demographic and clinical
characteristics of the present study population (n=57).
| Characteristic | Value |
|---|
| Sex, n (%) | |
|
Male | 45 (78.9) |
|
Female | 12 (21.1) |
| Age (years), mean ±
SD | 57.0±12.1 |
| Age group (years), n
(%) | <40:6 (10.5);
40-60:30 (52.6); >60:21 (36.8) |
| BMI (kg/m²), n
(%) | |
|
<18.5 | 7 (12.3) |
|
18.5-24.9 | 44 (77.2) |
|
25-29.9 | 4 (7.0) |
|
≥30 | 2 (3.5) |
| Reason for admission,
n (%) | |
|
Incidentally
detected liver mass | 24 (42.1) |
|
Right upper
quadrant abdominal pain | 26 (45.6) |
|
Other
reasons | 7 (12.3) |
| Viral hepatitis
markers, n (%) | |
|
HBsAg
positive only | 47 (82.5) |
|
Anti-HCV
positive only | 1 (1.8) |
|
HBsAg and
anti-HCV positive (co-infection) | 2 (3.5) |
|
HBsAg and
anti-HCV negative | 7 (12.3) |
| Alpha-fetoprotein
(ng/ml), n (%) | |
|
<20 | 17 (29.8) |
|
20-400 | 16 (28.1) |
|
≥400 | 24 (42.1) |
| Child-Pugh class, n
(%) | |
|
Child-Pugh
A | 57 (100.0) |
|
Child-Pugh
B | 0 (0.0) |
| BCLC stage, n
(%) | |
|
Stage 0 | 1 (1.8) |
|
Stage A | 5 (8.8) |
|
Stage B | 51 (89.5) |
| Table IIPreoperative laboratory findings of
the present study cohort (n=57). |
Table II
Preoperative laboratory findings of
the present study cohort (n=57).
| Laboratory
variable | Value |
|---|
| Hemoglobin (g/dl),
mean ± SD | 13.5±1.8 |
| Anemia (Hb 9-12
g/dl), n (%) | 13 (22.8) |
| Platelet count
(x103/µl), mean ± SD | 215.5±86.5 |
| Thrombocytopenia
(<150x103/µl), n (%) | 10 (17.5) |
| Prothrombin time
≥70%, n (%) | 57 (100.0) |
| INR <1.7, n
(%) | 57 (100.0) |
| Total bilirubin
(µmol/l), mean ± SD | 11.1±4.0 |
| AST (U/l), mean ±
SD | 48.9±32.1 |
| AST ≥37 U/l, n
(%) | 33 (57.9) |
| ALT (U/l), mean ±
SD | 42.8±25.9 |
| ALT ≥40 U/l, n
(%) | 24 (42.1) |
| Albumin (g/l), mean ±
SD | 37.8±3.5 |
| Albumin <35 g/l, n
(%) | 11 (19.3) |
The tumor characteristics are presented in Table III. Typical HCC imaging features
on contrast-enhanced CT/MRI were present in 75.4% of the patients.
A solitary tumor of >5 cm in size was the most common pattern
(43.9%). The mean tumor size on imaging (6.5±3.0 cm) was similar to
that on gross pathology (6.6±3.0 cm). As per the histopathological
examination, the majority of tumors were moderately differentiated
(70.2%), whereas 19.3% were poorly differentiated.
| Table IIITumor characteristics on imaging and
pathology. |
Table III
Tumor characteristics on imaging and
pathology.
| Tumor
characteristic | Value |
|---|
| CT/MRI appearance
typical for HCC, n (%) | 43 (75.4) |
| Ultrasound
echogenicity | |
|
Hyperechoic | 21 (36.8) |
|
Hypoechoic | 20 (35.1) |
|
Heterogeneous | 16 (28.1) |
| Tumor burden on
CT/MRI | |
|
Solitary
<5 cm | 14 (24.6) |
|
Solitary
>5 cm | 25 (43.9) |
|
Multiple,
max <5 cm | 8 (14.0) |
|
Multiple,
max >5 cm | 10 (17.5) |
| Tumor size on CT/MRI
(cm), mean ± SD | 6.5±3.0 |
| Tumor size on
pathology (cm), mean ± SD | 6.6±3.0 |
| Gross type | |
|
Mass-forming | 39 (68.4) |
|
Nodular | 11 (19.3) |
|
Diffuse | 7 (12.3) |
| Histological
grade | |
|
Well
differentiated | 6 (10.5) |
|
Moderately
differentiated | 40 (70.2) |
|
Poorly
differentiated | 11 (19.3) |
Operative details and early outcomes of the patients
are presented in Table IV.
Posterior sectionectomy was the most frequent procedure (28.1%),
followed by left hepatectomy (21.1%). The mean operative time was
156.6±34.8 min, and the mean estimated blood loss was 399.0±212.6
ml. Intraoperative adverse events occurred in 5.3% of patients.
Overall, 15.8% of patients developed ≥1 post-operative
complications, most commonly PHLF (7.0%) and bile leak (5.3%). No
post-operative mortality was observed.
| Table IVOperative details and early
postoperative outcomes. |
Table IV
Operative details and early
postoperative outcomes.
| Perioperative
outcome | Value |
|---|
| Type of hepatectomy,
n (%) | |
|
Right
hepatectomy | 5 (8.8) |
|
Left
hepatectomy | 12 (21.1) |
|
Left lateral
sectionectomy | 0 (0.0) |
|
Central
hepatectomy | 4 (7.0) |
|
Anterior
sectionectomy | 8 (14.0) |
|
Posterior
sectionectomy | 16 (28.1) |
|
Segmentectomy | 7 (12.3) |
|
Bisegmentectomy | 5 (8.8) |
| Incision, n
(%) | |
|
J-shaped
subcostal (Makuuchi-type) | 56 (98.2) |
|
Midline
laparotomy | 1 (1.8) |
| Operative time
(min), mean ± SD (range) | 156.6±34.8
(60-240) |
| Estimated blood
loss (ml), mean ± SD (range) | 399.0±212.6
(105-1,000) |
| Intraoperative
adverse events, n (%) | |
|
Hemorrhage | 2 (3.5) |
|
Iatrogenic
organ injury | 1 (1.8) |
| Post-operative
complications (patients may have >1), n (%) | |
|
Post-operative
bleeding | 1 (1.8) |
|
Bile
leak | 3 (5.3) |
|
Ascites | 2 (3.5) |
|
Surgical
site infection | 3 (5.3) |
|
Pleural
effusion | 2 (3.5) |
|
Post-hepatectomy
liver failure | 4 (7.0) |
| Post-operative
analgesic use (days), mean ± SD | 5.3±1.7 |
| Post-operative
hospitalization period (days), mean ± SD | 8.9±2.4 |
The factors associated with any post-operative
complications are summarized in Table
V. Complications occurred more frequently in patients with
pre-operative hypoalbuminemia (<35 g/l; 36.4 vs. 10.9%;
P=0.0389), BCLC stage B (17.6 vs. 0% for BCLC A; P=0.0016) and
those undergoing major hepatectomy (28.6 vs 8.3%; P=0.0451).
Although thrombocytopenia exhibited a numerically higher
complication rate, the association was not statistically
significant (30.0 vs. 12.8%; P=0.1786).
| Table VUnivariable analysis of factors
associated with post-operative complications (any complication)
following hepatectomy. |
Table V
Univariable analysis of factors
associated with post-operative complications (any complication)
following hepatectomy.
| Factor | Complications
(n) | Total (n) | Complication rate
(%) | P-value |
|---|
| Platelet count
(x103/µl) | | | | |
|
<150 | 3 | 10 | 30.0 | 0.1786 |
|
≥150 | 6 | 47 | 12.8 | |
| Serum albumin
(g/l) | | | | |
|
<35 | 4 | 11 | 36.4 | 0.0389 |
|
≥35 | 5 | 46 | 10.9 | |
| BCLC stage | | | | |
|
BCLC A | 0 | 6 | 0.0 | 0.0016 |
|
BCLC B | 9 | 51 | 17.6 | |
| Extent of
hepatectomy | | | | |
|
Major
hepatectomy | 6 | 21 | 28.6 | 0.0451 |
|
Minor
hepatectomy | 3 | 36 | 8.3 | |
Discussion
In the present retrospective cohort of 57 patients
undergoing open hepatectomy for HCC at a tertiary oncology center
in Vietnam, early outcomes were acceptable, with an overall
complication rate of 15.8% and no post-operative mortality. All
patients had Child-Pugh A liver function, and the majority had
chronic viral hepatitis, reflecting the epidemiological profile of
HCC in Vietnam (2).
Notably, almost 90% of the patients were classified
as BCLC stage B. Although transarterial chemoembolization is
commonly recommended for intermediate-stage HCC, multidisciplinary
selection and treatment stage migration may identify subsets with
resectable disease and preserved liver reserve who could still be
considered for surgery (3,4,8). The
findings of the present study suggest that hepatectomy can be
performed with acceptable short-term safety in carefully selected
patients in this category; however, the present study did not
include a non-surgical comparator group or long-term oncological
follow-up. Therefore, these findings should not be interpreted as
support for routine resection in all patients with stage B HCC.
PHLF (7.0%) and bile leak (5.3%) were the most
frequent complications. These events are clinically important as
they can prolong recovery and increase resource utilization. The
observed rates are within the range reported in contemporary
hepatectomy series, noting that incidence varies with baseline
liver disease, the extent of resection and application of
standardized definitions such as those from the ISGLS (5,6,11-13).
Operation time and blood loss in the present study
cohort indicated technically feasible open resections in this
setting. While minimally invasive liver surgery is increasingly
adopted worldwide, open hepatectomy remains the primary approach in
numerous centers due to tumor complexity, cirrhotic background and
resource or training constraints. Ensuring consistent perioperative
pathways and timely recognition and management of complications
therefore remains essential (14,15).
Among the evaluated factors, pre-operative
hypoalbuminemia was associated with a higher complication rate.
Serum albumin reflects nutritional status, systemic inflammation
and hepatic synthetic function; low values may identify patients
with limited physiological reserve. Preoperative nutritional
assessment and optimization, when feasible, may help reduce
postoperative risk. Since the present analysis was limited to
univariable comparisons, this association should be regarded as
exploratory rather than an independent predictor.
Major hepatectomy was also associated with
complications, consistent with the pivotal role of resection extent
and future liver remnant in postoperative safety. In settings where
quantitative volumetry or functional testing is not routinely
available, cautious selection, meticulous operative technique and
intensive post-operative monitoring are particularly important. The
association between BCLC stage and complications may reflect
greater tumor burden and operative complexity rather than stage
alone. In addition, the predominance of moderately differentiated
tumors on pathology provides useful context for interpreting the
surgical case mix in the present cohort.
Although open hepatectomy remains the mainstay in
numerous low- and middle-income settings, minimally invasive liver
resection (laparoscopic or robotic) has expanded rapidly and is
increasingly supported for appropriately selected patients
(16,17). Recent systematic reviews and
meta-analyses suggest that minimally invasive approaches can reduce
blood loss and shorten recovery while maintaining comparable
short-term safety and oncological adequacy vs. conventional
resection when performed in experienced centers (15,18).
Current practice guidelines continue to endorse surgical resection
as a potentially curative treatment for selected patients with
preserved liver function and resectable disease (3,4,8). In
this context, the data of the present study provide a critical
benchmark for open hepatectomy outcomes, and may inform stepwise
adoption of advanced techniques (such as laparoscopy) through
structured training and careful case selection.
In addition, perioperative optimization could
further improve outcomes in similar real-world environments. The
Enhanced Recovery After Surgery (ERAS) Society recommendations for
liver surgery emphasize standardized pathways, including multimodal
analgesia, goal-directed fluid therapy, early mobilization and
early enteral nutrition, which have been associated with lower
morbidity and a more rapid functional recovery (19). Using standardized ISGLS definitions
for PHLF and bile leakage facilitates transparent benchmarking
across studies (5,6). Given the association between
hypoalbuminemia and post-operative complications in the present
study cohort, targeted pre-habilitation, the optimization of
hepatic reserve and parenchymal-sparing strategies for borderline
patients may be particularly valuable (12).
These findings provide local benchmark data for the
early outcomes of patients undergoing hepatectomy in Vietnam and
highlight potentially actionable risk factors. Patients with
hypoalbuminemia or those planned for major hepatectomy may benefit
from enhanced perioperative optimization and closer post-operative
surveillance.
The present study has several limitations which
should be mentioned. Its retrospective single-center design is
susceptible to incomplete documentation and may undercapture
complications occurring following discharge. The sample size and
event number were limited, and only 9 complication events were
observed; consequently, only univariable analyses were performed
and residual confounding cannot be excluded. The archived screening
log did not permit reliable reconstruction of the exact number of
exclusions in each category. In addition, the study did not assess
several important long-term oncological outcomes, including
resection margin status, recurrence, disease-free survival and
overall survival. Therefore, future prospective studies with
standardized complication grading, more comprehensive pathology
datasets and longer follow-up are warranted.
In conclusion, open hepatectomy for HCC in carefully
selected patients in the present study was associated with
acceptable early post-operative outcomes and no 30-day mortality.
Hypoalbuminemia, BCLC stage B disease and major hepatectomy were
associated with post-operative complications in univariable
analysis; however, these findings should be interpreted with
caution due to the limited sample size and event number. Larger
prospective studies with detailed pathological assessment and
long-term follow-up are required to corroborate the present
findings.
Acknowledgements
Not applicable.
Funding
Funding: No funding was received.
Availability of data and materials
The data generated in the present study may be
requested from the corresponding author.
Authors contributions
Both authors (VTD and VKL) contributed equally to
the conception and design of the study, as well as in data
collection and analysis, and in the writing of the manuscript. VTD
and VKL confirm the authenticity of the raw data. Both authors have
read and approved the final version of the manuscript.
Ethics approval and consent to
participate
The present study was approved by The Academic and
Ethics Committee of Da Nang University of Medical Technology and
Pharmacy (Approval no. 11/CT-HDDD, dated January 12, 2023), and
permission to access patient medical records was granted by Da Nang
Oncology Hospital. As this was a retrospective study using
de-identified data, the requirement for informed consent was waived
according to the ethics approval.
Patient consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing
interests.
References
|
1
|
Bray F, Laversanne M, Sung H, Ferlay J,
Siegel RL, Soerjomataram I and Jemal A: Global cancer statistics
2022: GLOBOCAN estimates of incidence and mortality worldwide for
36 cancers in 185 countries. CA Cancer J Clin. 74:229–263.
2024.PubMed/NCBI View Article : Google Scholar
|
|
2
|
Llovet JM, Kelley RK, Villanueva A, Singal
AG, Pikarsky E, Roayaie S, Lencioni R, Koike K, Zucman-Rossi J and
Finn RS: Hepatocellular carcinoma. Nat Rev Dis Primers.
7(6)2021.PubMed/NCBI View Article : Google Scholar
|
|
3
|
Singal AG, Llovet JM, Yarchoan M, Mehta N,
Heimbach JK, Dawson LA, Jou JH, Kulik LM, Agopian VG, Marrero JA,
et al: AASLD practice guidance on prevention, diagnosis, and
treatment of hepatocellular carcinoma. Hepatology. 78:1922–1965.
2023.PubMed/NCBI View Article : Google Scholar
|
|
4
|
European Association for the Study of the
Liver. EASL Clinical Practice Guidelines on the management of
hepatocellular carcinoma. J Hepatol. 82:315–374. 2025.PubMed/NCBI View Article : Google Scholar
|
|
5
|
Rahbari NN, Garden OJ, Padbury R,
Brooke-Smith M, Crawford M, Adam R, Koch M, Makuuchi M, Dematteo
RP, Christophi C, et al: Posthepatectomy liver failure: A
definition and grading by the International study group of liver
surgery (ISGLS). Surgery. 149:713–724. 2011.PubMed/NCBI View Article : Google Scholar
|
|
6
|
Koch M, Garden OJ, Padbury R, Rahbari NN,
Adam R, Capussotti L, Fan ST, Yokoyama Y, Crawford M, Makuuchi M,
et al: Bile leakage after hepatobiliary and pancreatic surgery: A
definition and grading of severity by the International study group
of liver surgery. Surgery. 149:680–688. 2011.PubMed/NCBI View Article : Google Scholar
|
|
7
|
Marrero JA, Kulik LM, Sirlin CB, Zhu AX,
Finn RS, Abecassis MM, Roberts LR and Heimbach JK: Diagnosis,
staging, and management of hepatocellular carcinoma: 2018 practice
guidance by the American association for the study of liver
diseases. Hepatology. 68:723–750. 2018.PubMed/NCBI View Article : Google Scholar
|
|
8
|
Reig M, Forner A, Rimola J, Ferrer-Fàbrega
J, Burrel M, Garcia-Criado Á, Kelley RK, Galle PR, Mazzaferro V,
Salem R, et al: BCLC strategy for prognosis prediction and
treatment recommendation: The 2022 update. J Hepatol. 76:681–693.
2022.PubMed/NCBI View Article : Google Scholar
|
|
9
|
Riaz AA, Ginimol M, Rasha R, et al:
Revised Strengthening the Reporting of Cohort, Cross-Sectional and
Case-Control Studies in Surgery (STROCSS) Guideline: An Update for
the Age of Artificial Intelligence. Premier Journal of Science 2:
2025. DOI: https://doi.org/10.70389/PJS.100081.
|
|
10
|
Clavien PA, Barkun J, de Oliveira ML,
Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J,
Slankamenac K, Bassi C, et al: The Clavien-Dindo classification of
surgical complications: five-year experience. Ann Surg.
250:187–196. 2009.PubMed/NCBI View Article : Google Scholar
|
|
11
|
Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK,
Yeung C and Wong J: Hepatectomy for hepatocellular carcinoma:
Toward zero hospital deaths. Ann Surg. 229:322–330. 1999.PubMed/NCBI View Article : Google Scholar
|
|
12
|
Kokudo T, Hasegawa K, Shirata C, Tanimoto
M, Ishizawa T, Kaneko J, Akamatsu N, Arita J, Demartines N, Uldry
E, et al: Assessment of preoperative liver function for surgical
decision making in patients with hepatocellular carcinoma. Liver
Cancer. 8:447–456. 2019.PubMed/NCBI View Article : Google Scholar
|
|
13
|
Wang HQ, Yang J, Yang JY, Wang WT and Yan
LN: Low immediate postoperative platelet count is associated with
hepatic insufficiency after hepatectomy. World J Gastroenterol.
20:11871–11877. 2014.PubMed/NCBI View Article : Google Scholar
|
|
14
|
Jiang S, Yu D, He H, Sun H, Sun Y, Zhou L,
Wu Z and Gu Q: Short- and long-term outcomes in laparoscopic versus
open hepatectomy for hepatocellular carcinoma in elderly patients:
A systematic review and meta-analysis. J Laparoendosc Adv Surg Tech
A. 33:321–334. 2023.PubMed/NCBI View Article : Google Scholar
|
|
15
|
Hu L, Shi X, Wang A and Zhang F: A
meta-analytic and systematic review to compare perioperative
outcomes and prognosis between robotic and conventional
(laparoscopic or open) liver resection in hepatocellular carcinoma
cases. World J Surg Oncol. 23(348)2025.PubMed/NCBI View Article : Google Scholar
|
|
16
|
Dincer HA and Dogrul AB: Advances in
minimally invasive liver surgery. North Clin Istanb. 11:586–592.
2024.PubMed/NCBI View Article : Google Scholar
|
|
17
|
Abu Hilal M, Hoogteijling TJ, Edwin B,
Dagher I, D'Hondt M, Marques HP, Swijnenburg RJ, Boggi U, Sucandy
I, Ferrero A, et al: The Brescia internationally validated European
guidelines on minimally invasive liver surgery. Br J Surg.
112(znaf113)2025.PubMed/NCBI View Article : Google Scholar
|
|
18
|
Pilz da Cunha G, Hoogteijling TJ,
Besselink MG, Alzoubi MN, Swijnenburg RJ and Abu Hilal M: Robotic
versus laparoscopic liver resection: A systematic review and
meta-analysis of comparative studies. Int J Surg. 111:5549–5571.
2025.PubMed/NCBI View Article : Google Scholar
|
|
19
|
Joliat GR, Kobayashi K, Hasegawa K,
Thomson JE, Padbury R, Scott M, Brustia R, Scatton O, Tran Cao HS,
Vauthey JN, et al: Guidelines for perioperative care for liver
surgery: Enhanced recovery after surgery (ERAS) Society
Recommendations 2022. World J Surg. 47:11–34. 2023.PubMed/NCBI View Article : Google Scholar
|
