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Vella I, di Francesco F, Accardo C, Boggi U, Gruttadauria S. Indications and results of right-lobe living donor liver transplantation. Updates Surg 2024:10.1007/s13304-024-01785-8. [PMID: 38801602 DOI: 10.1007/s13304-024-01785-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/12/2024] [Indexed: 05/29/2024]
Abstract
The shortage of deceased liver donor organs over the years has always posed the need to expand the donor pool. A viable alternative to deceased donors is that of the living donor. Indeed, the living donor in liver transplantation, initially in pediatric transplantation, but for several years now also in adult transplantation, is a more than viable alternative to deceased liver donation. In fact, right liver lobe donation has proven to be a surgical procedure with low impact on the donor's life in terms of morbidity and mortality, with excellent results in recipients of such organs. In recent years, an increasing number of studies have been published that show excellent results in right-lobe living donor liver transplantation, encouraging this practice not only in countries that have historically had a shortage of deceased donor organs, such as Asian countries, but making it a practice of increasing use in Western countries as well. In addition, thanks to improvements in surgical technique and the experience of high-volume centers, this surgery has also begun to be performed using minimally invasive surgical techniques, allowing us to envision ever better outcomes for both donor and recipient in the coming years.
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Affiliation(s)
- Ivan Vella
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC), Via E. Tricomi 5, 90127, Palermo, Italy
| | - Fabrizio di Francesco
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC), Via E. Tricomi 5, 90127, Palermo, Italy
| | - Caterina Accardo
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC), Via E. Tricomi 5, 90127, Palermo, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC), Via E. Tricomi 5, 90127, Palermo, Italy.
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
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Ju MK, Yoo SH, Choi KH, Yoon DS, Lim JH. Selective hanging maneuver and rubber band retraction technique for pure laparoscopic donor right hepatectomy. Asian J Surg 2024; 47:354-359. [PMID: 37806879 DOI: 10.1016/j.asjsur.2023.08.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/06/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Pure laparoscopic donor hepatectomy (PLDH) is an increasingly performed procedure despite its technical difficulties. This study introduced a selective liver parenchymal hanging maneuver and rubber band retraction technique for PLDH. METHODS We retrospectively reviewed perioperative data from 58 patients who underwent donor right hepatectomy (including right extended) between March 2009 and February 2021. Eighteen patients underwent open donor right hepatectomy (ODRH) and 38 patients underwent pure laparoscopic donor right hepatectomy (PLDRH). RESULTS All PLDRH donors underwent the procedure without the need for open conversion. The median PLDRH operative time was 396.84 ± 72.459 min, the median PLDRH intraoperative bleeding amount was 496.05 ± 272.591 ml, and the warm ischemic time was 8.77 ± 3.062 min. Compared to ODRH, laparoscopic surgery showed further advantages in terms of postoperative hospital stay (10.94 ± 4.036 days vs. 8.03 ± 2.646 days, respectively, P = 0.01) and estimated blood loss (676.67 ± 321.046 ml vs. 496.05 ± 272.591 ml, respectively, P = 0.033). CONCLUSIONS The selective liver parenchymal hanging maneuver and rubber band retraction technique is a simple and effective pure laparoscopic procedure for donor hepatectomy. Our results demonstrate the safety and feasibility of this technique.
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Affiliation(s)
- Man Ki Ju
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea; Liver Clinic, Gangnam Severance Hospital, Seoul, South Korea
| | - Sung Hwan Yoo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; Liver Clinic, Gangnam Severance Hospital, Seoul, South Korea
| | - Ki Hong Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Sub Yoon
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Hong Lim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea; Liver Clinic, Gangnam Severance Hospital, Seoul, South Korea.
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Kim SH, Kim KH, Cho HD, Suh KS, Hong SK, Lee KW, Choi GS, Kim JM, Choon Hyuck David K, Cho JY, Han HS, Han J, Han YS. Donor Safety and Risk Factors of Pure Laparoscopic Living Donor Right Hepatectomy: A Korean Multicenter Study. Ann Surg 2023; 278:e1198-e1203. [PMID: 37395608 DOI: 10.1097/sla.0000000000005976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
OBJECTIVE The aim of this study was to identify safety and risk factors of living donor after pure laparoscopic donor right hepatectomy in a Korean multicenter cohort study. BACKGROUND Pure laparoscopic donor right hepatectomy is not yet a standardized surgical procedure due to lack of data. METHODS This retrospective study included 543 patients undergoing PLRDH between 2010 and 2018 in 5 Korean transplantation centers. Complication rates were assessed and multivariate logistic regression analyses were performed to identify risk factors of open conversion, overall complications, major complications, and biliary complications. RESULTS Regarding open conversion, the incidence was 1.7% and the risk factor was body mass index >30 kg/m 2 [ P =0.001, odds ratio (OR)=22.72, 95% CI=3.56-146.39]. Rates of overall, major (Clavien-Dindo classification III-IV), and biliary complications were 9.2%, 4.4%, and 3.5%, respectively. For overall complications, risk factors were graft weight >700 g ( P =0.007, OR=2.66, 95% CI=1.31-5.41), estimated blood loss ( P <0.001, OR=4.84, 95% CI=2.50-9.38), and operation time >400 minutes ( P =0.01, OR=2.46, 95% CI=1.25-4.88). For major complications, risk factors were graft weight >700 g ( P =0.002, OR=4.01, 95% CI=1.67-9.62) and operation time >400 minutes ( P =0.003, OR=3.84, 95% CI=1.60-9.21). For biliary complications, risk factors were graft weight >700 g ( P =0.01, OR=4.34, 95% CI=1.40-13.45) and operation time >400 minutes ( P =0.01, OR=4.16, 95% CI=1.34-12.88). CONCLUSION Careful donor selection for PLRDH considering body mass index, graft weight, estimated blood loss, and operation time combined with skilled procedure can improve donor safety.
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Affiliation(s)
- Sang-Hoon Kim
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ki-Hun Kim
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hwui-Dong Cho
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwon Choon Hyuck David
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jaryung Han
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook, National University Hospital, Daegu, Republic of Korea
- Department of Surgery, Daegu Catholic University Hospital, School of Medicine Catholic University of Daegu, Daegu, Republic of Korea
| | - Young Seok Han
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook, National University Hospital, Daegu, Republic of Korea
- Department of Surgery, Daegu Catholic University Hospital, School of Medicine Catholic University of Daegu, Daegu, Republic of Korea
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Ziogas IA, Kakos CD, Moris DP, Kaltenmeier C, Tsoulfas G, Montenovo MI, Alexopoulos SP, Geller DA, Pomfret EA. Systematic review and meta-analysis of open versus laparoscopy-assisted versus pure laparoscopic versus robotic living donor hepatectomy. Liver Transpl 2023; 29:1063-1078. [PMID: 36866856 DOI: 10.1097/lvt.0000000000000115] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/13/2023] [Indexed: 03/04/2023]
Abstract
The value of minimally invasive approaches for living donor hepatectomy remains unclear. Our aim was to compare the donor outcomes after open versus laparoscopy-assisted versus pure laparoscopic versus robotic living donor hepatectomy (OLDH vs. LALDH vs. PLLDH vs. RLDH). A systematic literature review of the MEDLINE, Cochrane Library, Embase, and Scopus databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement (up to December 8, 2021). Random-effects meta-analyses were performed separately for minor and major living donor hepatectomy. The risk of bias in nonrandomized studies was assessed using the Newcastle-Ottawa Scale. A total of 31 studies were included. There was no difference in donor outcomes after OLDH versus LALDH for major hepatectomy. However, PLLDH was associated with decreased estimated blood loss, length of stay (LOS), and overall complications versus OLDH for minor and major hepatectomy, but also with increased operative time for major hepatectomy. PLLDH was associated with decreased LOS versus LALDH for major hepatectomy. RLDH was associated with decreased LOS but with increased operative time versus OLDH for major hepatectomy. The scarcity of studies comparing RLDH versus LALDH/PLLDH did not allow us to meta-analyze donor outcomes for that comparison. There seems to be a marginal benefit in estimated blood loss and/or LOS in favor of PLLDH and RLDH. The complexity of these procedures limits them to transplant centers with high volume and experience. Future studies should investigate self-reported donor experience and the associated economic costs of these approaches.
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Affiliation(s)
- Ioannis A Ziogas
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Christos D Kakos
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Dimitrios P Moris
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Christof Kaltenmeier
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Georgios Tsoulfas
- Department of Transplantation Surgery, Hippokration General Hospital, Aristotle University School of Medicine, Thessaloniki, Greece
| | - Martin I Montenovo
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - David A Geller
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Elizabeth A Pomfret
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Kikuchi K, Nitta H, Umemura A, Katagiri H, Kanno S, Takeda D, Ando T, Amano S, Sasaki A. Risk-Adjusted Assessment of the Learning Curve for Pure Laparoscopic Donor Hepatectomy for Adult Recipients. World J Surg 2023; 47:2488-2498. [PMID: 37326677 DOI: 10.1007/s00268-023-07089-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Studies on pure laparoscopic donor hepatectomy (PLDH) have been reported. However, only few studies have reported on the learning curve of PLDH. In this report, we aimed to determine the learning curve of PLDH in adult patients using cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) analyses. METHODS The data of donors who underwent PLDH at a single center between December 2012 and May 2022 were retrospectively reviewed. The learning curve was evaluated using the CUSUM and RA-CUSUM methods based on surgery duration. RESULTS Forty-eight patients were finally included in the present study. The mean operation time was 393.6 ± 80.3 min. PLDH was converted to laparotomy in three cases (6.3%). According to the Clavien-Dindo classification, nine cases (18.8%) had higher-than-grade III postoperative complications and the most frequent complications were biliary complications. The CUSUM graph shows two peaks, at the 13th and 27th case. The multivariate analysis revealed that a body mass index ≥ 23 kg/m2 and intraoperative cholangiography were the only factors that were independently associated with longer operation time. Based on these results, an RA-CUSUM analysis was performed to assess the learning curve, which showed a decrease in the learning curve after 33 to 34 PLDH procedures. CONCLUSIONS A learning curve effect was demonstrated in this study after 33 to 34 PLDH procedures. There are relatively many biliary complications, and it is necessary to further examine the method of bile duct transection.
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Affiliation(s)
- Koji Kikuchi
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan.
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
| | - Akira Umemura
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
| | - Hirokatsu Katagiri
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
| | - Shoji Kanno
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
| | - Daiki Takeda
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
| | - Taro Ando
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
| | - Satoshi Amano
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
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Rhu J, Choi GS, Kim JM, Kwon CHD, Joh JW. Risk Factors Associated With Surgical Morbidities of Laparoscopic Living Liver Donors. Ann Surg 2023; 278:96-102. [PMID: 36994737 DOI: 10.1097/sla.0000000000005851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE This study analyzed the incidence and risk factors for surgical morbidities of laparoscopic living donors. BACKGROUND Although laparoscopic living donor programs have been established safely in leading centers, donor morbidities have not been discussed sufficiently. METHODS Laparoscopic living donors operated on from May 2013 to June 2022 were reviewed. Donor complications were reviewed, and factors related to bile leakage and biliary stricture were analyzed using the multivariable logistic regression method. RESULTS A total of 636 donors underwent laparoscopic living donor hepatectomy. The open conversion rate was 1.6%, and the 30-day complication rate was 16.8% (n=107). Grade IIIa and IIIb complications occurred in 4.4% (n=28) and 1.9% (n=12) of patients, respectively. The most common complication was bleeding (n=38, 6.0%). Fourteen donors (2.2%) required reoperation. Portal vein stricture, bile leakage, and biliary stricture occurred in 0.6% (n=4), 3.3% (n=21), and 1.6% (n=10) of cases, respectively. The readmission rate and reoperation rate were 5.2% (n=33) and 2.2% (n=14), respectively. Risk factors related to bile leakage were 2 hepatic arteries in the liver graft (OR=13.836, CI=4.092-46.789, P <0.001), division-free margin<5 mm from the main duct (OR=2.624, CI=1.030-6.686, P =0.043), and estimated blood loss during operation (OR=1.002, CI=1.001-1.003, P =0.008), while the Pringle maneuver (OR=0.300, CI=0.110-0.817, P =0.018) was protective against leakage. Regarding biliary stricture, bile leakage was the only significant factor (OR=11.902, CI=2.773-51.083, P =0.001). CONCLUSIONS Laparoscopic living donor surgery showed excellent safety for the majority of donors, and critical complications were resolved with proper management. To minimize bile leakage, cautious surgical manipulation is needed for donors with complex hilar anatomy.
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Affiliation(s)
- Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Choon Hyuck David Kwon
- Department of General Surgery, Digestive Disease & Surgery Institute, Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Law JH, Tan CHN, Tan KHJ, Gao Y, Pang NQ, Bonney GK, Iyer SG, Soubrane O, Kow WCA. Safely Implementing a Program of Pure Laparoscopic Donor Right Hepatectomy: The Experience From a Southeast Asian Center. Transplant Direct 2023; 9:e1486. [PMID: 37250490 PMCID: PMC10212616 DOI: 10.1097/txd.0000000000001486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 05/31/2023] Open
Abstract
Laparoscopic donor right hepatectomy (LDRH) is a technically challenging procedure. There is increasing evidence demonstrating the safety of LDRH in high-volume expert centers. We report our center's experience in implementing an LDRH program in a small- to medium-sized transplantation program. Methods Our center systematically introduced a laparoscopic hepatectomy program in 2006. We started with minor wedge resections followed by major hepatectomies with increasing complexities. In 2017, we performed our first laparoscopic living donor left lateral sectionectomy. Since 2018, we have performed 8 cases of right lobe living donor hepatectomy (laparoscopy-assisted: 4 and pure laparoscopic: 4). Results The median operative time was 418 (298-540) min, whereas the median blood loss was 300 (150-900) mL. Two patients (25%) had surgical drain placed intraoperatively. The median length of stay was 5 (3-8) d, and the median time to return to work was 55 (24-90) d. None of the donors sustained any long-term morbidity or mortality. Conclusions Small- to medium-sized transplant programs face unique challenges in adopting LDRH. Progressive introduction of complex laparoscopic surgery, a mature living donor liver transplantation program, appropriate patient selection, and the invitation of an expert to proctor the LDRH are necessary to ensure success.
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Affiliation(s)
- Jia-Hao Law
- Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Hospital, Singapore
- National University Center for Organ Transplantation, National University Hospital, Singapore
| | - Chun Han Nigel Tan
- Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Hospital, Singapore
- National University Center for Organ Transplantation, National University Hospital, Singapore
| | - Kah Hwee Jarrod Tan
- Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Hospital, Singapore
- National University Center for Organ Transplantation, National University Hospital, Singapore
| | - Yujia Gao
- Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Hospital, Singapore
- National University Center for Organ Transplantation, National University Hospital, Singapore
| | - Ning Qi Pang
- Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Hospital, Singapore
- National University Center for Organ Transplantation, National University Hospital, Singapore
| | - Glenn Kunnath Bonney
- Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Hospital, Singapore
- National University Center for Organ Transplantation, National University Hospital, Singapore
| | - Shridhar Ganpathi Iyer
- Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Hospital, Singapore
- National University Center for Organ Transplantation, National University Hospital, Singapore
| | - Olivier Soubrane
- Department of Hepatobiliary and Liver Transplantation Surgery, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris and University of Paris, Paris, France
| | - Wei Chieh Alfred Kow
- Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Hospital, Singapore
- National University Center for Organ Transplantation, National University Hospital, Singapore
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Kakos CD, Papanikolaou A, Ziogas IA, Tsoulfas G. Global dissemination of minimally invasive living donor hepatectomy: What are the barriers? World J Gastrointest Surg 2023; 15:776-787. [PMID: 37342850 PMCID: PMC10277954 DOI: 10.4240/wjgs.v15.i5.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/16/2023] [Accepted: 03/16/2023] [Indexed: 05/26/2023] Open
Abstract
Minimally invasive donor hepatectomy (MIDH) is a relatively novel procedure that can potentially increase donor safety and contribute to faster rehabilitation of donors. After an initial period in which donor safety was not effectively validated, MIDH currently seems to provide improved results, provided that it is conducted by experienced surgeons. Appropriate selection criteria are crucial to achieve better outcomes in terms of complications, blood loss, operative time, and hospital stay. Beyond a pure laparoscopic technique, various approaches have been recommended such as hand-assisted, laparoscopic-assisted, and robotic donation. The latter has shown equal outcomes compared to open and laparoscopic approaches. A steep learning curve seems to exist in MIDH, mainly due to the fragility of the liver parenchyma and the experience needed for adequate control of bleeding. This review investigated the challenges and the opportunities of MIDH and the barriers to its global dissemination. Surgeons need expertise in liver transplantation, hepatobiliary surgery, and minimally invasive techniques to perform MIDH. Barriers can be categorized into surgeon-related, institutional-related, and accessibility. More robust data and the creation of international registries are needed for further evaluation of the technique and the acceptance from more centers worldwide.
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Affiliation(s)
- Christos Dimitrios Kakos
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54622, Greece
| | - Angelos Papanikolaou
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Ioannis A Ziogas
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Georgios Tsoulfas
- Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54622, Greece
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Mu C, Chen C, Wan J, Chen G, Hu J, Wen T. Minimally Invasive Donors Right Hepatectomy versus Open Donors Right Hepatectomy: A Meta-Analysis. J Clin Med 2023; 12:jcm12082904. [PMID: 37109241 PMCID: PMC10146341 DOI: 10.3390/jcm12082904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/06/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND How to obtain a donor liver remains an open issue, especially in the choice of minimally invasive donors right hepatectomy versus open donors right hepatectomy (MIDRH versus ODRH). We conducted a meta-analysis to clarify this question. METHODS A meta-analysis was performed in PubMed, Web of Science, EMBASE, Cochrane Central Register, and ClinicalTrials.gov databases. Baseline characteristics and perioperative outcomes were analyzed. RESULTS A total of 24 retrospective studies were identified. For MIDRH vs. ODRH, the operative time was longer in the MIDRH group (mean difference [MD] = 30.77 min; p = 0.006). MIDRH resulted in significantly less intraoperative blood loss (MD = -57.86 mL; p < 0.00001), shorter length of stay (MD = -1.22 days; p < 0.00001), lower pulmonary (OR = 0.55; p = 0.002) and wound complications (OR = 0.45; p = 0.0007), lower overall complications (OR = 0.79; p = 0.02), and less self-infused morphine consumption (MD = -0.06 days; 95% CI, -1.16 to -0.05; p = 0.03). In the subgroup analysis, similar results were observed in pure laparoscopic donor right hepatectomy (PLDRH) and the propensity score matching group. In addition, there were no significant differences in post-operation liver injury, bile duct complications, Clavien-Dindo ≥ 3 III, readmission, reoperation, and postoperative transfusion between the MIDRH and ODRH groups. DISCUSSION We concluded that MIDRH is a safe and feasible alternative to ODRH for living donators, especially in the PLDRH group.
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Affiliation(s)
- Chunyang Mu
- Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chuwen Chen
- Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianghong Wan
- Department of Outpatient, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guoxin Chen
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jing Hu
- Department of Health Management, West China Fourth Hospital, Sichuan University, Chengdu 610093, China
| | - Tianfu Wen
- Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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10
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Vargas PA, Goldaracena N. Right vs Left Hepatectomy for LDLT, Safety and Regional Preference. CURRENT TRANSPLANTATION REPORTS 2022. [DOI: 10.1007/s40472-022-00386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Rhu J, Choi GS, Kim JM, Kwon CHD, Joh JW. Complete transition from open surgery to laparoscopy: 8-year experience with more than 500 laparoscopic living donor hepatectomies. Liver Transpl 2022; 28:1158-1172. [PMID: 35138684 DOI: 10.1002/lt.26429] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 01/13/2023]
Abstract
This study was designed to review laparoscopic living donor liver transplantations (LDLTs) at a single center that achieved complete transition from open surgery to laparoscopy. LDLTs performed from January 2013 to July 2021 were reviewed. Comparisons between open and laparoscopic surgeries were performed according to periods divided into initial, transition, and complete transition periods. A total of 775 LDLTs, 506 laparoscopic and 269 open cases, were performed. Complete transition was achieved in 2020. Bile duct variations were significantly abundant in the open group both in the initial period (30.2% vs. 8.1%; p < 0.001) and transition period (48.1% vs. 24.3%; p < 0.001). Portal vein variation was more abundant in the open group only in the initial period (13.0% vs. 4.1%; p = 0.03). Although the donor reoperation rate (0.0% vs. 4.1%; p = 0.02) and Grade III or higher complication rate (5.6% vs. 13.5%; p = 0.03) were significantly higher in the laparoscopy group in the initial period, there were no differences during the transition period as well as in overall cases. Median number of opioids required by the donor (three times [interquartile range, IQR, 1-6] vs. 1 time [IQR, 0-3]; p < 0.001) was lower, and the median hospital stay (10 days [IQR, 8-12] vs. 8 days [IQR, 7-9]; p < 0.001) was shorter in the laparoscopy group. Overall recipient bile leakage rate (23.8% vs. 12.8%; p < 0.001) and overall Grade III or higher complication rate (44.6% vs. 37.2%; p = 0.009) were significantly lower in the laparoscopy group. Complete transition to laparoscopic living donor hepatectomy was possible after accumulating a significant amount of experience. Because donor morbidity can be higher in the initial period, donor selection for favorable anatomy is required for both the donor and recipient.
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Affiliation(s)
- Jinsoo Rhu
- Department of SurgerySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Gyu-Seong Choi
- Department of SurgerySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Jong Man Kim
- Department of SurgerySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Choon Hyuck David Kwon
- Department of General SurgeryDigestive Disease & Surgery InstituteLerner College of MedicineCleveland ClinicClevelandOhioUSA
| | - Jae-Won Joh
- Department of SurgerySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
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12
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Rotellar F, Ciria R, Wakabayashi G, Suh KS, Cherqui D. World Survey on Minimally Invasive Donor Hepatectomy: A Global Snapshot of Current Practices in 2370 Cases. Transplantation 2022; 106:96-105. [PMID: 33586922 DOI: 10.1097/tp.0000000000003680] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Having little evidence on the real extent of the minimally invasive donor hepatectomy (MIDH), a world survey was conducted aiming to picture the spread of MIDH and to identify geographical, institutional, and individual differences. METHODS A web-based survey was created with 5 sections (general, institutional, surgeon's experience, technical, and spread and dissemination), comprising up to a total of 47 questions. A thorough search was carried out to identify all possible centers and surgeons performing MIDH. RESULTS A global MIDH experience of 2370 cases was collected: 1587 right hepatectomies (RHs; 48.9% pure laparoscopic), 471 left lateral sectionectomies (LLS; 81.1% pure laparoscopic), and 366 left hepatectomies (LHs; 77.6% laparoscopic-assisted). LLS and adult MIDH conversion rates were 5.4% and 3.9%, respectively. Median blood loss was 250 mL (100-600), 100 mL (50-250), and 150 mL (50-500) for RH, LLS, and LH, respectively. Intra- and postoperative transfusion rates were 0.5%, 0%, and 0.3%; and 1.3%, 1.6%, and 0% for RH, LLS, and LH, respectively. Geographically, Asia accounts up to 1730 cases (73% of the global experience, 49.6% pure lap), of which 1374 cases are RH; Europe and Middle East-395 cases-stands out for its experience in left lateral sectionectomy: 289 cases (93% pure lap). Finally, America accounts for 245 cases, using a laparoscopic-assisted technique in 72.6% of the cases (178). CONCLUSIONS This world survey provides evidence and data on the global spread of MIDH and anticipates how in a near future a large-scale adoption of these techniques may be observed.
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Affiliation(s)
- Fernando Rotellar
- HPB and Liver Transplant Unit, Department of General Surgery, Clínica Universidad de Navarra, University of Navarra, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Ruben Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, Cordoba, Spain
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Japan
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Daniel Cherqui
- AP-HP, Hepatobiliary Center, Paul Brousse Hospital, Université Paris Saclay, Villejuif, France
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13
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Broering D, Sturdevant ML, Zidan A. Robotic donor hepatectomy: A major breakthrough in living donor liver transplantation. Am J Transplant 2022; 22:14-23. [PMID: 34783439 DOI: 10.1111/ajt.16889] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 02/06/2023]
Abstract
Living donation in many countries is the main resource of organs. Healthy, volunteering individuals deserve the highest safety standards possible in addition to the least invasive technique to procure the organs. Since the introduction of living donor liver transplantation, many efforts have been made to minimize the surgical trauma inherent to living donor surgery. The journey started with a large Mercedes incision and evolved to reverse L-shaped and small upper midline incisions before the introduction of minimally invasive laparoscopic techniques originated. The technical difficulties of the laparoscopic approach due to suboptimal instrumentation, challenging ergonomics, and the long learning curve limited the application of the fully laparoscopic approach to a few centers. The recent introduction of the robotic platform with its superb optical system and advanced instruments allows for the first time, a genuine emulation of open donor surgery in a closed abdomen, thus allowing all liver donors to benefit from minimally invasive surgery (better cosmesis, less pain and morbidity, and better quality of life) without compromising donor safety. This attribute in combination with the ubiquitous presence of the robot in major transplant centers may well lead to the desired endpoint of this technology, namely, the widespread dissemination of minimally invasive donor surgery.
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Affiliation(s)
- Dieter Broering
- Organ Transplant Center of Excellence - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Mark L Sturdevant
- Organ Transplant Center of Excellence - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.,Department of Surgery, Division of Transplant - University of Washington Medical Center, Seattle, Washington
| | - Ahmed Zidan
- Organ Transplant Center of Excellence - King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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14
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Kim JM, Rhu J, Ha SY, Choi GS, Kwon CHD, Kim G, Joh JW. Realization of improved outcomes following liver resection in hepatocellular carcinoma patients aged 75 years and older. Ann Surg Treat Res 2021; 101:257-265. [PMID: 34796141 PMCID: PMC8564081 DOI: 10.4174/astr.2021.101.5.257] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/01/2021] [Accepted: 09/24/2021] [Indexed: 01/27/2023] Open
Abstract
Purpose Little is known about liver resection (LR) in hepatocellular carcinoma (HCC) patients older than 75 years of age. This study aimed to compare the postoperative and long-term outcomes of hepatectomy in this patient population according to operation period. Methods This study included 130 elderly patients who underwent LR for solitary treatment-naïve HCC between November 1998 and March 2020. Group 1 included patients who underwent LR before 2016 (n = 68) and group 2 included those who underwent LR during or after 2016 (n = 62). Results The proportion of major LR, anatomical LR, and laparoscopic LR (LLR) in group 1 was significantly lower than those in group 2. Also, the median operation time, amount of blood loss, hospitalization length, rates of intraoperative blood transfusion, and complications in group 2 were less than those in group 1. In the subgroup analysis of group 1, high proteins induced by vitamin K absence or antagonist-II, long hospitalization, and LLR were closely associated with mortality. In the subgroup analysis of group 2, however, none of the factors increased mortality. Nevertheless, the presence of tumor grade 3 or 4 and the incidence of microvascular invasion were higher in group 1 than in group 2, and the disease-free survival and overall survival were better in group 2 than in group 1 because of minimized blood loss and quicker recovery period by increased surgical techniques and anatomical approach, and LLR. Conclusion LR in elderly HCC patients has been frequently performed recently, and the outcomes have improved significantly compared to the past.
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Affiliation(s)
- Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Yun Ha
- Department of Pathology and Translational Genomics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Choon Hyuck David Kwon
- Department of Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gaabsoo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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15
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Zhao X, Lei Z, Gao F, Yang J, Xie Q, Jiang K, Jie G. Minimally invasive versus open living donors right hepatectomy: A systematic review and meta-analysis. Int J Surg 2021; 95:106152. [PMID: 34688930 DOI: 10.1016/j.ijsu.2021.106152] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although minimally invasive technology has been widely used in hepatectomy, it remains controversial with regards to liver transplantation, especially in donors right hepatectomy. Herein, we compared the short-term safety and efficacy of minimally invasive donors right hepatectomy (MIDRH) with open donors right hepatectomy (ODRH). METHODS A systematic literature search was carried out using PubMed, Embase, Web of Science and the Cochrane Library database in order to identify comparison studies of MIDRH and ODRH. Next, we obtained the relevant data, and carried out the meta-analysis. RESULTS This meta-analysis included 12 studies, which included 1755 cases that underwent donors right hepatectomy. Compared to ODRH, patients that underwent MIDRH had less bleeding (SWD = -0.52, p<0.001), shorter hospital stays (SWD = -0.58, p < 0.001) and lower overall postoperative complications of donors (RR = 0.74, p = 0.008). However, MIDRH was found to be associated with prolonged operative times (SWD = 0.74, p < 0.001), as well as a higher rate of biliary complications in donors (RR = 2.26, p = 0.007) and recipients (RR = 1.69, p < 0.001). There were no statistically significant differences between MIDRH and ODRH in postoperative liver function, rate of major complications and vascular complications of both donors and recipients and overall postoperative complications. DISCUSSION MIDRH is superior to ODRH with regards to intraoperative bleeding, postoperative hospital stay and overall donor complications. Although biliary-related complications are higher, it is feasible to develop MIDRH in experienced liver transplant centers. However, higher-quality research is still needed for corroboration.
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Affiliation(s)
- Xin Zhao
- Department of Hepatobiliary Surgery, The People's Hospital of Leshan, Leshan, Sichuan, 614000, China Diagnosis and Treatment Center for Liver, Gallbladder, Pancreas and Spleen System Diseases of Leshan, Leshan, Sichuan, 614000, China
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16
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Lai Q, Giovanardi F, Mennini G, Berardi G, Rossi M. The impact of mini-invasive right hepatectomy in the setting of living donation: a meta-analysis. Updates Surg 2021; 74:23-34. [PMID: 34487336 PMCID: PMC8827159 DOI: 10.1007/s13304-021-01160-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/26/2021] [Indexed: 02/07/2023]
Abstract
Adult-to-adult living-donor liver transplantation (A2ALDLT) represents a challenging procedure, mainly when the right hepatic lobe is donated. Therefore, especially in Western countries, the medical community still considers it a “risky procedure”. The present meta-analysis investigated the postoperative results reported in donors undergoing right hepatectomy for A2ALDLT through a minimally invasive liver resection (MILR) vs. open liver resection (OLR) approach, with the intent to clarify the hypothesis that the MILR approach should minimize the risks for the donor. A systematic literature search was performed using MEDLINE-PubMed, Cochrane Library, and EMBASE electronic databases. The primary outcome investigated was the complication rate after transplant. Fifteen studies were included (n = 2094; MILR = 553 vs. OLR = 1541). The MILR group only merged the statistical relevance in terms of advantage in terms of a lower number of complications (OR = 0.771, 95% CI 0.578–1.028; P value = 0.077). Investigating the complications ≥ IIIa according to the Dindo-Clavien classification, the estimated blood loss, and the length of hospital stay, no statistical difference was reported between the two groups. MILR represents a novel and promising approach for improving the results in A2ALDLT. However, no benefits have been reported regarding blood loss, length of stay, and postoperative complications. More extensive experiences are needed to re-evaluate the impact of MILR in right lobe live donation.
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Affiliation(s)
- Quirino Lai
- General Surgery and Organ Transplantation Unit, Department of General and Specialistic Surgery, Umberto I Polyclinic of Rome, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Francesco Giovanardi
- General Surgery and Organ Transplantation Unit, Department of General and Specialistic Surgery, Umberto I Polyclinic of Rome, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Gianluca Mennini
- General Surgery and Organ Transplantation Unit, Department of General and Specialistic Surgery, Umberto I Polyclinic of Rome, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giammauro Berardi
- Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Tokyo, Japan
| | - Massimo Rossi
- General Surgery and Organ Transplantation Unit, Department of General and Specialistic Surgery, Umberto I Polyclinic of Rome, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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17
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A Novel Technique for Bile Duct Division During Laparoscopic Living Donor Hepatectomy to Overcome Biliary Complications in Liver Transplantation Recipients: "Cut and Clip" Rather Than "Clip and Cut". Transplantation 2021; 105:1791-1799. [PMID: 32826797 DOI: 10.1097/tp.0000000000003423] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was designed to analyze the clinical impact of a new bile duct division technique during laparoscopic living donor hepatectomy. METHODS Laparoscopic donor right hepatectomies performed by a single surgeon between December 2016 and August 2019 were included. Magnetic resonance cholangiopancreatography of the donors was reconstructed, and the length of the common channel of the dividing intrahepatic duct was measured. Patients were divided into 2 groups based on the bile duct division techniques of "clip and cut" versus "cut and clip." Outcome of bile duct division was categorized based on the graft and bile duct type and number of bile duct openings. RESULTS A total of 147 transplantations were included. Outcomes in the "cut and clip" group were better than those in the "clip and cut" group with regard to obtaining an adequate division point (94.2% versus 78.8%; P = 0.019). The "cut and clip" showed superior biliary stricture-free survival than the "clip and cut" group (hazard ratio [HR], 0.456; confidence interval [CI], 0.217-0.957; P = 0.038) whereas recipients with hepaticojejunostomy (HR, 3.358; CI, 1.090-10.350; P = 0.035) and bile duct type other than type I (HR, 2.214; CI, 1.143-4.289; P = 0.018) showed increased risk for biliary stricture-free survival. Better outcome in terms of obtaining a single opening was also obtained in the "cut and clip" group (68.2% versus 84.6%; P = 0.040), and this difference was significant especially with a common channel shorter than 10 mm (45.5% versus 81.2%; P = 0.043). CONCLUSIONS The "cut and clip" technique showed superior outcomes to the "clip and cut" technique in terms of fewer bile duct openings and biliary stricture-free survival of the recipients.
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18
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Hobeika C, Cauchy F, Fuks D, Barbier L, Fabre JM, Boleslawski E, Regimbeau JM, Farges O, Pruvot FR, Pessaux P, Salamé E, Soubrane O, Vibert E, Scatton O. Laparoscopic versus open resection of intrahepatic cholangiocarcinoma: nationwide analysis. Br J Surg 2021; 108:419-426. [PMID: 33793726 DOI: 10.1093/bjs/znaa110] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/28/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The relevance of laparoscopic resection of intrahepatic cholangiocarcinoma (ICC) remains debated. The aim of this study was to compare laparoscopic (LLR) and open (OLR) liver resection for ICC, with specific focus on textbook outcome and lymph node dissection (LND). METHODS Patients undergoing LLR or OLR for ICC were included from two French, nationwide hepatopancreatobiliary surveys undertaken between 2000 and 2017. Patients with negative margins, and without transfusion, severe complications, prolonged hospital stay, readmission or death were considered to have a textbook outcome. Patients who achieved both a textbook outcome and LND were deemed to have an adjusted textbook outcome. OLR and LLR were compared after propensity score matching. RESULTS In total, 548 patients with ICC (127 LLR, 421 OLR) were included. Textbook-outcome and LND completion rates were 22.1 and 48.2 per cent respectively. LLR was independently associated with a decreased rate of LND (odds ratio 0.37, 95 per cent c.i. 0.20 to 0.69). After matching, 109 patients remained in each group. LLR was associated with a decreased rate of transfusion (7.3 versus 21.1 per cent; P = 0.001) and shorter hospital stay (median 7 versus 14 days; P = 0.001), but lower rate of LND (33.9 versus 73.4 per cent; P = 0.001). Patients who underwent LLR had lower rate of adjusted TO completion than patients who had OLR (6.5 versus 17.4 per cent; P = 0.012). CONCLUSION The laparoscopic approach did not substantially improve quality of care of patients with resectable ICC.
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Affiliation(s)
- C Hobeika
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France.,Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hopitaux de Paris and Sorbonne University, Paris, France
| | - F Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - D Fuks
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Université Paris V, Paris, France
| | - L Barbier
- Department of Digestive, Endocrine, Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Trousseau, Centre Hospitalier Régional Universitaire Tours, Tours, France
| | - J M Fabre
- Department of Digestive, Hepatopancreatobiliary Surgery and Liver Transplantation, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - E Boleslawski
- Department of Digestive Surgery and Liver Transplantation, Hôpital Huriez, Centre Hospitalier Universitaire de Lille, Université Nord de France, Lille, France
| | - J M Regimbeau
- Department of Digestive Surgery, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - O Farges
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - F R Pruvot
- Department of Digestive Surgery and Liver Transplantation, Hôpital Huriez, Centre Hospitalier Universitaire de Lille, Université Nord de France, Lille, France
| | - P Pessaux
- Department of Digestive Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - E Salamé
- Department of Digestive, Endocrine, Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Trousseau, Centre Hospitalier Régional Universitaire Tours, Tours, France
| | - O Soubrane
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - E Vibert
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Paul Brousse, Assistance Publique-Hopitaux de Paris and Université Paris XI, Paris, France
| | - O Scatton
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hopitaux de Paris and Sorbonne University, Paris, France
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19
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Chua D, Syn N, Koh YX, Goh BKP. Learning curves in minimally invasive hepatectomy: systematic review and meta-regression analysis. Br J Surg 2021; 108:351-358. [PMID: 33779690 DOI: 10.1093/bjs/znaa118] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/07/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Minimally invasive hepatectomy (MIH) has become an important option for the treatment of various liver tumours. A major concern is the learning curve required. The aim of this study was to perform a systematic review and summarize current literature analysing the learning curve for MIH. METHODS A systematic review of the literature pertaining to learning curves in MIH to July 2019 was performed using PubMed and Scopus databases. All original full-text articles published in English relating to learning curves for both laparoscopic liver resection (LLR), robotic liver resection (RLR), or a combination of these, were included. To explore quantitatively the learning curve for MIH, a meta-regression analysis was performed. RESULTS Forty studies relating to learning curves in MIH were included. The median overall number of procedures required in studies utilizing cumulative summative (CUSUM) methodology for LLR was 50 (range 25-58) and for RLR was 25 (16-50). After adjustment for year of adoption of MIH, the CUSUM-derived caseload to surmount the learning curve for RLR was 47.1 (95 per cent c.i. 1.2 to 71.6) per cent; P = 0.046) less than that required for LLR. A year-on-year reduction in the number of procedures needed for MIH was observed, commencing at 48.3 cases in 1995 and decreasing to 23.8 cases in 2015. CONCLUSION The overall learning curve for MIH decreased steadily over time, and appeared less steep for RLR compared with LLR.
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Affiliation(s)
- Darren Chua
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Nicholas Syn
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ye-Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.,Duke-National University of Singapore (NUS) Medical School, Singapore
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20
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Lapisatepun W, Hong SK, Hong K, Han ES, Lee JM, Yi NJ, Lee KW, Suh KS. Influence of Large Grafts Weighing ≥ 1000 g on Outcome of Pure Laparoscopic Donor Right Hepatectomy. J Gastrointest Surg 2021; 25:1980-1988. [PMID: 33104954 DOI: 10.1007/s11605-020-04837-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/17/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Depending on a transplant center's level of experience, utilization of pure laparoscopic donor right hepatectomy (PLDRH) may be limited due to graft size or anatomical variations. Here, we aimed to evaluate the influence of large hepatic grafts (≥ 1000 g) when performing PLDRH in both donors and recipients of such grafts. METHODS Medical records of living donors who underwent either PLDRH from November 2015 to August 2019 or open conventional donor right hepatectomy (CDRH) from January 2010 to August 2019 and those of the graft recipients were retrospectively reviewed. Donors were separated into three groups: PLDRH graft ≥ 1000 g (n = 10; study group), PLDRH graft < 1000 g (n = 280; control-I group), and CDRH graft ≥ 1000 g (n = 24; control-II group). RESULTS Total operative duration (P = 0.017) and warm ischemia time (P < 0.001) were significantly longer in the study than in the control-I and control-II groups, respectively. ΔAlanine aminotransferase% was significantly lower in the study than in the control-I group (P = 0.001). There was no significant difference in minor complication incidence between the study and control-I (P = 0.068) and control-II (P = 0.618) donors. There were no major complications in the study and control-II donors, whereas six control-I donors (2.1%) experienced a major complication (P = 1.000). Length of hospitalization was significantly shorter in the study than in the control-II group (P < 0.001). There was no significant difference in early and late major complication incidence for recipients between the study and control-I and control-II groups. CONCLUSIONS PLDRH for grafts weighing ≥ 1000 g appears to be safe and feasible when performed by experienced surgeons in a well-equipped center.
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Affiliation(s)
- Worakitti Lapisatepun
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongrogu, Seoul, 03080, Korea.,Division of Hepatobiliary Pancreas Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongrogu, Seoul, 03080, Korea.
| | - Kwangpyo Hong
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongrogu, Seoul, 03080, Korea
| | - Eui Soo Han
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongrogu, Seoul, 03080, Korea
| | - Jeong-Moo Lee
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongrogu, Seoul, 03080, Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongrogu, Seoul, 03080, Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongrogu, Seoul, 03080, Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongrogu, Seoul, 03080, Korea
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21
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Rhu J, Kim MS, Choi GS, Kim JM, Kwon CHD, Joh JW. Laparoscopic Living Donor Right Hepatectomy Regarding the Anatomical Variation of the Portal Vein: A Propensity Score-Matched Analysis. Liver Transpl 2021; 27:984-996. [PMID: 33711190 DOI: 10.1002/lt.26050] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/18/2021] [Accepted: 02/10/2021] [Indexed: 12/15/2022]
Abstract
This study is designed to analyze the feasibility of laparoscopic living donor right hemihepatectomy in living donors with portal vein variation. Living donor liver transplantation cases using a right liver graft during the period of January 2014 to September 2019 were included. Computed tomographic angiographies of the donor were 3-dimensionally reconstructed, and the anatomical variation of the portal vein was classified. To reduce selection bias, a 1:1 ratio propensity score-matched analysis between the laparoscopy group and the open group was performed. Surgical and recovery-related outcomes as well as portal vein complication-free survival, graft survival, and overall survival rates were analyzed. After matching, 171 cases in each group from 444 original cases were compared. The laparoscopy group had a shorter operation time (P < 0.001), a smaller number of additional opioids required by the donor (P < 0.001), and a shorter hospital stay (P < 0.001). There were no differences in the portal vein complication-free survival (P = 0.16), graft survival (P = 0.26), or overall survival rates (P = 0.53). Although portal vein complication-free survival was inferior in portal veins other than type I (P = 0.01), the laparoscopy group showed similar portal vein complication-free survival regardless of the anatomical variation of portal vein (P = 0.35 in type I and P = 0.30 in other types). Laparoscopic living donor right hemihepatectomy can be performed as safely as open surgery regardless of the anatomical variation of the portal vein.
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Affiliation(s)
- Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Seung Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Choon Hyuck David Kwon
- Department of General Surgery, Digestive Disease & Surgery Institute, Lerner College of Medicine, Cleveland Clinic, Cleveland, OH
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Marubashi S, Nagano H. Laparoscopic living-donor hepatectomy: Review of its current status. Ann Gastroenterol Surg 2021; 5:484-493. [PMID: 34337297 PMCID: PMC8316741 DOI: 10.1002/ags3.12450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/19/2021] [Accepted: 02/03/2021] [Indexed: 11/24/2022] Open
Abstract
The laparoscopic living-donor hepatectomy procedure has been developing rapidly. Although its use has increased worldwide, it is still only performed by experienced surgeons at a limited number of institutions. However, technical innovations have improved the feasibility of more widespread use of laparoscopic living-donor hepatectomy. The advantages of laparoscopic living-donor hepatectomy should not be overemphasized, and the fundamental principle of "living-donor safety first" cannot be neglected. This review aims to summarize the current status of laparoscopic living-donor hepatectomy and to emphasize that, while this procedure may soon be used as a reliable, donor-friendly substitute for traditional open donor hepatectomy, its safety and efficacy require further substantiation first.
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Affiliation(s)
- Shigeru Marubashi
- Department of Hepato‐Biliary‐Pancreatic and Transplant SurgeryFukushima Medical UniversityFukushimaJapan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine SurgeryYamaguchi University Graduate School of MedicineUbeJapan
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Han ES, Suh KS, Lee KW, Yi NJ, Hong SK, Lee JM, Hong KP, Tan MY. Advances in the surgical outcomes of 300 cases of pure laparoscopic living donor right hemihepatectomy divided into three periods of 100 cases: a single-centre case series. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:553. [PMID: 33987251 DOI: 10.21037/atm-20-6886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Minimally invasive surgery has been widely used for hepatobiliary operations. This study aimed to determine the safety and feasibility of pure laparoscopic living donor right hepatectomy. Methods From November 2015 to April 2019, 300 cases of adult pure laparoscopic living donor right hepatectomy performed at Seoul National University Hospital were divided into three subgroups of periods 1-3 of 100 cases each: 1-100, 101-200, and 201-300, respectively. We retrospectively reviewed and analysed the safety and feasibility outcomes. Results The operative time (period 1: 318.9±62.2 min, period 2: 256.7±71.4 min, period 3: 227.7±57.4 min) and blood loss (period 1: 419.7±196.5 mL, period 2: 198.9±197.2 mL, period 3: 166.0±130.0 mL) gradually decreased (P<0.01). Similarly, the length of hospital stay decreased (period 1: 8.1±2.0 days, period 2: 7.3±3.1 days, period 3: 6.9±2.4 days, P<0.01). There was no requirement for intraoperative transfusions or care in the intensive care unit. The overall complication rate was 20/300 (6.7%), of which 8/300 (2.7%) were Clavien-Dindo grade III and above. Complications were not different among the three periods. In terms of anatomical variations, the incidences of multiple portal veins, multiple hepatic arteries, and multiple bile ducts were 32/300 (10.7%), 11/300 (3.7%), and 161/300 (53.7%), respectively. No differences were found among the three periods. Conclusions Owing to the technical improvements over time, pure laparoscopic living donor hepatectomy is currently feasible and safe even for donors with anatomical variations.
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Affiliation(s)
- Eui Soo Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Moo Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang Pyo Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ming Yuan Tan
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Bang YJ, Jun JH, Gwak MS, Ko JS, Kim JM, Choi GS, Joh JW, Kim GS. Postoperative outcomes of purely laparoscopic donor hepatectomy compared to open living donor hepatectomy: a preliminary observational study. Ann Surg Treat Res 2021; 100:235-245. [PMID: 33854993 PMCID: PMC8019986 DOI: 10.4174/astr.2021.100.4.235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/27/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To lessen the physical, cosmetic, and psychological burden of donors, purely laparoscopic donor hepatectomy (PLDH) has been proposed as an ideal method for living donors. Our study aimed to prospectively compare the effect of PLDH and 2 other types of open living donor hepatectomy (OLDH) on postoperative pain and recovery. Methods Sixty donors scheduled to undergo donor hepatectomy between March 2015 and November 2017 were included. Donors were divided into 3 groups by surgical technique: OLDH with a subcostal incision (n = 20), group S; OLDH with an upper midline incision (n = 20), group M; and PLDH (n = 20), group L. The primary outcomes were postoperative pain and analgesic requirement during postoperative day (POD) 3. Other variables regarding postoperative recovery were also analyzed. Results Although pain relief during POD 3, assessed by visual analog scale (VAS) score and analgesic requirement, was similar among the 3 groups, group L showed lower VAS scores and opioid requirements than group M. Moreover, group L was associated with a rapid postoperative recovery evidenced by the shorter hospital length of stay and more frequent return to normal activity on POD 30. Conclusion This pilot study failed to verify the hypothesis that PLDH reduces postoperative pain. PLDH did not reduce postoperative pain but showed faster recovery than OLDH.
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Affiliation(s)
- Yu Jeong Bang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Hyun Jun
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Mi Sook Gwak
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Justin Sangwook Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gaab Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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25
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Living donor left lateral sectionectomy: Should the procedure still be performed open? JOURNAL OF LIVER TRANSPLANTATION 2021. [DOI: 10.1016/j.liver.2020.100001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Rhu J, Choi GS, Kim MS, Kim JM, Joh JW. Image guidance using two-dimensional illustrations and three-dimensional modeling of donor anatomy during living donor hepatectomy. Clin Transplant 2020; 35:e14164. [PMID: 33222255 DOI: 10.1111/ctr.14164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 10/23/2020] [Accepted: 11/07/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND For living donor liver transplantation, preoperative imaging is required for the safety of both the donor and the recipient. We previously initiated our image-guidance program using two-dimensional illustrations and three-dimensional modeling in September 2018; herein, we analyzed the resultant changes in the clinical outcomes. METHODS Living donors and recipients who underwent liver transplantation between September 2017 and August 2019 were included. Cases with image guidance were compared to those without image guidance regarding the operative outcome, especially bile-duct opening in the graft as well as surgical complications. RESULTS Among 200 living donor transplantation, 90 transplantations were completed with image guidance. The image-guidance group had a higher rate of laparoscopy (80.9% vs. 97.8%; p < .001) as compared with the group without image guidance. Although there was no difference in the type of bile duct (p = .144), more grafts with single bile-duct openings were found in the image-guidance group (52.7% vs. 80.0%; p = .001). Consequently, achievements in bile-duct openings were superior in the image-guidance group (p = .022). There were no differences in bile leakage, graft failure, or number of deaths during the first month post-transplantation. CONCLUSION As we initiated our image-guidance program for living donor liver transplantation, clinical outcomes, especially bile-duct division, were improved relative to before implementation.
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Affiliation(s)
- Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Seung Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim JM, Kim S, Rhu J, Choi GS, Kwon CHD, Joh JW. Elderly Hepatocellular Carcinoma Patients: Open or Laparoscopic Approach? Cancers (Basel) 2020; 12:cancers12082281. [PMID: 32823929 PMCID: PMC7466133 DOI: 10.3390/cancers12082281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/12/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
It remains unclear whether the short-term benefits and long-term outcomes of laparoscopic liver resection (LLR) accrue to elderly patients with medical comorbidities. The aim of the present study was to compare the outcomes between LLR and open liver resection (OLR) in elderly patients (≥65 years) with solitary, treatment-naïve solitary hepatocellular carcinoma (HCC). From January 2013 to August 2017, 256 elderly patients with solitary treatment-naive HCC underwent liver resection. All patients were Child–Pugh class A and older than 65 years. The OLR and LLR groups contained 160 and 96 patients, respectively. The median tumor size in the OLR group was significantly larger than that in the LLR group (3.9 vs. 2.6 cm), but the tumor size did not differ between the two groups after matching. The median operation time, blood loss, transfusion rate, and postoperative complications in the OLR group did not differ from those in the LLR group, but the operation time in the LLR group was longer than that in the OLR group after matching. The median hospitalization in the LLR group was significantly shorter than that in the OLR group. Disease-free survival (DFS) in the LLR group was better than that in the OLR group before and after matching, but the difference was not significant. Patient survival (PS) in the LLR group was similar to that in the OLR group. LLR is feasible and safe for elderly patients with solitary, treatment-naïve HCC. The short- and long-term benefits of LLR are evident in geriatric oncological liver surgery patients.
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Affiliation(s)
- Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.M.K.); (S.K.); (J.R.); (G.-S.C.)
| | - Sangjin Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.M.K.); (S.K.); (J.R.); (G.-S.C.)
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.M.K.); (S.K.); (J.R.); (G.-S.C.)
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.M.K.); (S.K.); (J.R.); (G.-S.C.)
| | - Choon Hyuck David Kwon
- Department of Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.M.K.); (S.K.); (J.R.); (G.-S.C.)
- Correspondence: ; Tel.: +82-2-3410-3466; Fax: +82-2-3410-0040
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Carpenter D, Chaudhry S, Samstein B. The Current State of Minimally Invasive Living Donor Hepatectomy. CURRENT TRANSPLANTATION REPORTS 2020. [DOI: 10.1007/s40472-020-00287-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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29
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Minimally invasive donor hepatectomy, systemic review. Int J Surg 2020; 82S:187-191. [PMID: 32615320 DOI: 10.1016/j.ijsu.2020.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
Abstract
Liver transplantation is a life-saving therapy for patients with end-stage liver disease. Living donation is a critical source of organs throughout the world. Reducing donor morbidity and mortality is of utmost importance while maintaining access to liver transplantation for recipients. While laparoscopy was more rapidly utilized in donor nephrectomy, laparoscopy has been slower to develop for living donor hepatectomies due to the concerns about hemostasis, safety of the donor and quality of the graft. Pure minimal invasive approach has become a standard of care for left lateral sectionectomy (LLS) for pediatric recipients. In the past few years, a number of centers with significant laparoscopic and living donor experience have reported fully minimally invasive approach to hemi-hepatectomies. In this manuscript we discuss the experiences, lessons learned and path forward for laparoscopic and minimal invasive surgery(MIS) in donor hepatectomies (DH).
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Hibi T, Wei Chieh AK, Chi-Yan Chan A, Bhangui P. Current status of liver transplantation in Asia. Int J Surg 2020; 82S:4-8. [PMID: 32535264 DOI: 10.1016/j.ijsu.2020.05.071] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/28/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023]
Abstract
In spite of early adoption of the brain death legislation, and all efforts at promoting deceased donation, various social, economic and cultural factors have acted as road blocks to the furthering of deceased donor liver transplantation (DDLT) in most Asian societies. On the other hand, Asian liver transplant centers have been the pioneers, innovators, and technical advancement catalysts for the world to follow, especially with regards to living donor liver transplantation (LDLT). With some high volume centers performing more than 200 LDLTs a year with good outcomes in the donor and recipient, techniques to expand the living donor pool have also been adopted like ABO-incompatible, paired exchange and dual lobe living donor liver transplants. Although large multicenter, and registry data as regards safety and outcomes of minimally invasive donor hepatectomy are awaited, expert centers have pioneered, and now regularly perform purely laparoscopic and robotic living donor hepatectomies, especially in Korea.
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Affiliation(s)
- Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Alfred Kow Wei Chieh
- Division of HPB Surgery, Department of Surgery, National University of Singapore, Singapore
| | | | - Prashant Bhangui
- Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi-NCR, India.
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This month on Twitter. Br J Surg 2020; 107:619. [DOI: 10.1002/bjs.11605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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