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FINOTTI M, D’AMICO F, TESTA G. The current and future role of robotic surgery in liver surgery and transplantation. Minerva Surg 2022; 77:380-390. [DOI: 10.23736/s2724-5691.22.09629-0] [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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Kadam P, Sutcliffe RP, Scatton O, Sucandy I, Kingham TP, Liu R, Choi GH, Syn NL, Gastaca M, Choi SH, Chiow AKH, Marino MV, Efanov M, Lee JH, Chong CC, Tang CN, Cheung TT, Pratschke J, Wang X, Robless Campos R, Ivanecz A, Park JO, Rotellar F, Fuks D, D'Hondt M, Han HS, Troisi RI, Goh BKP. An international multicenter propensity-score matched and coarsened-exact matched analysis comparing between robotic versus laparoscopic partial liver resections of the anterolateral segments. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:843-854. [PMID: 35393759 DOI: 10.1002/jhbp.1149] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/23/2022] [Accepted: 02/15/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Robotic liver resections RLR may have the ability to address some of the drawbacks of laparoscopic(L)LR but few studies have done a head-to-head comparison of the outcomes after anterolateral segment resections by the two techniques. METHODS A retrospective study was conducted of 3202 patients who underwent minimally-invasive LR of the anterolateral liver segments at 26 international centres from 2005 to 2020. 2606 cases met study criteria of which there were 358 RLR and 1868 LLR. Peri-operative outcomes were compared between the two groups using a 1:3 Propensity Score Matched(PSM) and 1:1 Coarsened Exact Matched(CEM) analysis. RESULTS Patients matched after 1:3 PSM(261 RLR vs. 783 LLR) and 1:1 CEM(296 RLR vs. 296 LLR) revealed no significant differences in length of stay, readmission rates, morbidity, mortality and involvement of or close oncological margins. RLR surgeries were associated with significantly less blood loss(50ml vs. 100ml, p<0.001) and lower rates of open conversion on both PSM(1.5% vs. 6.8%, p=0.003) and CEM(1.4% vs. 6.4%, p=0.004) compared to LLR. Though PSM analysis showed RLR to have a longer operating time than LLR(170 min vs. 160 min, p=0.036), this difference proved to be insignificant on CEM(167 min vs. 163 min. p=0.575). CONCLUSION This multicentre international combined PSM and CEM study showed that both RLR and LLR have equivalent perioperative outcomes when performed in selected patients at high volume centres. The robotic approach was associated with significantly lower blood loss and allowed more surgeries to be completed in a minimally-invasive fashion.
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Affiliation(s)
- Prashant Kadam
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Robert P Sutcliffe
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Olivier Scatton
- Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, APHP, Université, Sorbonne, Paris, France
| | - Iswanto Sucandy
- AdventHealth Tampa, Digestive Health Institute, Tampa, Florida, USA
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Gi Hong Choi
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nicholas L Syn
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Ministry of Health Holdings, Singapore
| | - Mikel Gastaca
- Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - Sung-Hoon Choi
- Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Adrian K H Chiow
- Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore
| | - Marco V Marino
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Oncologic Surgery Department, Giaccone University Hospital, Palermo, Italy
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - Jae-Hoon Lee
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Charing C Chong
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong, New Territories, Hong Kong SAR, China
| | - Chung-Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Tan-To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Johann Pratschke
- Department of Surgery, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Xiaoying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Arpad Ivanecz
- Department of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - James O Park
- Hepatobiliary Surgical Oncology, Department of Surgery, University of Washington Medical Center. Seattle, Washington, USA
| | - Fernando Rotellar
- HPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, Universidad de Navarra, and Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France
| | - Mathieu D'Hondt
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho-Seong Han
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, II University Hospital Naples, Federico, Naples, Italy
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and Duke-National University Singapore Medical School
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Robotic-assisted versus laparoscopic major liver resection: analysis of outcomes from a single center. HPB (Oxford) 2019; 21:906-911. [PMID: 30617001 DOI: 10.1016/j.hpb.2018.11.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/29/2018] [Accepted: 11/08/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Debate exists regarding outcomes of robot-assisted versus laparoscopic hepatectomy. We reviewed and analyzed major hepatectomies (resection of ≥3 Couinaud liver segments) performed in a minimally invasive fashion at a single institution. METHODS From 2011 to 2016, 473 major hepatectomy procedures were performed, of which 173 (37%) were performed in a minimally invasive fashion (57 robot-assisted and 116 laparoscopic). Patient demographics, operating statistics and outcomes were analyzed retrospectively. RESULTS Patients undergoing robot-assisted versus laparoscopic hepatectomy were older (58.1 vs 53.2 years, respectively; p = 0.030), admitted to ICU postoperatively less frequently (43.9% vs 61.2%, respectively; p = 0.043), and readmitted less often within 90 days (7.0% vs 28.5%, respectively; p = 0.001). No significant differences were identified in relation to complications, blood loss, operative times, and length of stay. CONCLUSION Robot-assisted is an effective alternative to laparoscopic major hepatectomy for resection of malignant and benign liver lesions. Robotic-assisted offers technical advantages compared to laparoscopic surgery including improved optic visualization, operative dexterity, and ease of dissection and suturing. This experience suggested that the robotic platform was associated with improved outcomes including reduced postoperative ICU admission and 90-day readmission.
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Marino MV, Glagolieva A, Guarrasi D. Resección robótica del lóbulo hepático caudado: descripción técnica y consideraciones iniciales. Cir Esp 2018; 96:162-168. [DOI: 10.1016/j.ciresp.2018.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/14/2017] [Accepted: 01/08/2018] [Indexed: 01/14/2023]
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Robotic Resection of the Liver Caudate Lobe: Technical Description and Initial Consideration. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.cireng.2018.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Stiles ZE, Behrman SW, Glazer ES, Deneve JL, Dong L, Wan JY, Dickson PV. Predictors and implications of unplanned conversion during minimally invasive hepatectomy: an analysis of the ACS-NSQIP database. HPB (Oxford) 2017; 19:957-965. [PMID: 28760630 DOI: 10.1016/j.hpb.2017.06.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 06/12/2017] [Accepted: 06/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Minimally-invasive hepatectomy (MIH) is increasingly utilized; however, predictors and outcomes for patients requiring conversion to an open procedure have not been adequately studied. METHODS The 2014-15 ACS-NSQIP database was analyzed. Unplanned conversion was compared to successful MIH and elective open hepatectomy. RESULTS Among 6918 hepatectomies, 1062 (15.4%) underwent attempted MIH: 989 laparoscopic, 73 robotic. Conversion occurred in 203 (19.1%). Compared to successful MIH, patients requiring unplanned conversion experienced higher rates of complications (34.5% vs 14.6%, p<0.001), including bile leaks (7.4% vs 2.8%, p=0.002), organ space infection (6.4% vs 2.9%, p=0.016), UTI (4.9% vs 1.2%, p=0.002), perioperative bleeding (21.2% vs 6.1%, p<0.001), DVT (3.0% vs 0.8%, p=0.024), and sepsis (5.9% vs 1.9%, p=0.001). Conversion led to greater LOS (5 days vs 3 days, p<0.001) and 30-day mortality (3.0% vs 0.5%, p=0.005). Compared to elective open hepatectomy, conversion was associated with greater perioperative bleeding (21.2% vs 15.3%, p = 0.037). On multivariate analysis, major hepatectomy (OR 2.21, p<0.001), concurrent ablation (OR 1.79, p=0.020), and laparoscopic approach (vs. robotic) (OR 3.22, p=0.014) were associated with conversion. CONCLUSION Analysis of this national database revealed unplanned conversion during MIH is associated with greater morbidity and mortality. MIH should be approached cautiously in patients requiring major hepatectomy.
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Affiliation(s)
- Zachary E Stiles
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Stephen W Behrman
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Evan S Glazer
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeremiah L Deneve
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lei Dong
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jim Y Wan
- Department of Preventive Medicine, Division of Biostatistics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Paxton V Dickson
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA.
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Brown KM, Geller DA. What is the Learning Curve for Laparoscopic Major Hepatectomy? J Gastrointest Surg 2016; 20:1065-71. [PMID: 26956007 DOI: 10.1007/s11605-016-3100-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/01/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic liver resection is rapidly expanding with more than 9500 cases performed worldwide. While initial series reported non-anatomic resection of benign peripheral hepatic lesions, approximately 50-65 % of laparoscopic liver resections are now being done for malignant tumors, primarily hepatocellular carcinoma (HCC) or colorectal cancer liver metastases (mCRC). METHODS We performed a literature review of published studies evaluating outcomes of major laparoscopic liver resection, defined as three or more Couinaud segments. RESULTS Initial fears of adverse oncologic outcomes or tumor seeding have not been demonstrated, and dozens of studies have reported comparable 5-year disease-free and overall survival between laparoscopic and open resection of HCC or mCRC in case-cohort and propensity score-matched analyses. Increased experience has led to laparoscopic anatomic liver resections including laparoscopic major hepatectomy. A steep learning curve of 45-60 cases is evident for laparoscopic hepatic resection. CONCLUSION Laparoscopic major hepatectomy is safe and effective in the treatment of benign and malignant liver tumors when performed in specialized centers with dedicated teams. Comparable to other complex laparoscopic surgeries, laparoscopic major hepatectomy has a learning curve of 45-60 cases.
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Affiliation(s)
- Kimberly M Brown
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - David A Geller
- Liver Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA. .,UPMC Liver Cancer Center, UPMC Montefiore, 3459 Fifth Ave, 7 South, Pittsburgh, PA, 15213-2582, USA.
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Cheek SM, Sucandy I, Tsung A, Marsh JW, Geller DA. Evidence supporting laparoscopic major hepatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:257-9. [PMID: 27040039 DOI: 10.1002/jhbp.338] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Laparoscopic liver resection (LLR) has been increasing in frequency with over 9,000 cases done worldwide. Benefits of laparoscopic resection include less blood loss, smaller incisions, decreased postoperative morbidity, and shorter length of stay compared to open liver resection. With increased experience, several centers have reported series of laparoscopic major hepatectomy, although this represents only about 25% of total LLR performed. Evidence is accumulating to support laparoscopic major hepatectomy with the understanding that there is a steep learning curve, and surgeons should begin with minor LLR before moving on to laparoscopic major hepatectomy. Controversy still remains concerning indications, techniques, learning curve, risks, and long-term cancer outcomes with laparoscopic major hepatectomy.
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Affiliation(s)
- Susannah M Cheek
- Division of Hepatobiliary and Pancreatic Surgery, UPMC Liver Cancer Center, University of Pittsburgh, 3459 Fifth Avenue, UPMC Montefiore, 7 South, Pittsburgh, PA 15213-2582, USA.
| | - Iswanto Sucandy
- Division of Hepatobiliary and Pancreatic Surgery, UPMC Liver Cancer Center, University of Pittsburgh, 3459 Fifth Avenue, UPMC Montefiore, 7 South, Pittsburgh, PA 15213-2582, USA
| | - Allan Tsung
- Division of Hepatobiliary and Pancreatic Surgery, UPMC Liver Cancer Center, University of Pittsburgh, 3459 Fifth Avenue, UPMC Montefiore, 7 South, Pittsburgh, PA 15213-2582, USA
| | - J Wallis Marsh
- Division of Hepatobiliary and Pancreatic Surgery, UPMC Liver Cancer Center, University of Pittsburgh, 3459 Fifth Avenue, UPMC Montefiore, 7 South, Pittsburgh, PA 15213-2582, USA
| | - David A Geller
- Division of Hepatobiliary and Pancreatic Surgery, UPMC Liver Cancer Center, University of Pittsburgh, 3459 Fifth Avenue, UPMC Montefiore, 7 South, Pittsburgh, PA 15213-2582, USA
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Tohme S, Goswami J, Han K, Chidi AP, Geller DA, Reddy S, Gleisner A, Tsung A. Minimally Invasive Resection of Colorectal Cancer Liver Metastases Leads to an Earlier Initiation of Chemotherapy Compared to Open Surgery. J Gastrointest Surg 2015; 19:2199-206. [PMID: 26438480 PMCID: PMC4892107 DOI: 10.1007/s11605-015-2962-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/17/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Previous studies have shown benefit not only from postoperative chemotherapy but also from a short interval to initiation of treatment after resection of primary colorectal cancer. The aim of this study was to determine difference in timing to postoperative chemotherapy for minimally invasive resection (MIR) vs. open resection (OR) of colorectal cancer liver metastases (CRCLM). METHODS This is a retrospective review of 1:1 matched patients undergoing MIR (n = 66) and OR (n = 66) for CRCLM at a single institution. RESULTS Patients undergoing MIR of CRCLM had significantly shorter length of hospital stay, fewer major complications, and shorter interval to postoperative chemotherapy (median 42 vs. 63 days, p < 0.001). Univariable analysis showed that surgical approach, postoperative complications, blood loss, number of lesions, and length of stay were associated with timing to chemotherapy. On multivariable analysis, surgical approach was still associated with timing to chemotherapy, and postoperative complications resulted in a delay of chemotherapy among patients who underwent OR but not among those who underwent MIR. In addition, worse disease-free survival was seen among patients who received postoperative chemotherapy more than 60 days after surgery. CONCLUSION By modifying the deleterious effects of postoperative complications on timing of postoperative chemotherapy, patients undergoing MIR for CRCLM are treated with chemotherapy sooner after surgery compared to those undergoing OR.
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Affiliation(s)
- Samer Tohme
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Liver Cancer Center, 3459 Fifth Ave., 7 South, Pittsburgh, PA 15213, USA
| | - Julie Goswami
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Liver Cancer Center, 3459 Fifth Ave., 7 South, Pittsburgh, PA 15213, USA
| | - Katrina Han
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Liver Cancer Center, 3459 Fifth Ave., 7 South, Pittsburgh, PA 15213, USA
| | - Alexis P. Chidi
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Liver Cancer Center, 3459 Fifth Ave., 7 South, Pittsburgh, PA 15213, USA
| | - David A. Geller
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Liver Cancer Center, 3459 Fifth Ave., 7 South, Pittsburgh, PA 15213, USA
| | - Srinevas Reddy
- Hepatobiliary and Pancreatic Surgery, Virginia Piper Cancer Institute—Allina Health, 800 East 28th Street, Ste 602, Minneapolis, MN 55415, USA
| | - Ana Gleisner
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Liver Cancer Center, 3459 Fifth Ave., 7 South, Pittsburgh, PA 15213, USA
| | - Allan Tsung
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Liver Cancer Center, 3459 Fifth Ave., 7 South, Pittsburgh, PA 15213, USA
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Geller DA, Tsung A. Long-term outcomes and safety of laparoscopic liver resection surgery for hepatocellular carcinoma and metastatic colorectal cancer. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:728-30. [PMID: 26123552 DOI: 10.1002/jhbp.278] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- David A Geller
- Department of Surgery, University of Pittsburgh, 3459 Fifth Avenue, Pittsburgh, PA 15213-2582, USA.
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh, 3459 Fifth Avenue, Pittsburgh, PA 15213-2582, USA
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Chiow AKH, Lewin J, Manoharan B, Cavallucci D, Bryant R, O'Rourke N. Intercostal and transthoracic trocars enable easier laparoscopic resection of dome liver lesions. HPB (Oxford) 2015; 17:299-303. [PMID: 25250870 PMCID: PMC4368392 DOI: 10.1111/hpb.12336] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 08/10/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dome liver lesions (those in segments VII or VIII) pose a challenge to standard laparoscopic resection. The use of additional intercostal and transthoracic trocars (ITTs) potentially facilitates resection over standard subcostal laparoscopic (SSL) techniques. METHODS A retrospective review of a prospectively collected liver resection database was performed, selecting all minor resections of segments VII and VIII using the ITT and SSL approaches. The techniques of intercostal transdiaphragmatic access are described and the surgical outcomes of the two groups compared. RESULTS A total of 19 patients were analysed. The ITT group included 8 patients and the SSL group included 11. The groups were comparable in median lesion size (20 mm in the ITT group and 26 mm in the SSL group). Blood loss, operative times, morbidity and conversion rates were similar. There was no lung injury or postoperative clinical pneumothorax in any patient undergoing transdiaphragmatic access. Median hospital stay was significantly shorter in the ITT group (2 days) than in the SSL group (6 days) (P = 0.032). CONCLUSIONS The ITT approach is safe, effective and complementary to standard laparoscopic techniques for the resection of small tumours in segments VII and VIII.
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Affiliation(s)
- Adrian K H Chiow
- Hepatopancreatobiliary Unit, Department of Surgery, Royal Brisbane and Women's HospitalHerston, Qld, Australia,Correspondence, Adrian Kah Heng Chiow, Wesley Medical Centre, Suite 23, Level 2, 40 Chasely Street, Auchenflower, Qld 4066, Australia. Tel: + 61 7 3876 7455. Fax: + 61 7 3876 7245. E-mail:
| | - Joel Lewin
- Hepatopancreatobiliary Unit, Department of Surgery, Royal Brisbane and Women's HospitalHerston, Qld, Australia
| | - Bavahuna Manoharan
- Hepatopancreatobiliary Unit, Department of Surgery, Royal Brisbane and Women's HospitalHerston, Qld, Australia
| | - David Cavallucci
- Hepatopancreatobiliary Unit, Department of Surgery, Royal Brisbane and Women's HospitalHerston, Qld, Australia
| | - Richard Bryant
- Hepatopancreatobiliary Unit, Department of Surgery, Royal Brisbane and Women's HospitalHerston, Qld, Australia
| | - Nicholas O'Rourke
- Hepatopancreatobiliary Unit, Department of Surgery, Royal Brisbane and Women's HospitalHerston, Qld, Australia
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Schiffman SC, Kim KH, Tsung A, Marsh JW, Geller DA. Laparoscopic versus open liver resection for metastatic colorectal cancer: a metaanalysis of 610 patients. Surgery 2014; 157:211-22. [PMID: 25282529 DOI: 10.1016/j.surg.2014.08.036] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 08/13/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) for metastatic colorectal cancer (mCRC) remains controversial. The objective of this manuscript was to perform a metaanalysis comparing outcomes of LLR with open liver resection (OLR) in patients with hepatic mCRC, and to identify which patients were suitable candidates for LLR. STUDY DESIGN A PubMed search identified 2,122 articles. When filtered for case-matched articles comparing LLR with OLR for mCRC, 8 articles were identified consisting of 610 patients (242 LLR, 368 OLR). A random effects metaanalysis was performed. RESULTS The 2 groups were well-matched for age, sex, American Society of Anesthesiologists score, tumor size, number of metastases, extent of major hepatectomy, and use of neoadjuvant/adjuvant chemotherapy. The mean number of metastases in the LLR and OLR groups were 1.4 and 1.5, respectively (P = .14). Estimated blood loss was less in LLR group (262 vs 385 mL; P = .049). Transfusion rate was significantly less in LLR group (9.9 vs 19.8%; P = .004). There was no difference in operative time (248.7 vs 262.8 min; P = .85). Length of stay (LOS) was less in the LLR group (6.5 vs 8.8 days; P = .007). The overall complication rate was less in LLR group (20.3% vs 33.2%; P = .03). Importantly, there was no difference in the 1-, 3-, and 5-year disease-free survival (DFS) or overall survival (OS) rates. CONCLUSION In carefully selected patients with limited mCRC (1 or 2 tumors), LLR provides marked perioperative benefits without compromising oncologic outcomes or long-term survival. Specifically, LLR offers decreased blood loss, LOS, and overall complication rates with comparable 5-year OS and DFS.
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Affiliation(s)
| | - Kevin H Kim
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - J Wallis Marsh
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - David A Geller
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
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Postriganova N, Kazaryan AM, Røsok BI, Fretland ÅA, Barkhatov L, Edwin B. Margin status after laparoscopic resection of colorectal liver metastases: does a narrow resection margin have an influence on survival and local recurrence? HPB (Oxford) 2014; 16:822-9. [PMID: 24308605 PMCID: PMC4159455 DOI: 10.1111/hpb.12204] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 10/30/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Recent studies of margin-related recurrence have raised questions on the necessity of ensuring wide resection margins in the resection of colorectal liver metastases. The aim of the current study was to determine whether resection margins of 10 mm provide a survival benefit over narrower resection margins. METHODS A total of 425 laparoscopic liver resections were carried out in 351 procedures performed in 317 patients between August 1998 and April 2012. Primary laparoscopic liver resections for colorectal metastases were included in the study. Two-stage resections, procedures accompanied by concomitant liver ablations and one case of perioperative mortality were excluded. A total of 155 eligible patients were classified into four groups according to resection margin width: Group 1, margins of < 1 mm [n = 33, including 17 patients with positive margins (Group 1a)]; Group 2, margins of 1 mm to < 3 mm (n = 31); Group 3, margins of ≥ 3 mm to <10 mm (n = 55), and Group 4, margins of ≥ 10 mm (n = 36). Perioperative and survival data were compared across the groups. Median follow-up was 31 months (range: 2-136 months). RESULTS Perioperative outcomes were similar in all groups. Unfavourable intraoperative incidents occurred in 9.7% of procedures (including 3.2% of conversions). Postoperative complications developed in 11.0% of patients. Recurrence in the resection bed developed in three (1.9%) patients, including two (6.1%) patients in Group 1. Rates of actuarial 5-year overall, disease-free and recurrence-free survival were 49%, 41% and 33%, respectively. Median survival was 65 months. Margin status had no significant impact on patient survival. The Basingstoke Predictive Index (BPI) generally underestimated survival. This underestimation was especially marked in Group 1 when postoperative BPI was applied. CONCLUSIONS Patients with margins of <1 mm achieved survival comparable with that in patients with margins of ≥ 10 mm. When modern surgical equipment that generates an additional coagulation zone is applied, the association between resection margin and survival may not be apparent. Further studies in this field are required. Postoperative BPI, which includes margin status among the core factors predicting postoperative survival, seems to be less precise than preoperative BPI.
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Affiliation(s)
- Nadya Postriganova
- Intervention Centre, Oslo University Hospital – RikshospitaletOslo, Norway,Department of Hospital Surgery, Moscow State University of Medicine and DentistryMoscow, Russia,Correspondence, Nadya Postriganova, Intervention Centre, Oslo University Hospital – Rikshospitalet, Oslo 0027, Norway. Tel: + 47 23070100. Fax: + 47 23070110. E-mail:
| | - Airazat M Kazaryan
- Intervention Centre, Oslo University Hospital – RikshospitaletOslo, Norway,Department of Surgery, Telemark HospitalSkien, Norway
| | - Bård I Røsok
- Department of Hepatopancreatobiliary Surgery, Oslo University Hospital – RikshospitaletOslo, Norway
| | - Åsmund A Fretland
- Intervention Centre, Oslo University Hospital – RikshospitaletOslo, Norway,Department of Hepatopancreatobiliary Surgery, Oslo University Hospital – RikshospitaletOslo, Norway
| | - Leonid Barkhatov
- Intervention Centre, Oslo University Hospital – RikshospitaletOslo, Norway
| | - Bjørn Edwin
- Intervention Centre, Oslo University Hospital – RikshospitaletOslo, Norway,Department of Hepatopancreatobiliary Surgery, Oslo University Hospital – RikshospitaletOslo, Norway,Institute of Clinical Medicine, Medical Faculty, University of OsloOslo, Norway
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14
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Abstract
OBJECTIVE To perform a matched comparison of surgical and postsurgical outcomes between our robotic and laparoscopic hepatic resection experience. BACKGROUND The application of robotic technology and technique to liver surgery has grown. Robotic methods may have the potential to overcome certain laparoscopic disadvantages, but few studies have drawn a matched comparison of outcomes between robotic and laparoscopic liver resections. METHODS Demographics, intraoperative variables, and postoperative outcomes among patients undergoing robotic (n = 57) and laparoscopic (n = 114) hepatic resections between November 2007 and December 2011 were reviewed. A 1:2 matched analysis was performed by individually matching patients in the robotic cohort to patients in the laparoscopic cohort based on demographics, comorbidities, performance status, and extent of liver resection. RESULTS Matched patients undergoing robotic and laparoscopic liver resections displayed no significant differences in operative and postoperative outcomes as measured by blood loss, transfusion rate, R0 negative margin rate, postoperative peak bilirubin, postoperative intensive care unit admission rate, length of stay, and 90-day mortality. Patients undergoing robotic liver surgery had significantly longer operative times (median: 253 vs 199 minutes) and overall room times (median: 342 vs 262 minutes) compared with their laparoscopic counterparts. However, the robotic approach allowed for an increased percentage of major hepatectomies to be performed in a purely minimally invasive fashion (81% vs 7.1%, P < 0.05). CONCLUSIONS This is the largest series comparing robotic to laparoscopic liver resections. Robotic and laparoscopic liver resection display similar safety and feasibility for hepatectomies. Although a greater proportion of robotic cases were completed in a totally minimally invasive manner, there were no significant benefits over laparoscopic techniques in operative outcomes.
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15
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Jung KU, Kim HC, Cho YB, Kwon CHD, Yun SH, Heo JS, Lee WY, Chun HK. Outcomes of Simultaneous Laparoscopic Colorectal and Hepatic Resection for Patients with Colorectal Cancers: A Comparative Study. J Laparoendosc Adv Surg Tech A 2014; 24:229-35. [DOI: 10.1089/lap.2013.0475] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Kyung Uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Beom Cho
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Choon Hyuck David Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Seok Heo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ho-Kyung Chun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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16
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Luo LX, Yu ZY, Bai YN. Laparoscopic Hepatectomy for Liver Metastases from Colorectal Cancer: A Meta-analysis. J Laparoendosc Adv Surg Tech A 2014; 24:213-22. [PMID: 24571350 DOI: 10.1089/lap.2013.0399] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Li-Xi Luo
- Department of Hepatobiliary Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Zhao-Yan Yu
- Department of Hepatobiliary Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Yan-Nan Bai
- Department of Hepatobiliary Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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17
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Montalti R, Berardi G, Laurent S, Sebastiani S, Ferdinande L, Libbrecht LJ, Smeets P, Brescia A, Rogiers X, de Hemptinne B, Geboes K, Troisi RI. Laparoscopic liver resection compared to open approach in patients with colorectal liver metastases improves further resectability: Oncological outcomes of a case-control matched-pairs analysis. Eur J Surg Oncol 2014; 40:536-544. [PMID: 24555996 DOI: 10.1016/j.ejso.2014.01.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/23/2013] [Accepted: 01/05/2014] [Indexed: 02/07/2023] Open
Abstract
AIMS Liver resection is considered the standard treatment of colorectal metastases (CRLM). However, to date, no long term oncological results and data regarding repeat hepatectomy after laparoscopic approach are known. The aim of this study is to analyze single center long-term surgical and oncological outcomes after liver resection for CRLM. METHODS A total of 57 open resections (OR) were matched with 57 laparoscopic resections (LR) for CRLM. Matching was based mainly on number of metastases, tumor size, segmental position of lesions, type of hepatectomy and type of resection. RESULTS Morbidity rate was significantly less in the LR group (p = 0.002); the length of hospital stay was 6.5 ± 5 days for the LR group and 9.2 ± 4 days for the OR group (p = 0.005). After a median follow up of 53.7 months for the OR group and 40.9 months for the LR group, the 5-y overall survival rate was 65% and 60% respectively (p = 0.36) and the 5-y disease free survival rate was 38% and 29% respectively (p = 0.24). More patients in the LR group received a third hepatectomy for CRLM relapse than in the OR group (80% vs. 14.3% respectively; p = 0.015). CONCLUSIONS Laparoscopic resection for CRLM offers advantages in terms of reduced blood loss, morbidity rate and hospital stay. It provides comparable long-term oncological outcomes but can improve further resectability in patients with recurrent disease.
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Affiliation(s)
- R Montalti
- Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000 Ghent, Belgium
| | - G Berardi
- Dept. of General Surgery, Sant'Andrea Hospital, "La Sapienza" University of Rome, Italy
| | - S Laurent
- Dept. of Gastroenterology-Abdominal Oncology Unit, Ghent University Hospital and Medical School, De Pintelaan 185, 9000 Ghent, Belgium
| | - S Sebastiani
- Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000 Ghent, Belgium
| | - L Ferdinande
- Dept. of Pathology, Ghent University Hospital and Medical School, De Pintelaan 185, 9000 Ghent, Belgium
| | - L J Libbrecht
- Dept. of Pathology, Ghent University Hospital and Medical School, De Pintelaan 185, 9000 Ghent, Belgium
| | - P Smeets
- Dept. of Radiology, Ghent University Hospital and Medical School, De Pintelaan 185, 9000 Ghent, Belgium
| | - A Brescia
- Dept. of General Surgery, Sant'Andrea Hospital, "La Sapienza" University of Rome, Italy
| | - X Rogiers
- Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000 Ghent, Belgium
| | - B de Hemptinne
- Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000 Ghent, Belgium
| | - K Geboes
- Dept. of Gastroenterology-Abdominal Oncology Unit, Ghent University Hospital and Medical School, De Pintelaan 185, 9000 Ghent, Belgium
| | - R I Troisi
- Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000 Ghent, Belgium.
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18
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Troisi RI, Montalti R, Van Limmen JGM, Cavaniglia D, Reyntjens K, Rogiers X, De Hemptinne B. Risk factors and management of conversions to an open approach in laparoscopic liver resection: analysis of 265 consecutive cases. HPB (Oxford) 2014; 16:75-82. [PMID: 23490275 PMCID: PMC3892318 DOI: 10.1111/hpb.12077] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 01/16/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND As a consequence of continuous technical developments in liver surgery, laparoscopic liver resection (LLR) is increasingly performed worldwide. METHODS Between January 2004 and December 2011, 265 LLR were performed in 242 patients for various diseases. The experience of LLR is reported focusing on risk factors of conversion and their management. RESULTS The overall conversion rate was 17/265 (6.4%), equally distributed over the period of the study. Statistically significant factors for conversion were found to be LLR of the postero-superior (P-S) segments (SI, SIVa; SVII; SVIII) (12.7% converted versus 2.5% non-converted groups, P = 0.01) and a major compared with a minor hepatectomy (15.2% vs. 4.6%, P = 0.02 respectively). A R0 resection was achieved in 93.2% of cases. According to Dindo's classification, complications were recorded as grade I (n = 20); grade II (6); grade III (11) and grade IV(1) events (total morbidity rate of 14%). Univariate analysis identified a major hepatectomy and resection involving P-S segments as prognostic factors for conversion whereas multivariate analysis identified the latter as an independent risk factor [P = 0.003, odds ratio (OR) = 5.9, 95% confidence interval (CI) = 1.8-18.8]. CONCLUSIONS LLR can be safely performed with low overall morbidity. According to this experience and irrespective of the learning curve, resections of P-S segments were identified as an independent risk factor for conversion in LLR.
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Affiliation(s)
- Roberto I Troisi
- Department of General & Hepato-Biliary Surgery, Liver Transplantation ServiceGhent, Belgium
| | - Roberto Montalti
- Department of General & Hepato-Biliary Surgery, Liver Transplantation ServiceGhent, Belgium
| | - Jurgen GM Van Limmen
- Department of Anesthesiology, Ghent University Hospital and Medical SchoolGhent, Belgium
| | - Daniele Cavaniglia
- Department of General & Hepato-Biliary Surgery, Liver Transplantation ServiceGhent, Belgium
| | - Koen Reyntjens
- Department of Anesthesiology, University of Groningen, University Medical Center GroningenGroningen, The Netherlands
| | - Xavier Rogiers
- Department of General & Hepato-Biliary Surgery, Liver Transplantation ServiceGhent, Belgium
| | - Bernard De Hemptinne
- Department of General & Hepato-Biliary Surgery, Liver Transplantation ServiceGhent, Belgium
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19
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Aliyev S, Agcaoglu O, Aksoy E, Taskin HE, Vogt D, Fung J, Siperstein A, Berber E. Efficacy of laparoscopic radiofrequency ablation for the treatment of patients with small solitary colorectal liver metastasis. Surgery 2013; 154:556-62. [PMID: 23859307 DOI: 10.1016/j.surg.2013.03.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 03/25/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although radiofrequency ablation (RFA) has been incorporated to the treatment algorithm of patients with unresectable colorectal liver metastasis (CLM), its utility in patients with resectable disease has not been well studied. The aims of this study were to define the clinical profile of patients with a solitary CLM who underwent laparoscopic RFA and to analyze their oncologic outcomes. METHODS Between 2000 and 2011, 44 patients underwent laparoscopic RFA and 60 patients resection of solitary CLM ≤3 cm. Data were analyzed from a prospectively maintained institutional review board-approved database using Student's t test, Chi-square, and Kaplan-Meier tests. RESULTS The indications for RFA were patient decision in 61% (n = 27), comorbidities in 34% (n = 15), and intraoperative findings in 5% (n = 2). In comparison with the resection group, RFA patients had a greater American Society of Anesthesiologists score (3.0 ± 0.1 vs 2.6 ± 0.1, respectively; P = .002), more frequent incidence of cardiopulmonary comorbidities (60% vs 38%, respectively; P = .045), and tumors located deeper in the liver parenchyma (39% vs 12%) that would have required a formal lobectomy. The 2 groups were otherwise similar for age, gender, carcinoembrradyogenic antigen, synchronous versus metachronous presentation of CLM, tumor size, and tumor and nodal status of primary colorectal cancer. The local recurrence rate was 18% after RFA and 4% after resection (P = .012). The overall Kaplan-Meier, cancer-specific, 5-year survival was 47% for RFA and 57% for resection (P = .464). Median disease-free survival was 25 months after RFA and 22 months after resection (P = .973). CONCLUSION Our results suggest that laparoscopic RFA might spare a number of patients at greater risk with a small solitary CLM the risk of morbidity from a formal liver resection. Furthermore, laparoscopic RFA might also be acceptable as the first line of therapy for patients with tumors that otherwise would have required a formal lobectomy or open resection. Nevertheless, the local recurrence rate of RFA should be kept in mind and the patients followed closely to treat failures promptly.
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Affiliation(s)
- Shamil Aliyev
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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20
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Short- and Long-Term Follow-Up. Updates Surg 2013. [DOI: 10.1007/978-88-470-2664-3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Packiam V, Bartlett DL, Tohme S, Reddy S, Marsh JW, Geller DA, Tsung A. Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy. J Gastrointest Surg 2012; 16:2233-8. [PMID: 23054901 PMCID: PMC3509231 DOI: 10.1007/s11605-012-2040-1] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 09/25/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND The purpose of this study was to compare the clinical and economic outcomes of robotic versus laparoscopic left lateral sectionectomy (LLS). METHODS A retrospective analysis was made comparing robotic (n = 11) and laparoscopic (n = 18) LLS performed at the University of Pittsburgh Medical Center between January 2009 and July 2011. Demographic data, operative, and postoperative outcomes were collected. RESULTS Demographic and tumor characteristics of robotic and laparoscopic LLS were similar. There were also no significant differences in operative outcomes including estimated blood loss and operating room time. Patients undergoing robotic LLS had more admissions to the ICU (46 versus 6 %), increased rate of minor complications (27 versus 0 %), and longer lengths of stay (4 versus 3 days). There were no significant differences in major complication rates or 90-day mortality. The cost of robotic and laparoscopic LLS was not significantly different when only considering direct costs ($5,130 versus $4,408, p = 0.401). However, robotic LLS costs were significantly greater when including indirect costs, which were estimated to be $1,423 per robotic case ($6,553 versus $4,408, p = 0.021). DISCUSSION Robotic LLS yields slightly inferior clinical outcomes and increased cost compared to the laparoscopic approach.
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Affiliation(s)
- Vignesh Packiam
- Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David L. Bartlett
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Samer Tohme
- Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Srinevas Reddy
- Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - J. Wallis Marsh
- Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David A. Geller
- Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Allan Tsung
- Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA,Corresponding author: Allan Tsung M.D., Division of Hepatobiliary and Pancreatic Surgery, UPMC Liver Cancer Center, Montefiore Hospital, 3459 Fifth Ave., 7 South, Pittsburgh, PA 15213, (tel) 412-692-2001, (facsimile) 412-692-2002,
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22
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Current World Literature. Curr Opin Support Palliat Care 2012; 6:109-25. [DOI: 10.1097/spc.0b013e328350f70c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Outcome of laparoscopic major liver resection for colorectal metastases. Surg Endosc 2012; 26:2451-5. [PMID: 22358126 DOI: 10.1007/s00464-012-2209-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 01/31/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND Minimally invasive liver resection (MILR) for colorectal liver metastases (CRLM) is gaining widespread acceptance. However, data are still lacking on the feasibility, long- and short-term outcomes of laparoscopic major hepatectomy (i.e., three or more liver segments). METHODS Between October 2002 and December 2008, prospectively collected data of 117 patients who underwent major liver resection [97 open (OMLR) and 20 laparoscopic (LMLR) procedures] for CRLM were analyzed. Twenty patients in the LMLR group were matched with 20 patients of the OMLR based on 13 parameters. We compared the long- and short-term outcomes between these two groups. RESULTS Median duration of surgery was 257.5 (range 75-360) min in LMLR versus 232.5 (range 120-400) min in OMLR (P = 0.228). Median blood loss during surgery was 550 ml in each group (range 100-4,000 vs. 100-2,500 ml, P = 0.884). There was no statistically significant difference in the rate of postoperative complications (both severity and location). Median magnitude of tumor-free resection margin was 7.5 versus 5.5 mm in the laparoscopy versus open group, respectively (P = 0.651). Median disease-free survival (DFS) of the entire study population was 18.4 months [95% confidence interval (CI) 11.9-50.0 months]. Median overall survival (OS) was 50.7 months (95% CI 36.2 months to undetermined). The estimated DFS and OS rates at 1, 2, and 5 years were comparable in the two groups (P = 0.637 and 0.872, respectively). CONCLUSION Laparoscopic MLR for selected CRLM is feasible and might result in comparable oncologic outcomes as in open liver resection.
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Minimally invasive liver surgery for metastases from colorectal cancer: oncologic outcome and prognostic factors. Surg Endosc 2012; 26:2288-98. [PMID: 22311303 DOI: 10.1007/s00464-012-2176-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 01/10/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few reports exist on long-term survival after minimally invasive liver surgery (MILS) for colorectal liver metastases (CRLM). No data are available assessing prognostic factors in the era of current modern treatment strategies. METHODS Between October 2002 and December 2008, 274 consecutive patients were analyzed on an intention-to-treat basis. Open liver surgery (OLS) was performed in 193 patients for a total of 437 metastases, and MILS was performed in 81 patients for 176 metastases. Systemic chemotherapy was administered preoperatively in 173 and postoperatively in 174 patients. The impact of 23 potential prognostic factors on disease-free (DFS) and overall survival (OS) was evaluated using univariable and multivariable Cox regression models. RESULTS Postoperative complications were observed in 54 patients after OLS and in 11 after MILS (p = 0.016). The median postoperative length of hospital stay was 9 days after OLS and 5 days after MILS (p < 0.0001). For the entire patient population, the 5 year DFS and OS rates were 29.9 and 59.5%, respectively. No differences in survival between patients treated with MILS and OLS were observed (p = 0.63). In univariable analyses, the number of liver metastases and the overall Fong's clinical risk score (CRS) were the only two variables that predicted DFS (p ≤ 0.0035) and OS (p ≤ 0.0005). In multivariable analyses, the total CRS was the only independent predictor of both DFS (p = 0.0002) and OS (p = 0.002). CONCLUSION The long-term oncologic outcome of surgically treated patients with CRLM is determined by the Fong's CRS. Although MILS does not influence long-term survival, it has a beneficial impact on the immediate postoperative clinical outcome.
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26
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Abstract
BACKGROUND Despite major advances in therapies for liver metastases, colorectal cancer remains one of the commonest causes of cancer-related deaths in the UK. SOURCES OF DATA The international literature on the management of colorectal liver metastases (CLM) was reviewed. AREAS OF AGREEMENT Due to a combination of highly active systemic agents and low perioperative mortality achieved by high-volume centres, a growing number of patients are being offered liver resection with curative intent. Patients with bilobar and/or extrahepatic disease who would previously have received palliative treatment only, are undergoing major surgery with good results. This review focuses on preoperative evaluation, surgical planning and the role of adjuvant therapies in the management of patients with CLM. AREAS OF CONTROVERSY Can ablative therapies match the outcomes of surgical resection? How can even more patients be rendered resectable? GROWING POINTS The use of other therapies, such as radiofrequency ablation and selective internal radiation therapy. AREAS TIMELY FOR DEVELOPING RESEARCH New chemotherapy regimens for neo-adjuvant therapy and the development of new modalities of liver tumour ablation.
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