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Wang D, Xiao M, Wan ZM, Lin X, Li QY, Zheng SS. Surgical treatment for recurrent hepatocellular carcinoma: Current status and challenges. World J Gastrointest Surg 2023; 15:544-552. [PMID: 37206072 PMCID: PMC10190723 DOI: 10.4240/wjgs.v15.i4.544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/05/2023] [Accepted: 03/21/2023] [Indexed: 04/22/2023] Open
Abstract
Primary liver cancer is the sixth most commonly diagnosed cancer and was the third leading cause of cancer deaths worldwide in 2020. It includes hepatocellular carcinoma (HCC) (representing 75%-85% of cases), intrahepatic cholangiocarcinoma (representing 10%-15% of cases), and other rare types. The survival rate of patients with HCC has risen with improved surgical technology and perioperative management in recent years; however, high tumor recurrence rates continue to limit long-term survival, even after radical surgical resection (exceeding 50% recurrence). For resectable recurrent liver cancer, surgical removal [either salvage liver transplantation (SLT) or repeat hepatic resection] remains the most effective therapy that is potentially curative for recurrent HCC. Thus, here, we introduce surgical treatment for recurrent HCC. Areas Covered: A literature search was performed for recurrent HCC using Medline and PubMed up to August 2022. Expert commentary: In general, long-term survival after the re-resection of recurrent liver cancer is usually beneficial. SLT has equivalent outcomes to primary liver transplantation for unresectable recurrent illness in a selected group of patients; however, SLT is constrained by the supply of liver grafts. SLT seems to be inferior to repeat liver resection when considering operative and postoperative results but has the major advantage of disease-free survival. When considering the similar overall survival rate and the current situation of donor shortages, repeat liver resection remains an important option for recurrent HCC.
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Affiliation(s)
- Di Wang
- Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
- Division of Hepatobiliary and Pancreatic Surgery, Jinan Microecological Biomedicine Shandong Laboratory, Jinan 250000, Shandong Province, China
| | - Min Xiao
- Division of Hepatobiliary and Pancreatic Surgery, Jinan Microecological Biomedicine Shandong Laboratory, Jinan 250000, Shandong Province, China
- Division of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310000, Zhejiang Province, China
| | - Zhen-Miao Wan
- Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
- Division of Hepatobiliary and Pancreatic Surgery, Jinan Microecological Biomedicine Shandong Laboratory, Jinan 250000, Shandong Province, China
| | - Xin Lin
- Division of Hepatobiliary and Pancreatic Surgery, Jinan Microecological Biomedicine Shandong Laboratory, Jinan 250000, Shandong Province, China
- Division of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310000, Zhejiang Province, China
| | - Qi-Yong Li
- Division of Hepatobiliary and Pancreatic Surgery, Jinan Microecological Biomedicine Shandong Laboratory, Jinan 250000, Shandong Province, China
- Division of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310000, Zhejiang Province, China
| | - Shu-Sen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Jinan Microecological Biomedicine Shandong Laboratory, Jinan 250000, Shandong Province, China
- Division of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310000, Zhejiang Province, China
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Ding Z, Fang H, Huang M, Yu T. Laparoscopic versus open in right posterior sectionectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:25. [PMID: 36637531 DOI: 10.1007/s00423-023-02764-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 11/17/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) is now widely adopted for the treatment of liver tumors due to its minimally invasive advantages. However, multicenter, large-sample population-based laparoscopic right posterior sectionectomy (LRPS) has rarely been reported. We aimed to assess the advantages and drawbacks of right posterior sectionectomy compared with laparoscopic and open surgery by meta-analysis. METHODS Relevant literature was searched using the PubMed, Embase, Cochrane, Ovid Medline, and Web of Science databases up to September 12, 2021. Quality assessment was performed based on a modified version of the Newcastle-Ottawa Scale (NOS). The data were analyzed by Review Manager 5.3. The data were calculated by odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI) for fixed-effects and random-effects models. RESULTS The meta-analysis included seven studies involving 739 patients. Compared with open right posterior sectionectomy (ORPS), the LRPS group had lower intraoperative blood loss (MD - 135.45; 95%CI - 170.61 to - 100.30; P < 0.00001) and shorter postoperative hospital stays (MD - 2.17; 95% CI - 3.03 to - 1.31; P < 0.00001). However, there were no statistically significant differences between LRPS and ORPS regarding operative time (MD 44.97; P = 0.11), pedicle clamping (OR 0.65; P = 0.44), clamping time (MD 2.72; P = 0.31), transfusion rate (OR 1.95; P = 0.25), tumor size (MD - 0.16; P = 0.13), resection margin (MD 0.08; P = 0.63), R0 resection (OR 1.49; P = 0.35), recurrence rate (OR 2.06; P = 0.20), 5-year overall survival (OR 1.44; P = 0.45), and 5-year disease-free survival (OR 1.07; P = 0.88). Furthermore, no significant difference was observed in terms of postoperative complications (P = 0.08), bile leakage (P = 0.60), ascites (P = 0.08), incisional infection (P = 0.09), postoperative bleeding (P = 0.56), and pleural effusion (P = 0.77). CONCLUSIONS LRPS has an advantage in the length of hospital stay and blood loss. LRPS is a very useful technology and feasible choice in patients with the right posterior hepatic lobe tumor.
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Affiliation(s)
- Zigang Ding
- Department of Hepatobiliary Pancreatic Surgery, The Jiujiang University Affiliated Hospital, No. 57, Xunyang East Road, Jiujiang, 332000, Jiangxi Province, China
| | - Hongcai Fang
- Department of Hepatobiliary Pancreatic Surgery, The Jiujiang University Affiliated Hospital, No. 57, Xunyang East Road, Jiujiang, 332000, Jiangxi Province, China
| | - Mingwen Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Tao Yu
- Department of Hepatobiliary Pancreatic Surgery, The Jiujiang University Affiliated Hospital, No. 57, Xunyang East Road, Jiujiang, 332000, Jiangxi Province, China.
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Tanaka S, Kubo S, Ishizawa T. Positioning of Minimally Invasive Liver Surgery for Hepatocellular Carcinoma: From Laparoscopic to Robot-Assisted Liver Resection. Cancers (Basel) 2023; 15:cancers15020488. [PMID: 36672437 PMCID: PMC9856586 DOI: 10.3390/cancers15020488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Laparoscopic liver resection (LLR) is widely accepted in the surgical treatment of hepatocellular carcinoma (HCC) through international consensus conferences and the development of difficulty classifications. LLR has been reported to result in earlier postoperative recovery and fewer postoperative complications than open liver resection (OLR) for HCC. However, the prevalence of liver cirrhosis, obesity, the elderly, HCC recurrence (repeat liver resection), and major resection must be considered for LLR for HCC. Some systematic reviews, meta-analysis studies, and large cohort studies indicated that LLR is technically feasible for selected patients with HCC with these factors that led to less intraoperative blood loss, fewer transfusions and postoperative complication incidences, and shorter hospital stays than OLR. Furthermore, some reported LLR prevents postoperative loss of independence. No difference was reported in long-term outcomes among patients with HCC who underwent LLR and OLR; however, some recent reports indicated better long-term outcomes with LLR. In recent years, robot-assisted liver resection (RALR) has gradually become popular, and its short- and long-term results for HCC are not different from those of LLR. Additionally, RALR is expected to become the mainstay of minimally invasive surgery in the future.
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Affiliation(s)
- Shogo Tanaka
- Correspondence: ; Tel.: +81-6-6645-3841; Fax: +81-6-6646-6057
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Bae SJ, Cho HD, Kim KH, Hwang S, Ahn CS, Moon DB, Ha TY, Song GW, Jung DH, Park GC, Yoon YI, Lee SG. Pure laparoscopic versus open left lateral sectionectomy for hepatocellular carcinoma: A propensity score matching analysis. Ann Hepatobiliary Pancreat Surg 2022; 26:133-137. [PMID: 35607809 PMCID: PMC9136418 DOI: 10.14701/ahbps.21-161] [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: 11/19/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
Abstract
Backgrounds/Aims Anatomical resection has superior oncologic outcomes over non-anatomical resection in hepatocellular carcinoma, and left lateral sectionectomy is the simplest and easiest perform anatomical resection procedure among liver resections. The purpose of this study was to find out the safety and feasibility of pure laparoscopic left lateral sectionectomy (PLLLS) for hepatocellular carcinoma. Methods Patients who underwent left lateral sectionectomy at a tertiary referral hospital, from August 2007 to April 2019 were enrolled in this retrospective study. After matching the 1 : 3 propensity score, 17 open and 51 pure laparoscopic cases were selected out of 102 cases of total left lateral resection for hepatocellular carcinoma. The group was analyzed in terms of patient demographics, preoperative data, and postoperative outcomes. Results During the study period, there was no open conversion case. The mean operative time and complication were not statistically significant different between the two groups. There was no statistically significant difference in disease-free survival and overall survival had no statistical between the two groups. There were no mortality cases, and postoperative hospital stay was significantly shorter in the PLLLS group than in the open left lateral sectionectomy (OLLS) group. Conclusions The oncologic outcomes and complication rate were the same in the PLLLS and OLLS groups. However, the hospital stay was shorter in the PLLLS group than in the OLLS group. The present study findings demonstrate that the PLLLS is a safe and feasible procedure for hepatocellular carcinoma.
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Affiliation(s)
- Se-Jong Bae
- Division of Hepatobiliary Surgery and Liver transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwui-Dong Cho
- Division of Hepatobiliary Surgery and Liver transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Hun Kim
- Division of Hepatobiliary Surgery and Liver transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Division of Hepatobiliary Surgery and Liver transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chul-Soo Ahn
- Division of Hepatobiliary Surgery and Liver transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok-Bog Moon
- Division of Hepatobiliary Surgery and Liver transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yong Ha
- Division of Hepatobiliary Surgery and Liver transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Division of Hepatobiliary Surgery and Liver transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Division of Hepatobiliary Surgery and Liver transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gil-Chun Park
- Division of Hepatobiliary Surgery and Liver transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-In Yoon
- Division of Hepatobiliary Surgery and Liver transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Gyu Lee
- Division of Hepatobiliary Surgery and Liver transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Zhu L, Liu Y, Hu M, Zhao Z, Li C, Zhang X, Tan X, Wang F, Liu R. Comparison of robotic and laparoscopic liver resection in ordinary cases of left lateral sectionectomy. Surg Endosc 2021; 36:4923-4931. [PMID: 34750706 DOI: 10.1007/s00464-021-08846-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Laparoscopy was considered the standard method of left lateral sectionectomy. The robotic approach showed advantages in complex cases of left lateral sectionectomy. However, the impact of the robotic system on ordinary cases is still unknown. METHODS Retrospective review of consecutive robotic left lateral sectionectomy (R-LLS) and laparoscopic left lateral sectionectomy (L-LLS) from January 2015 to December 2019. Univariate and multivariate logistic regression was used to determine the effects of surgical method and surgical complexity on postoperative length of stay, surgical and overall cost. RESULTS 258 consecutive patients who underwent minimally invasive left lateral sectionectomy were analyzed. L-LLS had comparable outcomes and decreased surgery (USD 2416.3 vs 4624.5; p < 0.001) and overall costs (USD 8004.5 vs 11897.1; p < 0.001) compared with R-LLS in the ordinary-case group, whereas R-LLS was associated with shorter postoperative LOS (5.0 vs 3.5 days; p = 0.004) in the complex-case group. On multivariable analysis, R-LLS was predictive of shorter postoperative LOS [odds ratio (OR) 0.388, 95% confidence interval (CI) 0.198-0.760, p = 0.006], whereas R-LLS was predictive of higher surgery (OR 65.640, 95% CI 17.406-247.535, p < 0.001) and overall costs (OR 102.233, 95% CI 22.241-469.931, p < 0.001). CONCLUSION Results of this study showed no clinical benefit to the R-LLS compared with L-LLS in ordinary cases. R-LLS had potential advantages in selected complex cases.
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Affiliation(s)
- Lin Zhu
- The First School of Clinical Medicine, Lanzhou University, No. 1, Donggangxi Rd, Chengguan District, Lanzhou, 730000, Gansu, China.,Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Yanzhe Liu
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Minggen Hu
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Zhiming Zhao
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Chenggang Li
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Xuan Zhang
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Xianglong Tan
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Fei Wang
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Rong Liu
- The First School of Clinical Medicine, Lanzhou University, No. 1, Donggangxi Rd, Chengguan District, Lanzhou, 730000, Gansu, China. .,Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China.
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Lam S, Cheng KC. Long-term survival outcome of laparoscopic liver resection for hepatocellular carcinoma. World J Gastrointest Surg 2021; 13:1110-1121. [PMID: 34754381 PMCID: PMC8554717 DOI: 10.4240/wjgs.v13.i10.1110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/14/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
Long-term survival is the most important outcome measurement of a curative oncological treatment. For hepatocellular carcinoma (HCC), the long-term disease-free and overall survival of laparoscopic liver resection (LLR) is shown to be non-inferior to the current standard of open liver resection (OLR). Some studies have reported a superior long-term oncological outcome in LLR when compared to OLR. It has been argued that improvement of visualization and instrumentation and reduced operative blood loss and perioperative blood transfusion may contribute to reduced risk of postoperative tumor recurrence. On the other hand, since most of the comparative studies of the oncological outcomes of LLR and OLR for HCC are non-randomized, it remained inconclusive as to whether LLR confers additional survival benefit compared to OLR. Despite the paucity of level 1 evidence, the practice of LLR for HCC has gained wide-spread acceptance due to the reproducible improvements in the perioperative outcomes and non-inferior oncological outcomes demonstrated by large-scaled, matched comparative studies. Meta-analyses of the outcomes of these studies by multiple systematic reviews have also returned noncontradictory conclusions. On the basis of a theoretical advantage of LLR over OLR in preventing tumor recurrence, the current review aims to dissect from the current meta-analyses and comparative studies any evidence of such superiority.
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Affiliation(s)
- Shi Lam
- Department of Surgery, Kwong Wah Hospital, Hong Kong, 999077, China
| | - Kai-Chi Cheng
- Department of Surgery, Kwong Wah Hospital, Hong Kong, 999077, China
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Kamarajah SK, Gujjuri RR, Hilal MA, Manas DM, White SA. Does minimally invasive liver resection improve long-term survival compared to open resection for hepatocellular carcinoma? A systematic review and meta-analysis. Scand J Surg 2021; 111:14574969211042455. [PMID: 34605328 DOI: 10.1177/14574969211042455] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Minimally invasive liver surgery for hepatocellular carcinoma has gained widespread interest as an alternative to conventional open liver surgery. However, long-term survival benefits of this approach seem unclear. This meta-analysis was conducted to investigate long-term survival following minimally invasive liver surgery. METHOD A systematic review was performed to identify studies comparing long-term survival after minimally invasive liver surgery and open liver surgery until January 2020. The I2 test was used to test for statistical heterogeneity and publication bias was assessed using Egger test. Random-effects meta-analysis was performed for all-cause 5-year (main outcome) and 3-year mortality, and disease-specific 5-year and 3-year mortality. Meta-regression was performed for the 5-year and 3-year survival outcomes with adjustment for study factors (region, design), annual center volume, patient factors (American Society of Anesthesiologists (ASA) grade, gender, age, body mass index, cirrhosis, tumor size, and number), and resection extent. Sensitivity analyses were performed on studies by study year, region, annual center volume, and resection type. RESULT The review identified 50 relevant studies including 13,731 patients undergoing liver resection for hepatocellular carcinoma of which 4071 (25.8%) underwent minimally invasive liver surgery. Pooled analysis revealed similar all-cause (odds ratio: 0.83, 95% confidence interval: 0.70-1.11, p = 0.3) and disease-specific (odds ratio: 0.93, 95% confidence interval: 0.80-1.09, p = 0.4) 5-year mortality after minimally invasive liver surgery compared with open liver surgery. Sensitivity analysis of published studies from 2010 to 2019 demonstrated a significantly lower disease-specific 3-year mortality (odds ratio: 0.75, 95% confidence interval: 0.59-0.96, p = 0.022) and all-cause 5-year mortality (odds ratio: 0.63, 95% confidence interval: 0.50-0.81, p = 0.002). Meta-regression identified no confounding factors in all analyses. CONCLUSIONS Improvement in minimally invasive liver surgery techniques over the past decade appears to demonstrate superior disease-specific mortality with minimally invasive liver surgery compared to open liver surgery. Therefore, minimally invasive liver surgery can be recommended as an alternative surgical approach for hepatocellular carcinoma.
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Affiliation(s)
- Sivesh K Kamarajah
- BMedSci, MBChB Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle University NHS Trust Hospitals, NE7 7DN, Newcastle upon Tyne, UK Institute of Cellular Medicine, Newcastle University, NE2 4HH, Newcastle upon Tyne, UK
| | - Rohan R Gujjuri
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Moh'd A Hilal
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Derek M Manas
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle University NHS Trust Hospitals, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Steven A White
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle University NHS Trust Hospitals, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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8
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International multicenter propensity score matched study on laparoscopic versus open left lateral sectionectomy. HPB (Oxford) 2021; 23:707-714. [PMID: 33039275 DOI: 10.1016/j.hpb.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 07/07/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite a lack of high-level evidence, current guidelines recommend laparoscopic left lateral sectionectomy (LLLS) as the routine approach over open LLS (OLLS). Randomized studies and propensity score matched studies on LLLS vs OLLS for all indications, including malignancy, are lacking. METHODS This international multicenter propensity score matched retrospective cohort study included consecutive patients undergoing LLLS or OLLS in six centers from three European countries (January 2000-December 2016). Propensity scores were calculated based on nine preoperative variables and LLLS and OLLS were matched in a 1:1 ratio. Short-term operative outcomes were compared using paired tests. RESULTS A total of 560 patients were included. Out of 200 LLLS, 139 could be matched to 139 OLLS. After matching, baseline characteristics were well balanced. LLLS was associated with shorter operative time (144 (110-200) vs 199 (138-283) minutes, P < 0.001), less blood loss (100 (50-300) vs 350 (100-750) mL, P = 0.005) and a 3-day shorter postoperative hospital stay (4 (3-7) vs 7 (5-9) days, P < 0.001). CONCLUSION This international multicenter propensity score matched study confirms the superiority of LLLS over OLLS based on shorter postoperative hospital stay, operative time, and less blood loss thus validating current guideline advice.
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Abstract
BACKGROUND Anatomical resection (AR) for colorectal liver metastasis (CLM) is disputable. We investigated the impact of AR on short-term outcomes and survival in CLM patients. METHODS Patients having hepatectomy with AR or nonanatomical resection (NAR) for CLM were reviewed. Comparison was made between AR and NAR groups. Group comparison was performed again after propensity score matching with ratio 1:1. RESULTS AR group (n = 234 vs n = 89 in NAR group) had higher carcinoembryonic antigen level (20 vs 7.8 ng/mL, p ≤ 0.001), more blood loss (0.65 vs 0.2 L, p < 0.001), more transfusions (19.2% vs 3.4%, p = 0.001), longer operation (339.5 vs 180 min, p < 0.001), longer hospital stay (9 vs 6 days, p < 0.001), more tumors (p < 0.001), larger tumors (4 vs 2 cm, p < 0.001), more bilobar involvement (20.9% vs 7.9%, p = 0.006), and comparable survival (overall, p = 0.721; disease-free, p = 0.695). After propensity score matching, each group had 70 patients, with matched tumor number, tumor size, liver function, and tumor marker. AR group had more open resections (85.7% vs 68.6%, p = 0.016), more blood loss (0.556 vs 0.3 L, p = 0.001), more transfusions (17.1% vs 4.3%, p = 0.015), longer operation (310 vs 180 min, p < 0.001), longer hospital stay (8.5 vs 6 days, p = 0.002), comparable overall survival (p = 0.819), and comparable disease-free survival (p = 0.855). CONCLUSION Similar disease-free survival and overall survival of CLM patients were seen with the use of AR and NAR. However, AR may entail a more eventful postoperative course. NAR with margin should be considered whenever feasible.
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Saad MR, Choi Y, Han HS, Yoon YS, Cho JY, Lee JS, Lee BR. Solo single-incision laparoscopic liver resection: a cohort series. ANZ J Surg 2020; 90:1108-1111. [PMID: 32378778 DOI: 10.1111/ans.15941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/19/2019] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Single-incision laparoscopic liver resection (SILLR) is still challenging due to the unstable surgical view, the crowding instruments and its crossover. In this study, we present a new option of solo SILLR for various liver tumours in order to overcome those difficulties. METHODS Solo SILLR is indicated for liver tumours located in the left liver or in the superficial right liver. Data for 54 consecutive patients, who underwent solo SILLR between October 2015 and October 2018, were collected and analysed prospectively. RESULTS A total of 30 patients (55.5%) underwent non-anatomical resection. Left hemi-hepatectomy was performed in 11 patients (20.4%) and left lateral was performed in 13 patients (24.1%). The median operative time was 114 (range 30-335) min with median blood loss of 400 (50-750) mL with no need of blood transfusion and no intraoperative complications. The median length of hospital stay was 3 (range 1-19) days. There was one case of post-operative intra-abdominal fluid collection and one case of incisional hernia during the follow-up. CONCLUSION Solo SILLR is more feasible and safer for liver tumours located in the superficial right liver or in the left one. Therefore, solo surgery can be an option in SILLR.
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Affiliation(s)
- Mohamed Rabie Saad
- Department of Surgery, Faculty of Medicine, Aswan University Hospital, Aswan, Egypt.,Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - YoungRok Choi
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Ho-Seong Han
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Yoo-Seok Yoon
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Jai Young Cho
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Jun Suh Lee
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - Bo Ram Lee
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea
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Xiangfei M, Yinzhe X, Yingwei P, Shichun L, Weidong D. Open versus laparoscopic hepatic resection for hepatocellular carcinoma: a systematic review and meta-analysis. Surg Endosc 2019; 33:2396-2418. [DOI: 10.1007/s00464-019-06781-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 04/04/2019] [Indexed: 12/17/2022]
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12
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Yamazaki S, Takayama T. Current topics in liver surgery. Ann Gastroenterol Surg 2019; 3:146-159. [PMID: 30923784 PMCID: PMC6422805 DOI: 10.1002/ags3.12233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/02/2018] [Accepted: 12/04/2018] [Indexed: 01/01/2023] Open
Abstract
Liver resection is one of the main treatment strategies for liver malignancies. Mortality and morbidity of liver surgery has improved significantly with progress in selection criteria, development of operative procedures and improvements in perioperative management. Safe liver resection has thus become more available worldwide. We have identified four current topics related to liver resection (anatomical liver resection, laparoscopic liver resection, staged liver resection and chemotherapy-induced liver injury). The balance between treatment effect and patient safety needs to be considered when planning liver resection. Progress in this area has been rapid thanks to the efforts of many surgeons, and outcomes have improved significantly as a result. These topics remain to be solved and more robust evidence is needed. Precise selection of the optimal procedure and risk evaluation should be standardized with further development of each topic. The present article reviews these four current topics with a focus on safety and efficacy in recent series.
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Affiliation(s)
- Shintaro Yamazaki
- Department of Digestive SurgeryNihon University School of MedicineTokyoJapan
| | - Tadatoshi Takayama
- Department of Digestive SurgeryNihon University School of MedicineTokyoJapan
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13
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Zacharoulis D, Tasiopoulou VS, Svokos KA, Svokos AA, Christodoulidis G, Mamaloudis I, Sioka E, Magouliotis DE. A meta-analysis of laparoscopic versus open left lateral hepatic sectionectomy. HPB (Oxford) 2018; 20:1130-1136. [PMID: 30045827 DOI: 10.1016/j.hpb.2018.06.1812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/24/2018] [Accepted: 06/30/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aimed to assess the perioperative outcomes of laparoscopic left lateral sectionectomy (LLLS) compared with an open (OLLS) approach. METHOD A systematic literature search was performed in PubMed, Scopus and Cochrane library, in accordance with the PRISMA guidelines. The Odds Ratio (ORs), the weighted mean difference (WMD) and 95% confidence interval (95% CI) were evaluated, by means of Random-Effects model. RESULTS Ten articles met the inclusion criteria and incorporated 2640 patients. This study reveals comparable mean operative time, mean operative margin size and rate of R1 resection between LLLS and OLLS. The intraoperative mean blood loss, mean length of ICU stay, mean hospital stay were significantly increased in the OLLS group (p < 0.05). Complications were assessed according to the Clavien-Dindo classification. The incidence of grade I-II complications was similar between the two groups. The incidence of grade III-V complications was increased in the OLLS group (p = 0.008). The mean perioperative cost was similar between the two techniques. CONCLUSION These outcomes for left lateral sectionectomy suggest that both approaches are feasible and safe. However, the results should be treated with caution given the small number of the included randomized controlled studies and potential for selection bias between the two techniques.
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Affiliation(s)
| | - Vasiliki S Tasiopoulou
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
| | - Konstantina A Svokos
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | | | - Eleni Sioka
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
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14
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Lee CW, Tsai HI, Cheng HT, Chen WT, Hsu HY, Chiu CC, Liu YP, Wu TH, Yu MC, Lee WC, Chen MF. Stapleless laparoscopic left lateral sectionectomy for hepatocellular carcinoma: reappraisal of the Louisville statement by a young liver surgeon. BMC Gastroenterol 2018; 18:178. [PMID: 30486797 PMCID: PMC6264597 DOI: 10.1186/s12876-018-0903-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 11/06/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Laparoscopic liver resection has been regarded as the standard treatment for liver tumors located at the left lateral liver sector. However, few studies have reported the results of laparoscopic left lateral sectionectomy (LLS) for HCC, not to mention the feasibility of this emerging technique for the less experienced liver surgeons. The current study would reappraise the Louisville statement by examining the outcome of LLS performed by a young liver surgeon. METHODS We retrospectively reviewed two separate groups of patients who underwent open or laparoscopic left lateral sectionectomies at Chung Gung Memorial Hospital, Linkou. All laparoscopic hepatectomies were performed by the index young surgeon following a stepwise stapleless LLS. The surgical results and oncological outcomes of laparoscopic vs. open hepatectomies (LH and OH, respectively) with the surgical indication of HCC at left lateral liver sector were further compared and analyzed. RESULTS 18 of 29 patients in the laparoscopic group and 75 patients in the conventional open group had primary HCC. The demographic data was essentially the same for the two groups. Statistical analysis revealed that the LH group had smaller tumor size, higher blood transfusion requirement, longer duration of inflow control and parenchymal transection, and longer operation time. However, no significant difference was observed in terms of complication rate, mortality rate, and hospital stay between the two groups. After adjusting for tumor size, LH and OH showed no statistical difference in the amount of blood transfusion, operation time and patient survival. CONCLUSIONS This study demonstrated that stapleless LLS is a safe and feasible procedure for less experienced liver surgeons to resect HCC located at the left lateral liver sector. This stepwise stapleless LSS can not only achieve surgical results comparable to OH but also can provide a platform for liver surgeons to apply laparoscopic technique before conducting more complicated liver resections.
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Affiliation(s)
- Chao-Wei Lee
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
| | - Hsin-I Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Anesthesiology, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Hao-Tsai Cheng
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Wei-Ting Chen
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Heng-Yuan Hsu
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Chien-Chih Chiu
- Department of Nursing, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Yi-Ping Liu
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Tsung-Han Wu
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Ming-Chin Yu
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China. .,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China. .,Department of Surgery, Xiamen Chang Gung Hospital, Xiamen, China.
| | - Wei-Chen Lee
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Miin-Fu Chen
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
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15
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Macacari RL, Coelho FF, Bernardo WM, Kruger JAP, Jeismann VB, Fonseca GM, Cesconetto DM, Cecconello I, Herman P. Laparoscopic vs. open left lateral sectionectomy: An update meta-analysis of randomized and non-randomized controlled trials. Int J Surg 2018; 61:1-10. [PMID: 30496866 DOI: 10.1016/j.ijsu.2018.11.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/28/2018] [Accepted: 11/14/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Left lateral sectionectomy (LLS) is thought to be the anatomical liver resection most suitable for the laparoscopic approach. Despite increasing popularity, comparative analysis of laparoscopic and open LLS are mostly limited to retrospective, underpowered studies with small sample size. Recent population-based studies and prospective trials have generated new data; however, this new body of knowledge has not been submitted systematic reviews or meta-analyses and high quality evidence regarding the actual benefits of minimally invasive LLS is lacking. METHODS Systematic review of studies published until December 31st, 2017 and indexed in Medline, EMBASE, Cochrane Library Central and Scielo/LILACS databases. Randomized controlled trials and observational studies comparing perioperative results of laparoscopic and open LLS were included. Studies with patients submitted to LLS for living donation were excluded. Treatment outcomes, including conversion rates, estimated blood loss, transfusion rates, operative time, length of in-hospital stay, morbidity and mortality rates, were evaluated. RESULTS The primary search yielded 2838 articles, 23 of which (21 observational studies and 2 randomized controlled trials; 3415 patients) were included in the meta-analysis. Overall conversion rate was 7.4%. Patients submitted to laparoscopic LLS had less blood loss (mean difference, MD = -119.81 ml, 95% CI = -127.90, -111.72, P < .00001, I2 = 32%, N = 618), lower transfusion rates (4.1% vs. 10.1%; risk difference, RD = - 0.06, 95% CI = - 0.08, - 0.05, P < .00001, I2 = 13%, N = 2968) and shorter length of in-hospital stay (MD = - 2.02 days, 95% CI = - 2.15, - 1.89, P < .00001, I2 = 77%, N = 3160) compared to those undergoing open surgery. Marginally decreased overall complication (21.4% vs. 27.5%; RD = - 0.03, 95% CI = - 0.06, 0.00, P = .05, I2 = 0%, N = 3268) and perioperative mortality (0.3% vs. 1.5%; RD = - 0.01, 95% CI = - 0.02, - 0.00, P = .01, I2 = 0%; N = 3332) rates were also observed. Operative time and biliary, cardiac or pulmonary complication rates did not differ significantly between groups. CONCLUSION Current evidence supports the safety and feasibility of laparoscopic LLS. The laparoscopic approach is associated with reduced blood loss, lower transfusion rates and shorter length of in-hospital stay and should be considered the gold-standard for LLS.
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Affiliation(s)
- Rodrigo Luiz Macacari
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil.
| | - Fabricio Ferreira Coelho
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Wanderley Marques Bernardo
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Jaime Arthur Pirola Kruger
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil; Digestive Surgery Division, Department of Gastroenterology, Instituto do Câncer do Estado de Sao Paulo (ICESP), Sao Paulo, Brazil
| | - Vagner Birk Jeismann
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil; Digestive Surgery Division, Department of Gastroenterology, Instituto do Câncer do Estado de Sao Paulo (ICESP), Sao Paulo, Brazil
| | - Gilton Marques Fonseca
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Danielle Menezes Cesconetto
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Ivan Cecconello
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Paulo Herman
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
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16
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Ciria R, Gomez-Luque I, Ocaña S, Cipriani F, Halls M, Briceño J, Okuda Y, Troisi R, Rotellar F, Soubrane O, Abu Hilal M. A Systematic Review and Meta-Analysis Comparing the Short- and Long-Term Outcomes for Laparoscopic and Open Liver Resections for Hepatocellular Carcinoma: Updated Results from the European Guidelines Meeting on Laparoscopic Liver Surgery, Southampton, UK, 2017. Ann Surg Oncol 2018; 26:252-263. [PMID: 30390167 DOI: 10.1245/s10434-018-6926-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The laparoscopic approach to liver resection has experienced exponential growth in recent years; however, its application is still under debate and objective, evidence-based guidelines for its safe future progression are needed. OBJECTIVE The aim of this study was to perform a systematic review and meta-analysis comparing the short- and long-term outcomes of laparoscopic and open liver resections for hepatocellular carcinoma (HCC). METHODS To identify all the comparative manuscripts reporting on laparoscopic and open liver resection for HCC, all published English-language studies with more than 10 cases were screened. In addition to the primary meta-analysis, four specific subgroup analyses were performed on patients with Child-Pugh A cirrhosis, resections for solitary tumors, and those undergoing minor and major resections. The quality of the studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology and the Newcastle-Ottawa Scale. RESULTS From the initial 361 manuscripts, 28 were included in the meta-analysis. Five of these 28 manuscripts were specific to patients with Child-Pugh A cirrhosis (321 cases), 11 focused on solitary tumors (1003 cases), 16 focused on minor resections (1286 cases), and 3 focused on major resections (164 cases). Three manuscripts compared 1079 cases but could not be assigned to any of the above subanalyses. In general terms, short-term outcomes were favorable when using a laparoscopic approach, especially in minor resections. The only advantage seen with an open approach was reduced operative time during major liver resections. No differences in long-term outcomes were observed between the approaches. CONCLUSIONS Laparoscopic liver resection for HCC is feasible and offers improved short-term outcomes, with comparable long-term outcomes as the open approach.
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Affiliation(s)
- Ruben Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, CIBER-EHD, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Cordoba, Spain.
| | - Irene Gomez-Luque
- Unit of Hepatobiliary Surgery and Liver Transplantation, CIBER-EHD, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Cordoba, Spain
| | - Sira Ocaña
- Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Clinic, University of Navarra, Pamplona, Spain
| | - Federica Cipriani
- Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy.,Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Halls
- Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Javier Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, CIBER-EHD, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Cordoba, Spain
| | - Yukihiro Okuda
- Unit of Hepatobiliary Surgery and Liver Transplantation, CIBER-EHD, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Cordoba, Spain.,Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Roberto Troisi
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy
| | - Fernando Rotellar
- Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Clinic, University of Navarra, Pamplona, Spain
| | - Olivier Soubrane
- Department of HPB Surgery and Liver Transplant, Beaujon Hospital, University Paris 7, Clichy, AP-HP, France
| | - Mohammed Abu Hilal
- Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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17
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Sugawara T, Hashimoto M, Shindoh J. Laparoscopic left lateral sectionectomy: A three-port method. J Minim Access Surg 2018; 16:220-223. [PMID: 29974877 PMCID: PMC7440003 DOI: 10.4103/jmas.jmas_233_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Background Laparoscopic liver resection has become popular recent years. Laparoscopic left lateral sectionectomy (LLS) is now a standard operation with sufficient safety and feasibility. To improve the benefits of minimally invasive surgery, we invented and have been performing a reduced port LLS procedure using 3 ports since 2009. Materials and Methods All patients who underwent LLS at Toranomon Hospital (Tokyo, Japan) were included, except for patients with a previous history of upper abdominal surgery or those who had undergone the simultaneous resection of another organ. An essential point of this procedure was the extracorporeal traction of the divided round ligament using a ligature. As a result, the operator was able to perform the parenchymal transection within a good operative field. Results Twelve patients were enrolled in the study. All the patients had a Child-Pugh classification of Class A. The median indocyanine green retention rate at 15 min was 9.5%. Compared with previously reported results for conventional LLS, the median operation time (82.5 min), blood loss (0 mL) and rate of blood transfusion (0%) were lower for the 3-port LLS procedure. The rates of complications (9%) and a positive surgical margin (0%) were similar to those reported for the conventional approach. Conclusion Three-port LLS appears to be a safe and feasible procedure.
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Affiliation(s)
- Toshitaka Sugawara
- Department of Digestive Surgery, Hepatobiliary-Pancreatic Surgery Division, Toranomon Hospital, Tokyo, Japan
| | - Masaji Hashimoto
- Department of Digestive Surgery, Hepatobiliary-Pancreatic Surgery Division, Toranomon Hospital, Tokyo, Japan
| | - Junichi Shindoh
- Department of Digestive Surgery, Hepatobiliary-Pancreatic Surgery Division, Toranomon Hospital, Tokyo, Japan
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18
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Jiang B, Yan XF, Zhang JH. Meta-analysis of laparoscopic versus open liver resection for hepatocellular carcinoma. Hepatol Res 2018; 48:635-663. [PMID: 29330919 DOI: 10.1111/hepr.13061] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/23/2017] [Accepted: 01/08/2018] [Indexed: 12/15/2022]
Abstract
AIM The aim of this study was to evaluate the surgical safety and effectiveness of laparoscopic hepatectomy (LH) in short- and long-term outcomes compared to open hepatectomy (OH) in patients treated for hepatocellular carcinoma (HCC). METHODS An electronic search of reports published before August 2017 was carried out to identify comparative studies evaluating LH versus OH for HCC. RESULTS A total of 5889 patients (2421 underwent LH; 3468 underwent OH) were included in our meta-analysis from 47 studies. Laparoscopic hepatectomies were associated with favorable outcomes in terms of operative blood loss (mean difference [MD], -147.27; 95% confidence interval [CI], -217.00, -77.55), blood transfusion requirement (odds ratio [OR], 0.51; 95% CI, 0.40, 0.65), pathologic resection margins (MD, 0.07; 95% CI, 0.02, 0.12; P = 0.01), R0 resection rate (OR, 1.34; 95% CI, 0.98, 1.84; P = 0.07), and length of hospital stay (MD, -5.13; 95% confidence interval, -6.23, -4.03). There were no differences between the groups in overall survival (OS) at 1 year (OR, 1.41; 95% CI, 1.00, 1.98), 3 years (OR, 1.12; 95% CI, 0.93, 1.36), or 5 years (OR, 1.18; 95% CI, 0.94, 1.46), in disease-free survival (DFS) at 1 (OR, 1.19; 95% CI, 0.94, 1.51), 3 years (OR, 1.07; 95% CI, 0.86, 1.33), or 5 years (OR, 1.13; 95% CI, 0.92, 1.40), or in recurrence (OR, 0.90; 95% CI, 0.74, 1.08). CONCLUSION Compared to OH, LH is superior in terms of lower intraoperative blood loss and the requirement for blood transfusion, larger pathologic resection margins, increased R0 resection rates, and shorter length of hospital stay. Laparoscopic hepatectomy and OH have similar OS, DFS, and recurrence.
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Affiliation(s)
- Bin Jiang
- Nanjing Medical University, Nanjing, China
| | | | - Jian-Huai Zhang
- General Surgery, Huai'an First People's Hospital, Nanjing, Nanjing Medical University, Nanjing, China
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19
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Yang TH, Chen JL, Lin YJ, Chao YJ, Shan YS, Hsu HP, Su ZM, Chou CC, Yen YT. Laparoscopic surgery for large left lateral liver tumors: safety and oncologic outcomes. Surg Endosc 2018; 32:4314-4320. [DOI: 10.1007/s00464-018-6287-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/18/2018] [Indexed: 01/27/2023]
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20
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Cheung TT, Ma KW, She WH, Dai WC, Tsang SHY, Chan ACY, Chok KSH, Lo CM. Pure laparoscopic hepatectomy with augmented reality-assisted indocyanine green fluorescence versus open hepatectomy for hepatocellular carcinoma with liver cirrhosis: A propensity analysis at a single center. Asian J Endosc Surg 2018; 11:104-111. [PMID: 29747235 DOI: 10.1111/ases.12492] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 03/18/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Laparoscopic hepatectomy is considered an acceptable treatment of choice in selected patients with primary hepatocellular carcinoma (HCC). Whether indocyanine green (ICG) immunofluorescence, a new technology, may improve surgery outcomes has yet to be tested. The aim of the present study was to investigate and compare the effect of ICG fluorescence imaging on the outcomes of pure laparoscopic hepatectomy and open hepatectomy for primary HCC with background cirrhosis. METHODS From January 2015 to June 2016, 20 patients with HCC and liver cirrhosis underwent laparoscopic hepatectomy with ICG immunofluorescence. The outcomes of pure laparoscopic hepatectomy with ICG immunofluorescence were compared with those of open hepatectomy. To avoid selection bias, patients were propensity score matched in a ratio of 1 : 6, with 20 patients in the laparoscopic group and 120 in the open group. RESULTS The laparoscopic group had 20 patients, and the open group had 120 patients. The laparoscopic group had less blood loss (125 vs 450 mL, P < 0.001), a shorter operation time (200 vs 250 min, P = 0.003), and a shorter hospital stay (5 vs 6 days, P < 0.001). The complication rate was 0% in the laparoscopic group compared to 15.0% in the open group (P = 0.135). All patients in the laparoscopic group had negative margin involvement. Four patients (3.3%) in the open resection group had positive margin involvement. Two patients in the ICG immunofluorescence group had additional lesions identified and resected during operation. CONCLUSION Pure laparoscopic hepatectomy with ICG immunofluorescence for primary HCC can be carried out safely with favorable short-term outcomes even in cirrhotic patients. Better identification of the bile duct structure and better assessment of the tumor resection margin and perfusion are advantages of this new technique.
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Affiliation(s)
- Tan To Cheung
- Department of Surgery, The University of Hong Kong, Hong Kong
| | - Ka Wing Ma
- Department of Surgery, The University of Hong Kong, Hong Kong
| | - Wong Hoi She
- Department of Surgery, The University of Hong Kong, Hong Kong
| | - Wing Chiu Dai
- Department of Surgery, The University of Hong Kong, Hong Kong
| | | | | | | | - Chung Mau Lo
- Department of Surgery, The University of Hong Kong, Hong Kong
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21
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Cheung TT. Laparoscopic liver resection in patients with liver cirrhosis-the path towards standard of care. Hepatobiliary Surg Nutr 2018. [PMID: 29531952 DOI: 10.21037/hbsn.2017.09.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Tan To Cheung
- Department of Surgery, The University of Hong Kong, Hong Kong, China
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22
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Cheung TT, Han HS, She WH, Chen KH, Chow PK, Yoong BK, Lee KF, Kubo S, Tang CN, Wakabayashi G. The Asia Pacific Consensus Statement on Laparoscopic Liver Resection for Hepatocellular Carcinoma: A Report from the 7th Asia-Pacific Primary Liver Cancer Expert Meeting Held in Hong Kong. Liver Cancer 2018; 7:28-39. [PMID: 29662831 PMCID: PMC5892359 DOI: 10.1159/000481834] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Laparoscopic liver resection has been gaining momentum, and it has become an accepted practice after the two international consensus conferences where experts worked up guidelines to standardize this approach and improve its safety. However, most laparoscopic hepatectomies were performed in patients with liver metastases. The concurrent presence of liver cirrhosis with hepatocellular carcinoma (HCC) poses a great challenge to clinicians trying to establish a routine use of laparoscopic liver resection for HCC. SUMMARY The first Asia Pacific consensus meeting on laparoscopic liver resection for HCC was held in July 2016 in Hong Kong. A group of expert liver surgeons with experience in both open and laparoscopic hepatectomy for HCC convened to formulate recommendations on the role and perspective of laparoscopic liver resection for primary liver cancer. The recommendations consolidate the most recent evidence pertaining to laparoscopic hepatectomy together with the latest thinking of practicing clinicians involved in laparoscopic hepatectomy, and give detailed guidance on how to deploy the treatment effectively for patients in need. KEY MESSAGE The panel of experts gathered evidence and produced recommendations providing guidance on the safe practice of laparoscopic hepatectomy for patients with HCC and cirrhosis. The inherent advantage of the laparoscopic approach may result in less blood loss if the procedure is performed in experienced centers. The laparoscopic approach to minor hepatectomy, particularly left lateral sectionectomy, is a preferred practice for HCC at experienced centers. Laparoscopic major liver resection for HCC remains a technically challenging operation, and it should be carried out in centers of excellence. There is emerging evidence that laparoscopic liver resection produces a better oncological outcome for HCC when compared with radiofrequency ablation, particularly when the lesions are peripherally located. Augmented features in laparoscopic liver resection, including indocyanine green fluorescence, 3D laparoscopy, and robot, will become important tools of surgical treatment in the near future. A combination of all of these features will enhance the experience of the surgeons, which may translate into better surgical outcomes. This is the first consensus workforce on laparoscopic liver resection for HCC, which is a unique condition that occurs in the Asia Pacific region.
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Affiliation(s)
- Tan To Cheung
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong (SAR), China,*Dr. Tan To Cheung, 102 Pok Fu Lam Road, Hong Kong, SAR (China), E-Mail
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National College of Medicine, Seoul, South Korea
| | - Wong Hoi She
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong (SAR), China
| | - Kuo-Hsin Chen
- Department of Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, China
| | | | - Boon Koon Yoong
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Kit Fai Lee
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (SAR), China
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Chung Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong (SAR), China
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
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Liu Z, Ding H, Xiong X, Huang Y. Laparoscopic left lateral hepatic sectionectomy was expected to be the standard for the treatment of left hepatic lobe lesions: A meta-analysis. Medicine (Baltimore) 2018; 97:e9835. [PMID: 29443745 PMCID: PMC5839853 DOI: 10.1097/md.0000000000009835] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Laparoscopic left lateral hepatic sectionectomy (LLLHS) has been widely accepted because of the benefits of minimally invasive surgery. We aimed to assess the benefits and drawbacks of left lateral sectionectomy (of segments II/III) compared with laparoscopic and open approaches. METHODS Relevant literature was searched using the PubMed, Embase, Cochrane, and Ovid Medline databases. We calculated odds ratios or mean differences with 95% confidence intervals (CIs) for fixed-effects and random-effects models. RESULTS The meta-analysis included 14 trials involving 685 patients. There were no statistically significant differences between LLLHS and open LLHS (OLLHS) regarding analgesia (P = .31), pedicle clamping (P = .70), operative time (P = .54), hospital expenses (P = .64), postoperative alanine aminotransferase levels (P = .57), resection margin (95% CI -3.02-4.28; P = .73), or tumor recurrence (95% CI 0.51-3.05; P = .62). However, the LLLHS group showed significantly better results regarding blood transfusion (95% CI 0.14-0.73; P = .007), blood loss (95% CI -140.95 to -67.23; P <.001), total morbidity (95% CI 0.24-0.56; P <.01), and hospital stay (95% CI -3.84 to -2.31; P <.001) than the OLLHS group. CONCLUSION LLLHS has an advantage in the hospital stay, blood loss, and total morbidity. It is an ideal method for LLHS surgery.
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Affiliation(s)
- Zhou Liu
- Department of Internal Medicine, Jiangxi Provincial Chest Hospital
| | - Haolong Ding
- Department of General Surgery, The Third Hospital of Nanchang
| | - Xiaoli Xiong
- Department of Radiology, The Second Affiliated Hospital of Nanchang University
| | - Yong Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Cheung TT. Superior oncological outcome in laparoscopic hepatectomy for hepatocellular carcinoma, hype or hope? Hepatobiliary Surg Nutr 2017; 6:437-438. [PMID: 29312985 DOI: 10.21037/hbsn.2017.09.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Tan To Cheung
- Department of Surgery, The University of Hong Kong, Hong Kong, China
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Abstract
The introduction of robotic surgical systems has revolutionized the practice of minimal invasive surgery (MIS). Although little data regarding robotic hepatectomies have been reported, it appears to be similar to conventional laparoscopic approach in terms of blood loss, morbidity rate, mortality rate and hospital stay at least. The application of robotic system in liver surgery was not well evaluated yet, particularly learning curve. Studies were identified by searching MEDLINE and PubMed databases for articles from January 2001 to May 2016 using the keywords "laparoscopic hepatectomy", "robotic hepatectomy", and "learning curve". With the limited data in robotic hepatectomy, the learning curve model of robotic hepatectomy needs to base on the experience of conventional laparoscopic hepatectomy. Based on the learning curve study experience for laparoscopic hepatectomies, the minimal number laparoscopic minor and major hepatectomies to overcome learning curve are 22-64 cases, and 45-75 cases, respectively. Left lateral sectionectomy technique is more standardized, and it is a good start for training of MIS liver surgery. However, the training program required for the robotic liver surgeons still highly depends on the surgeons' experience of previous open and laparoscopic liver surgery, the surgeons' previous experience of other robotic surgeries, the experience of the surgical team including the assistant surgeons and nursing staffs, and the complexity of the diseases. We discourage performance of robotic hepatectomy in the occasional patient by a team that is not well prepared and is not embedded in a specialized center. Knowledge and practical skills are both required in MIS liver surgery and cannot be replaced by newer tools, including the most advanced robotic system.
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Affiliation(s)
- Eric C H Lai
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China
| | - Chung Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China
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Pure Laparoscopic Hepatectomy Versus Open Hepatectomy for Hepatocellular Carcinoma in 110 Patients With Liver Cirrhosis: A Propensity Analysis at a Single Center. Ann Surg 2017; 264:612-20. [PMID: 27433917 DOI: 10.1097/sla.0000000000001848] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the long-term outcomes of pure laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma (HCC) with background cirrhosis. BACKGROUND Laparoscopic hepatectomy has been gaining popularity, but has not been widely accepted, because published data were gathered from small numbers of patients. METHODS Data of patients diagnosed with HCC and cirrhosis treated by hepatectomy were reviewed. The outcomes of pure laparoscopic hepatectomy were compared with those of open hepatectomy. Propensity score matching of patients in a ratio of 1:3 was conducted. RESULTS There were 110 patients and 330 patients in the laparoscopic group and the open group, respectively. The laparoscopic group had less blood loss (150 vs 400 mL; P < 0.001), shorter operation time (185 vs 255 minutes; P < 0.001), and shorter hospital stay (4vs 7 days; P < 0.001). The median overall survival was 136 months in the laparoscopic group and 120 months in the open group. The 1, 3, and 5-year overall survival rates were 98.9%, 89.8%, and 83.7%, respectively, in the laparoscopic group, and 94%, 79.3%, and 67.4%, respectively, in the open group (P = 0.033). The median disease-free survival was 66.37 months in the laparoscopic group and 52.4 months in the open group. The 1, 3, and 5-year disease-free survival rates were 87.7%, 65.8%, and 52.2%, respectively, in the laparoscopic group, and 75.2%, 56.3%, and 47.9%, respectively, in the open group (P = 0.141). CONCLUSIONS Pure laparoscopic hepatectomy for HCC can be carried out safely with favorable short-term and long-term outcomes even in cirrhotic patients at high-volume liver cancer centers.
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Sotiropoulos GC, Prodromidou A, Kostakis ID, Machairas N. Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma. Updates Surg 2017; 69:291-311. [PMID: 28220382 DOI: 10.1007/s13304-017-0421-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/06/2017] [Indexed: 02/07/2023]
Abstract
Laparoscopic liver resections (LLR) are widely accepted as safe and effective procedures for the management of hepatocellular carcinoma (HCC) in the hands of experienced surgeons. The efficacy and extent of benefits of pure as well as hand-assisted laparoscopic and laparoscopy-assisted liver resection over open liver resection (OLR) have been investigated by numerous studies during the last 10 years. The aim of our meta-analysis is to investigate the effect of LLR in short- and long-term outcomes compared to OLR in patients operated for HCC. A total of 5203 patients from forty-four studies were included in our meta-analysis reporting for short- and long-term results for both LLR and OLR for HCC. Among them, 1830 underwent pure laparoscopic hepatectomy, 282 underwent pure laparoscopic or hand-assisted laparoscopic or laparoscopy-assisted hepatectomy, and 3091 were operated through open approach. LLRs were found to be significantly associated with lower blood loss, need for blood transfusion, successful achievement of R0 resection as well as wider resection margin, shorter hospital stay, lower morbidity and 30-day mortality rates. Operative time, tumor recurrence, 1-, 3-, and 5-year overall survival as well as 1-, 3-, and 5-year disease-free survival were not found different between the groups. This meta-analysis clearly demonstrates the superiority of laparoscopic resection over the open approach for patients with small HCC.
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Affiliation(s)
- Georgios C Sotiropoulos
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, General Hospital Laiko, Agiou Thoma Str. 17, 11527, Athens, Greece
| | - Anastasia Prodromidou
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, General Hospital Laiko, Agiou Thoma Str. 17, 11527, Athens, Greece
| | - Ioannis D Kostakis
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, General Hospital Laiko, Agiou Thoma Str. 17, 11527, Athens, Greece
| | - Nikolaos Machairas
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, General Hospital Laiko, Agiou Thoma Str. 17, 11527, Athens, Greece.
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28
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Zhong JH, Peng NF, Gu JH, Zheng MH, Li LQ. Is laparoscopic hepatectomy superior to open hepatectomy for hepatocellular carcinoma? World J Hepatol 2017; 9:167-170. [PMID: 28217254 PMCID: PMC5295156 DOI: 10.4254/wjh.v9.i4.167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/30/2016] [Accepted: 12/09/2016] [Indexed: 02/06/2023] Open
Abstract
The low perioperative morbidity and shorter hospital stay associated with laparoscopic hepatectomy have made it an often-used option at many liver centers, despite the fact that many patients with hepatocellular carcinoma have cirrhosis, which makes the procedure more difficult and dangerous. Type of surgical procedure proves not to be a primary risk factor for poor outcomes after hepatic resection for hepatocellular carcinoma, the available evidence clearly shows that laparoscopic hepatectomy is an effective alternative to the open procedure for patients with early-stage hepatocellular carcinoma, even in the presence of cirrhosis. Whether the same is true for patients with intermediate or advanced disease is less clear, since laparoscopic major hepatectomy remains a technically demanding procedure.
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Jrearz R, Govindarajan A, Jayaraman S. A survey of current practices and barriers to expanding laparoscopic HPB surgery in Canada. HPB (Oxford) 2017; 19:42-46. [PMID: 27884545 DOI: 10.1016/j.hpb.2016.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/05/2016] [Accepted: 09/14/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The purpose of this survey was to determine the extent to which laparoscopy is used in hepatopancreatobiliary (HPB) resections in Canada, and to assess HPB surgeons' attitudes and their perceived barriers to its further adoption. METHODS Using an electronic questionnaire, 68 Canadian Hepatopancreatobiliary Association (CHPBA) surgical members were surveyed. The questionnaire consisted of 12 questions regarding: surgeon demographics, the use and limitations of laparoscopy in their practice, and interest in increasing the use of laparoscopic techniques. RESULTS The survey response rate was 75%. Of the 51 respondents, 86% reported performing minor laparoscopic resections such as hepatic wedge resections. Only 23% of surgeons reported performing laparoscopic liver lobectomies. Eighty-two percent of respondents indicated a wish to increase the use of laparoscopy in their practice. Barriers identified included operating time constraints (61%), a lack of equipment (41%) and lack of adequate training (43%). DISCUSSION This survey demonstrates that currently, most Canadian HPB surgeons use laparoscopy for minor HPB resections; however, there is a strong desire to expand the use of minimally invasive techniques amongst Canadian HPB surgeons. Training centered on addressing the limitations and barriers to the uptake of minimally invasive techniques in HPB surgery are needed.
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Affiliation(s)
- Ricky Jrearz
- University of Toronto, Division of General Surgery, St. Joseph Health's Centre, Canada
| | - Anand Govindarajan
- University of Toronto, Division of General Surgery, St. Joseph Health's Centre, Canada
| | - Shiva Jayaraman
- University of Toronto, Division of General Surgery, St. Joseph Health's Centre, Canada.
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Dai WC, Cheung TT. Strategic overview on the best treatment option for intrahepaitc hepatocellular carcinoma recurrence. Expert Rev Anticancer Ther 2016; 16:1063-72. [PMID: 27548586 DOI: 10.1080/14737140.2016.1226136] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The long-term survival after hepatectomy for HCC remains unsatisfactory because of the high incidence of recurrence. The cumulative 5-year recurrence rate ranged from 60-100% in previous studies and majority of them remains intrahepatic recurrence. The therapeutic modalities commonly used for primary tumors, including surgical resection, liver transplantation, TACE, local ablative therapy and radiotherapy have been used to treat recurrent tumors in the liver remnant and the outcomes with the heterogeneous therapeutic options are reviewed. It is important to note that the level of evidence for most therapeutic options is limited to cohort investigations with few RCTs and most were limited due to enrollment of various tumor stages and did not compare treatment modalities for specific tumor stages. AREAS COVERED A literature search for recurrent HCC was performed using Medline and PubMed up to May 2016. Expert commentary: The long term survival results after re-resection for recurrent HCC were favourable and aggressive management of postoperative intrahepatic recurrence remains the most important strategy in prolonging the survival of patients after resection of HCC.
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Affiliation(s)
- Wing Chiu Dai
- a Department of Surgery , The University of Hong Kong , Hong Kong , China
| | - Tan To Cheung
- a Department of Surgery , The University of Hong Kong , Hong Kong , China
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Takahara T, Wakabayashi G, Nitta H, Hasegawa Y, Katagiri H, Takeda D, Makabe K, Sasaki A. Laparoscopic liver resection for hepatocellular carcinoma with cirrhosis in a single institution. Hepatobiliary Surg Nutr 2016; 4:398-405. [PMID: 26734624 DOI: 10.3978/j.issn.2304-3881.2015.12.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In a statement by the second International Consensus Conference for Laparoscopic Liver Resection (LLR), minor LLR was confirmed to be a standard surgical practice, as it has become adopted by an increasing proportion of surgeons. However, it is unclear whether this applies to the more complex group of patients suffering from cirrhosis. Therefore, the aim of this retrospective study was to compare the feasibility and safety of LLR for hepatocellular carcinoma (HCC) between non-liver cirrhosis (NLC) patients and liver cirrhosis (LC) patients at a single high-volume laparoscopy center. METHODS From the beginning of 2000 to the end of 2013, open liver resection (OLR) was performed in 99 HCC patients, and LLR was in 118. The HCC patients who underwent LLR were divided into NLC-LLR (n=60) and LC-LLR (n=58) groups, and we compare the short-term outcomes between them. RESULTS There was no significant difference in the incidence of blood loss and transfusion requirements between the NLC-LLR group and the LC-LLR group, although wedge resection was mainly performed in the LC-LLR group. There was no significant difference in the complication rate between the two groups, and the remarkable finding was that there was a significantly lower incidence of postoperative ascites in the LC-LLR group than in the NLC-LLR group. CONCLUSIONS According to our experience, it appears that LLR for selected HCC patients with cirrhosis is a feasible and promising procedure that is associated with less blood loss and fewer postoperative complications, especially the incidence of postoperative ascites. Further investigations are clearly warranted.
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Affiliation(s)
- Takeshi Takahara
- 1 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan ; 2 Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Go Wakabayashi
- 1 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan ; 2 Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Hiroyuki Nitta
- 1 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan ; 2 Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Yasushi Hasegawa
- 1 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan ; 2 Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Hirokatsu Katagiri
- 1 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan ; 2 Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Daiki Takeda
- 1 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan ; 2 Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Kenji Makabe
- 1 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan ; 2 Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Akira Sasaki
- 1 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan ; 2 Department of Surgery, Ageo Central General Hospital, Saitama, Japan
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Benzing C, Krenzien F, Atanasov G, Seehofer D, Sucher R, Zorron R, Pratschke J, Schmelzle M. Single incision laparoscopic liver resection (SILL) - a systematic review. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2015; 4:Doc17. [PMID: 26734538 PMCID: PMC4686817 DOI: 10.3205/iprs000076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Today, minimally invasive liver resections for both benign and malignant tumors are routinely performed. Recently, some authors have described single incision laparoscopic liver resection (SILL) procedures. Since SILL is a relatively young branch of laparoscopy, we performed a systematic review of the current literature to collect data on feasibility, perioperative results and oncological outcome. Methods: A literature research was performed on Medline for all studies that met the eligibility criteria. Titles and abstracts were screened by two authors independently. A study was included for review if consensus was obtained by discussion between the authors on the basis of predefined inclusion criteria. A thorough quality assessment of all included studies was performed. Data were analyzed and tabulated according to predefined outcome measures. Synthesis of the results was achieved by narrative review. Results: A total of 15 eligible studies were identified among which there was one prospective cohort study and one randomized controlled trial comparing SILL to multi incision laparoscopic liver resection (MILL). The rest were retrospective case series with a maximum of 24 patients. All studies demonstrated convincing results with regards to feasibility, morbidity and mortality. The rate of wound complications and incisional hernia was low. The cosmetic results were good. Conclusions: This is the first systematic review on SILL including prospective trials. The results of the existing studies reporting on SILL are favorable. However, a large body of scientific evidence on the field of SILL is missing, further randomized controlled studies are urgently needed.
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Affiliation(s)
- Christian Benzing
- Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Krenzien
- Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georgi Atanasov
- Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Seehofer
- Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Sucher
- Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ricardo Zorron
- Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johann Pratschke
- Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Schmelzle
- Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
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