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Kobayashi N, Yoshida H, Fujikawa N, Yoshimachi S, Kohyama A, Kawaguchi S. Diagnostic utility of EUS-FNA in distinguishing hepatocellular carcinoma from gastric submucosal tumor: A case report. Int J Surg Case Rep 2023; 110:108715. [PMID: 37633197 PMCID: PMC10509792 DOI: 10.1016/j.ijscr.2023.108715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Extrahepatically growing hepatocellular carcinoma (HCC) account for only 0.3 %-2.4 % of all hepatocellular carcinoma cases. We present the rare case of a patient in whom endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was used to distinguish an extrahepatically growing HCC from a gastric submucosal tumor. CASE PRESENTATION The patient was a 44-year-old man who underwent an esophagogastroduodenoscopy (EGD) and was found to have a submucosal tumor (SMT). A gastrointestinal stromal tumor was suspected. Computed tomography (CT) showed an unclear connecting between the tumor and the liver. On immunohistochemical analysis, the tumor cells were positive for CK7, PIVKA-II, and glypican-3, and negative for C-kit. Based on these findings, HCC was suspected, and ethoxybenzyl diethylenetriamine-enhanced magnetic resonance imaging (EOB-MRI) was performed. EOB-MRI revealed the connecting of the tumor and the liver. Thus, the patient was diagnosed as having an extrahepatically protruding HCC, and laparoscopic S2 partial hepatectomy was performed. Pathologically, the tumor was identified as a moderately differentiated HCC. According to the 8th edition of the UICC TNM Classification, the tumor was classified as T1bN0M0 and stage IB. CLINICAL DISCUSSION Owing to its rarity, the diagnosis of an extrahepatically protruding HCC is often difficult when the differentiation of a gastric SMT and HCC is unclear on CT. As in this case, if an HCC is also differentiated on hematoxylin and eosin staining after EUS-FNA, immunohistochemistry findings can help in the diagnosis. CONCLUSION The findings show that EUS-FNA could be helpful for diagnosis when an HCC needs to be differentiated from a gastric SMT.
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Affiliation(s)
- Naoya Kobayashi
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan.
| | - Hiroshi Yoshida
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan
| | - Nanako Fujikawa
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan
| | - Shingo Yoshimachi
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan
| | - Atsushi Kohyama
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan
| | - Shinya Kawaguchi
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan
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Chiang MH, Tsai KY, Chen HA, Wang WY, Huang MT. Comparison of surgical outcomes for laparoscopic liver resection of large hepatocellular carcinomas: A retrospective observation from single-center experience. Asian J Surg 2021; 44:1376-1382. [PMID: 33888363 DOI: 10.1016/j.asjsur.2021.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/21/2020] [Accepted: 03/24/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND/PURPOSE Although laparoscopic liver resection (LLR) is a common surgical procedure for hepatocellular carcinoma (HCC), its suitability for large HCCs (≥5 cm) remains controversial. This study compared surgical outcomes of open hepatectomy with LLR for large HCCs. METHODS A total of 313 patients with HCC who underwent hepatectomy between January 2010 and June 2017 were analyzed retrospectively. Demographic data, short-term outcomes, and long-term survivals were analyzed. RESULTS Among patients with large HCCs (n = 122), the open group (n = 85) had larger tumor sizes (10.91 ± 4.72 vs. 7.45 ± 2.95 cm; p < 0.001) and more advanced stages (stages 3/4: 71.8% vs. 45.9%; p = 0.029) than the LLR group (n = 37), while LLR group achieved less blood loss (623.24 ± 841.75 mL vs. 1091.76 ± 1004.72 mL, p = 0.014) and shorter LOS (9.00 ± 5.13 d vs. 12.82 ± 8.51 d, p = 0.013). There were no significant differences in complication and mortality rates between groups. The 5-year overall and recurrence-free survival rates between the two groups were not significantly different (p = 0.408 and 0.644 respectively). The surgical outcomes showed equal benefit of the two operation types. CONCLUSION With sufficient surgeon experience and appropriate patient selection, LLR is a feasible treatment choice for large HCCs.
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Affiliation(s)
- Meng-Hsuan Chiang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuei-Yen Tsai
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsin-An Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wan-Yu Wang
- Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ming-Te Huang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Gil E, Kwon CHD, Kim JM, Choi GS, Heo JS, Cho W, Gwak MS, Gwak GY, Joh JW. Laparoscopic Liver Resection of Hepatocellular Carcinoma with a Tumor Size Larger Than 5 cm: Review of 45 Cases in a Tertiary Institution. J Laparoendosc Adv Surg Tech A 2017; 27:799-803. [PMID: 28080205 DOI: 10.1089/lap.2016.0575] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Although laparoscopic liver resection (LLR) has developed rapidly, its usefulness for the treatment of large tumors is less clear, due to concerns about compromising oncological principles and patient safety. The purpose of this study was to explore the feasibility and safety of LLR for the treatment of hepatocellular carcinoma (HCC) with a tumor size larger than 5 cm. PATIENTS AND METHODS From January 2007 to December 2014, we performed LLR in 45 patients with HCC with a tumor size ≥5 cm. Perioperative outcome, tumor recurrence, and overall patient survival were analyzed. RESULTS Median age was 60 years (interquartile range [IQR] 52-68) and 64.4% (29/45) were male. Seven patients (15.6%) had larger than 10 cm of HCC. No operative deaths occurred and six of the laparoscopic procedures were converted to open resection (conversion rate 13.3%). Median operation time was 365 minutes (IQR 277-443) and median estimated blood loss (EBL) was 400.0 mL (IQR 275-600). There was no R1 or R2 resection and median resection margin was 19.0 mm (IQR 8.0-33.0). Complications above Clavien-Dindo classification grade III occurred in four patients (8.9%). The median overall follow-up time was 10.7 month (range 1.1-62.1). One-year recurrence free survival (RFS) and overall survival (OS) were 86.0% and 95.5%, and 3-year RFS and OS were 70.7% and 86.0%. CONCLUSION LLR appears safe and feasible in patients with HCC with a tumor size larger than 5 cm. Expansion of indication for LLR in patients with HCC may be considered.
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Affiliation(s)
- Eunmi Gil
- 1 Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea.,2 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Choon Hyuck D Kwon
- 2 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Jong Man Kim
- 2 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Gyu-Seong Choi
- 2 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Jin Seok Heo
- 2 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Wontae Cho
- 3 Department of Surgery, Hallym University Dongtan Sacred Heart Hospital , Hwaseong, Korea
| | - Mi Sook Gwak
- 4 Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Geum-Youn Gwak
- 5 Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Jae-Won Joh
- 2 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
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Shelat VG, Cipriani F, Basseres T, Armstrong TH, Takhar AS, Pearce NW, AbuHilal M. Pure laparoscopic liver resection for large malignant tumors: does size matter? Ann Surg Oncol 2015; 22:1288-93. [PMID: 25256130 DOI: 10.1245/s10434-014-4107-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) for large malignant tumors can be technically challenging. Data on this topic are scarce, and many question its feasibility, safety, and oncologic efficiency. This study aimed to assess outcomes of LLR for large (≥ 5 cm) and giant (≥ 10 cm) malignant liver tumors. METHODS A prospectively collected database of 422 LLRs was reviewed from August 2003 to August 2013. The data for 52 patients undergoing LLR for large malignant tumors were analyzed. A subgroup analysis of giant tumors also is reported. RESULTS During the period studied, 52 LLRs were performed (males, 53.8 %; mean age, 64.6 years) for large malignant tumors. Colorectal liver metastasis was the most common indication (42.3 %). The 52 LLRs included 32 major (61.5 %) and 20 minor (38.5 %) LLRs for tumors with a mean diameter of 83 mm. The median operative time was 240 min [interquartile range (IQR), 150-330 min], and the blood loss was 500 ml (IQR, 200-1,373 ml). Eight conversions (15.4 %) were performed. Six patients experienced complications (11.5 %). Among the 44 patients with successful LLRs, two patients (4.5 %) had an R1 resection. The median hospital stay was 5 days (range, 1-21 days), and no mortality occurred during a 90-day period. A subgroup analysis of patients with giant tumors showed greater blood loss (p = 0.002) and a longer operative time (p = 0.052) but no difference in terms of conversions (p = 0.64) or complications (p = 0.32). CONCLUSION The findings showed that LLR is feasible and safe for large malignant tumors and can be performed with acceptable morbidity and oncologic efficiency. When used for giant malignant tumors, LLR is associated with greater blood loss and a longer operative time but no increase in complications.
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Affiliation(s)
- Vishal G Shelat
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Glenisson M, Salloum C, Lim C, Lacaze L, Malek A, Henriquez A, Compagnon P, Laurent A, Azoulay D. Les lobes accessoires du foie : anatomie et implications cliniques. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.jchirv.2014.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Glenisson M, Salloum C, Lim C, Lacaze L, Malek A, Enriquez A, Compagnon P, Laurent A, Azoulay D. Accessory liver lobes: anatomical description and clinical implications. J Visc Surg 2014; 151:451-5. [PMID: 25448768 DOI: 10.1016/j.jviscsurg.2014.09.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Accessory liver lobes are a rare condition and appear to be due to excessive development of the liver. The presence of an accessory hepatic lobe is often diagnosed incidentally and sometimes revealed if it develops torsion, especially in pedunculated forms. In most cases, the accessory lobe is located below the liver, i.e., infrahepatic. Riedel's lobe is the best-known example of an accessory lobe, corresponding to hypertrophy of segments V and VI. While accessories lobes can simulate tumors, there have also been reports of hepatocellular tumor(s) that developed in these accessory lobes. Based on a review of the literature, this update focuses on accessory hepatic lobes.
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Affiliation(s)
- M Glenisson
- Service de chirurgie digestive, hépatobiliaire, pancréatique et transplantation hépatique, hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - C Salloum
- Service de chirurgie digestive, hépatobiliaire, pancréatique et transplantation hépatique, hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - C Lim
- Service de chirurgie digestive, hépatobiliaire, pancréatique et transplantation hépatique, hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - L Lacaze
- Service de chirurgie digestive, hépatobiliaire, pancréatique et transplantation hépatique, hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - A Malek
- Service de chirurgie digestive, hépatobiliaire, pancréatique et transplantation hépatique, hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - A Enriquez
- Service de chirurgie digestive, hépatobiliaire, pancréatique et transplantation hépatique, hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - P Compagnon
- Service de chirurgie digestive, hépatobiliaire, pancréatique et transplantation hépatique, hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - A Laurent
- Service de chirurgie digestive, hépatobiliaire, pancréatique et transplantation hépatique, hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - D Azoulay
- Service de chirurgie digestive, hépatobiliaire, pancréatique et transplantation hépatique, hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
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Beppu T, Nitta H, Tsukamoto M, Imai K, Hayashi H, Okabe H, Hashimoto D, Chikamoto A, Ishiko T, Baba H. Percutaneous radiofrequency ablation-assisted laparoscopic hepatectomy. Asian J Endosc Surg 2014; 7:188-92. [PMID: 24754887 DOI: 10.1111/ases.12088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/09/2013] [Accepted: 12/15/2013] [Indexed: 12/07/2022]
Abstract
Metachronous rectal liver metastasis (15 mm in segment 8 ventral) was managed with laparoscopic hepatectomy using segmental blood flow occlusion with radiofrequency ablation. During liver dissection, the ischemic area was visible as a distinct hypoechoic area on intraoperative enhanced ultrasound; with a photodynamic eye camera, it appeared as a discolored lesion. The resection was completed with adequate margins.
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Affiliation(s)
- Toru Beppu
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan; Department of Multidisciplinary Treatment for Gastroenterological Cancer, Innovation Center for Translational Research, Kumamoto University Hospital, Kumamoto, Japan
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Ai JH, Li JW, Chen J, Bie P, Wang SG, Zheng SG. Feasibility and safety of laparoscopic liver resection for hepatocellular carcinoma with a tumor size of 5-10 cm. PLoS One 2013; 8:e72328. [PMID: 23991092 PMCID: PMC3749106 DOI: 10.1371/journal.pone.0072328] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 07/09/2013] [Indexed: 12/23/2022] Open
Abstract
Background Although laparoscopic liver resection has developed rapidly and gained widespread acceptance for the treatment of benign liver diseases and hepatocellular carcinoma with a small tumor size, its usefulness for the treatment of large tumors is less clear, due to concerns about compromising oncological principles and patient safety. The purpose of this study was to explore the safety and feasibility of laparoscopic liver resection for the treatment of hepatocellular carcinoma with a tumor size of 5–10 cm. Methods From March 2007 to December 2011, we performed liver resection in 275 patients with hepatocellular carcinoma with a tumor size of 5–10 cm. Laparoscopic liver resection was performed in 97 patients (Lap-Hx group) and open liver resection was performed in 178 patients (Open-Hx group). Operative time, estimated intraoperative blood loss, blood transfusion rate, and length of postoperative hospital stay were compared between the two groups. Early and intermediate-term postoperative outcomes were also compared. Results Only one liver resection was performed for every patient with HCC in the present study.No operative deaths occurred in either group. Nine of the laparoscopic procedures were converted to open resection (conversion rate 9.28%). There were no significant differences in mean operative time (245±105 min vs 225±112 min; P = .469), mean estimated intraoperative blood loss (460±426 mL vs 454±365 mL; P = .913), or blood transfusion rate (4.6%, 4/88) vs (2.8%, 5/178)(P = .480) between the Lap-Hx and Open-Hx groups. However, postoperative hospital stay was shorter in the Lap-Hx group than the Open-Hx group (8.2±3.6 days vs 13.5±3.8 days; P = .028). There was a lower rate of postoperative complications in the Lap-Hx group than the Open-Hx group (9% vs 30%; P = .001), but there were no severe complications in either group. The median overall follow-up time was 21 months (range 2–50 months) and the median follow-up of time of survivors was 23 months. The median follow-up time was 25 months in the Lap-Hx group and 20 months in the Open-Hx group. The follow-up rate was 95% (84 patients) in the Lap-Hx group and 95% (169 patients) in the Open-Hx group, which was not a significant difference between the two groups (P = .20). Tumor recurrence occurred in 17 patients (20%) in the Lap-Hx group and 35 patients (21%) in the Open-Hx group, which was not a significant difference between the two groups (P = .876). A total of 33 patients (13%) died during the study period, including 12 patients (14%) in the Lap-Hx group and 21 patients (12%) in the Open-Hx group, which was not a significant difference between the two groups (P = .695). There were also no significant differences in the 1-year rates of overall survival (94% vs 95%; P = .942) or disease-free survival (93% vs 92%; P = .941), or the 3-year rates of overall survival (86% vs 88%; P = .879) or disease-free survival (66% vs 67%; P = .931), between the Lap-Hx and Open-Hx groups. Conclusions Laparoscopic liver resection is safe and feasible in patients with hepatocellular carcinoma with a tumor size of 5–10 cm. Laparoscopic liver resection can avoid some of the disadvantages of open resection, and is beneficial in selected patients based on preoperative liver function, tumor size and location.
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Affiliation(s)
- Jun-hua Ai
- Department of General Surgery, Chinese People’s Armed Police Force 8710 Hospital, Putian, People’s Republic of China
- The Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, People’s Republic of China
| | - Jian-wei Li
- The Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, People’s Republic of China
| | - Jian Chen
- The Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, People’s Republic of China
| | - Ping Bie
- The Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, People’s Republic of China
| | - Shu-guang Wang
- The Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, People’s Republic of China
| | - Shu-Guo Zheng
- The Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, People’s Republic of China
- * E-mail:
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Toro A, Gagner M, Di Carlo I. Has laparoscopy increased surgical indications for benign tumors of the liver? Langenbecks Arch Surg 2012; 398:195-210. [PMID: 23053460 DOI: 10.1007/s00423-012-1012-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 09/25/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND We aimed to analyze the risk of an increased surgical indication rate in patients with benign tumors of the liver since the development of laparoscopy. Previous articles have reported increased numbers of laparoscopic procedures in different surgical fields. METHODS A literature search of MEDLINE (PubMed), Google Scholar, and The Cochrane Library was carried out. All articles that analyzed benign liver tumors (hemangiomas, focal nodular hyperplasia, and adenoma) were divided in two groups: group I included all manuscripts with open procedures between 1971 at 1990, and group II included all manuscripts with open or laparoscopic procedures between 1991 and 2010. Group II articles were divided into two subgroups. Subgroup IIA patients were treated by open or laparoscopic procedures between 1991 and 2000, and subgroup IIB patients were treated by open or laparoscopic procedures between 2001 and 2010. RESULTS Specific analysis of each kind of tumor observed in the two groups showed fewer surgically treated patients for hepatic hemangioma and hepatic adenoma in group II compared with group I and a greater number of patients for focal nodular hyperplasia. Fewer patients were treated with laparoscopic procedures in subgroup IIA than in subgroup IIB. A chi-square test with Yates' correction gave a P value of <0.001. CONCLUSION Laparoscopy has increased the rate of hepatic resection for benign tumors with doubtful indications.
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Affiliation(s)
- Adriana Toro
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, Cannizzaro Hospital, University of Catania, Via Messina 829, Catania, Italy
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Ishii J, Otsuka Y, Tsuchiya M, Kubota Y, Katagiri T, Maeda T, Tamura A, Kaneko H. Application of microwave tissue coagulator in laparoscopic hepatectomy for the patients with liver cirrhosis. ACTA ACUST UNITED AC 2012. [DOI: 10.3380/jmicrowavesurg.30.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Eiriksson K, Fors D, Rubertsson S, Arvidsson D. High intra-abdominal pressure during experimental laparoscopic liver resection reduces bleeding but increases the risk of gas embolism. Br J Surg 2011; 98:845-52. [PMID: 21523699 DOI: 10.1002/bjs.7457] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND Various recommendations exist regarding intra-abdominal pressure (IAP) during laparoscopic liver resection. A high IAP may reduce bleeding but at the same time increase the risk of gas embolism. This study investigated the effects of two different IAPs during laparoscopic left liver lobe resection in piglets. METHODS Sixteen piglets underwent laparoscopic left liver lobe resection using carbon dioxide pneumoperitoneum of either 8 or 16 mmHg (8 per group). A combination of CUSA System 200™ and LigaSure™ instruments was used for parenchymal division. During resection, a standard injury to the left liver vein was also created to increase the risk of bleeding and/or gas embolism during the operation. Heart rate, cardiac output, and arterial, pulmonary arterial, pulmonary capillary wedge and central venous pressures were measured. Arterial blood gases were monitored continuously. Transoesophageal echocardiography was video recorded to detect and quantify gas embolism within the right cardiac ventricle. The duration of operation and bleeding were noted. RESULTS High IAP resulted in reduced bleeding (P = 0·016), but gas embolism occurred more frequently (P = 0·001) than with low IAP. Gas embolism disturbed gas exchange, with an increase in arterial pressure of carbon dioxide, and a decrease in arterial partial pressure of oxygen and pH. These effects were sustained for at least 30 min after surgery. CONCLUSION High IAP reduces the amount of bleeding but increases the risk of gas embolism. Monitoring for gas embolism is therefore indicated if a high IAP is used during laparoscopic liver resection.
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Affiliation(s)
- K Eiriksson
- Department of Surgery, Stavanger University Hospital, Stavanger, Norway.
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12
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Endo Y, Ohta M, Sasaki A, Kai S, Eguchi H, Iwaki K, Shibata K, Kitano S. A comparative study of the long-term outcomes after laparoscopy-assisted and open left lateral hepatectomy for hepatocellular carcinoma. Surg Laparosc Endosc Percutan Tech 2011; 19:e171-4. [PMID: 19851245 DOI: 10.1097/sle.0b013e3181bc4091] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic hepatectomy was initially reported in 1992. However, the reported experiences are scarce, and this operation has not been a standard procedure until now. The aims of this study were to assess our results of laparoscopy-assisted left lateral hepatectomy for hepatocellular carcinoma (HCC) and to compare them with those of open conventional procedures. METHODS From 1984 to 2002, left lateral hepatectomy for HCC less than 5 cm in diameter was carried out in 21 patients. Ten patients received a laparoscopy-assisted procedure, and remaining 11 patients received an open procedure. RESULTS There were no significant differences in the operation time, blood loss, resected liver weight, and resection margin between the 2 groups. The total time that analgesics were given, body temperature on postoperative day 1, weight loss on postoperative day 7, and postoperative hospital stay in the laparoscopic group were significantly better than in the conventional group. With regard to the long-term prognosis, there were no differences in patient survival or disease-free survival rates between the 2 groups. CONCLUSIONS Laparoscopy-assisted left lateral hepatectomy for HCC is superior to the conventional open surgery in terms of its short-term results and does not cause the long-term survival to deteriorate. Therefore, laparoscopic hepatectomy may be an alternative choice for treatment of HCC.
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Affiliation(s)
- Yuichi Endo
- Department of Surgery I, Oita University Faculty of Medicine, Oita, Japan.
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Yoon YS, Han HS, Cho JY, Ahn KS. Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc 2009; 24:1630-7. [PMID: 20035349 DOI: 10.1007/s00464-009-0823-6] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 07/01/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) is still not a well-established treatment modality for hepatocellular carcinoma (HCC). Moreover, most reported cases have been limited to tumors in the anterolateral (AL) segments (segments 2, 3, 4b, 5, and 6). We evaluated clinical and oncologic outcomes after LLR for HCC located in all segments, including lesions located in the posterosuperior (PS) segments (segments 1, 4a, 7, and 8). METHODS This retrospective study included 69 patients who had undergone LLR for HCC between September 2003 and November 2008. The patients were divided into two groups (group AL and group PS) according to tumor location. The clinical data of the two groups were retrospectively analyzed. RESULT There was no postoperative mortality. Fifteen patients (21.7%) experienced 19 postoperative complications. During a median follow-up period of 21.3 months, recurrence was detected in 21 (30.4%) patients. The 3-year overall survival rate and disease-free survival rate were 90.4 and 60.4%, respectively. There was no difference in clinicopathologic characteristics between the two groups except for a male predominance in group PS (p = 0.021) and that there were more patients with thrombocytopenia in group AL (p = 0.001). Although group PS patients had longer operative time (p = 0.001) and longer postoperative hospital stay (p = 0.039), along with a tendency toward a higher rate of open conversion (p = 0.054) and greater blood loss (p = 0.068), there was no significant difference in rates of postoperative complications (p = 0.375), recurrence (p = 0.740), 3-year overall survival (p = 0.237) or disease-free survival (p = 0.411) between the two groups. CONCLUSIONS Our experience shows that LLR can be safely performed in selected patients with HCC located in all segments of the liver, including the posterosuperior segments, with acceptable postoperative morbidity and oncologic results.
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Affiliation(s)
- Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi, 463-707, Korea
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Abstract
AIM: To summarize the clinical experience of laparoscopic hepatectomy at a single center.
METHODS: Between November 2003 and March 2009, 78 patients with hepatocellular carcinoma (n = 39), metastatic liver carcinoma (n = 10), and benign liver neoplasms (n = 29) underwent laparoscopic hepatectomy in our unit. A retrospective analysis was done on the clinical outcomes of the 78 patients.
RESULTS: The lesions were located in segments I (n = 3), II (n = 16), III (n = 24), IV (n = 11), V (n = 11), VI (n = 9), and VIII (n = 4). The lesion sizes ranged from 0.8 to 15 cm. The number of lesions was three (n = 4), two (n = 8) and one (n = 66) in the study cohort. The surgical procedures included left hemi-hepatectomy (n = 7), left lateral lobectomy (n = 14), segmentectomy (n = 11), local resection (n = 39), and resection of metastatic liver lesions during laparoscopic surgery for rectal cancer (n = 7). Laparoscopic liver resection was successful in all patients, with no conversion to open procedures. Only four patients received blood transfusion (400-800 mL). There were no perioperative complications, such as bleeding and biliary leakage. The liver function of all patients recovered within 1 wk, and no liver failure occurred.
CONCLUSION: Laparoscopic hepatectomy is a safe and feasible operation with minimal surgical trauma. It should be performed by a surgeon with sufficient experience in open hepatic resection and who is proficient in laparoscopy.
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Kaneko H, Tsuchiya M, Otsuka Y, Yajima S, Minagawa T, Watanabe M, Tamura A. Laparoscopic hepatectomy for hepatocellular carcinoma in cirrhotic patients. ACTA ACUST UNITED AC 2009; 16:433-8. [PMID: 19458892 DOI: 10.1007/s00534-009-0123-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 03/31/2009] [Indexed: 02/08/2023]
Abstract
INTRODUCTION We have used laparoscopic hepatectomy as a surgical treatment for HCC in patients with cirrhosis. We describe the indications, evaluate invasiveness and analyze the outcomes of laparoscopic hepatectomy. METHODS AND RESULTS With respect to operative method, laparoscopic hepatectomy involving either partial hepatectomy or left lateral sectionectomy is a less invasive procedure in patients with cirrhosis than conventional hepatectomy. Among our laparoscopic hepatectomy cases, operative time was shorter and bleeding was less in recent, as compared to earlier, cases. Furthermore, laparoscopic hepatectomy was less invasive than conventional hepatectomy, as determined by the E-PASS scoring system. Patients also recovered more quickly, which resulted in shorter hospital stays even for patients with cirrhosis. Both the 5-year survival rate and the rate of survival without recurrence of HCC were nearly identical to those of open conventional hepatectomy. CONCLUSION These findings indicate that laparoscopic hepatectomy avoids the disadvantages of standard hepatectomy for HCC in properly selected patients with cirrhosis and that its minimal invasiveness improves patients' quality of life.
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Affiliation(s)
- Hironori Kaneko
- Department of Surgery (Omori), Toho University School of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-0015, Japan.
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16
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Laparoscopic left lobe liver resection in a porcine model: a study of the efficacy and safety of different surgical techniques. Surg Endosc 2008; 23:1038-42. [DOI: 10.1007/s00464-008-0115-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 06/26/2008] [Accepted: 07/13/2008] [Indexed: 12/26/2022]
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17
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Santambrogio R, Aldrighetti L, Barabino M, Pulitanò C, Costa M, Montorsi M, Ferla G, Opocher E. Laparoscopic liver resections for hepatocellular carcinoma. Is it a feasible option for patients with liver cirrhosis? Langenbecks Arch Surg 2008; 394:255-64. [PMID: 18553101 DOI: 10.1007/s00423-008-0349-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Accepted: 04/28/2008] [Indexed: 12/29/2022]
Abstract
BACKGROUND Laparoscopic surgery has gained growing acceptance, but this does not hold for laparoscopic surgery of the liver, above all for patients with hepatocellular carcinoma (HCC) and cirrhosis. This approach mainly includes diagnostic procedures and interstitial therapies. However, we believe there is room for laparoscopic liver resections in well-selected cases. The aim of this study is to assess: (a) the risk of intraoperative bleeding and postoperative complications, (b) the safety and the respect of oncological criteria, and (c) the potential benefit of laparoscopic ultrasound in guiding liver resection. METHODS A prospective study of laparoscopic liver resections for hepatocellular carcinoma was undertaken in patients with compensated cirrhosis. Hepatic involvement had to be limited and located in the left or peripheral right segments (segments 2-6), and the tumor had to be 5 cm or smaller. Tumor location and its transection margins were defined by laparoscopic ultrasound. RESULTS From January 1997, 22 out of 250 patients with HCC (9%) underwent laparoscopic liver resections. The mean patient age was 61.4 years (range, 50-79 years). In three patients, conversion to laparotomy was necessary. The laparoscopic resections included five bisegmentectoies (2 and 3), nine segmentectomies, two subsegmentectomies and three nonanatomical resections for extrahepatic growing lesions. The mean operative time, including laparoscopic ultrasonography, was 199 +/- 69 min (median, 220; range, 80-300). Perioperative blood loss was 183 +/- 72 ml (median, 160; range, 80-400 ml). There was no mortality. Postoperative complications occurred in two out of 19 patients: an abdominal wall hematoma occurred in one patient and a bleeding from a trocar access in the other patient requiring a laparoscopic re-exploration. Mean hospital stay of the whole series was 6.5 +/- 4.3 days (median, 5; range, 4-25), while the mean hospital stay of the 19 laparoscopic patients was 5.4 +/- 1 (median, 5; range, 4-8). CONCLUSION Laparoscopic treatment should be considered in selected patients with HCC and liver cirrhosis in the left lobe or segments 5 and 6 of the liver. It is clear that certain types of laparoscopic resection are feasible and safe when carried out by adequately skilled surgeons with appropriate instruments.
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Affiliation(s)
- R Santambrogio
- Bilio-Pancreatic Surgery Unit, Università degli Studi di Milano, Ospedale San Paolo, Milan, Italy.
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Laparoscopy-assisted hepatectomy for giant hepatocellular carcinoma. Surg Laparosc Endosc Percutan Tech 2008; 18:127-31. [PMID: 18288006 DOI: 10.1097/sle.0b013e318158237b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED The indications for laparoscopic hepatectomy were limited; generally, tumors smaller than 5 cm serve as proper indications. Here, we initially report on a patient with huge hepatocellular carcinoma (HCC) sized 15 cm in the left lateral segment who was treated by laparoscopy-assisted technique. SURGICAL TECHNIQUE 3 trocars were inserted under pneumoperitoneum. The attached ligament was divided and mobilization of the liver could be performed with laparoscopic coagulating system. In accomplishing this maneuver, upper median skin incision of 7 cm was made. The left lateral segment was exposed to be lifted up the tape around the liver. Dissecting sealer (DS30) was used for transection of the liver parenchyma. The relatively large branched vessels and ducts were ligated and transected by direct view from upper median 7-cm incision. Segment 2 and 3 Glisson's sheaths and left hepatic vein were divided using an endolinear stapler. A Hand Port system laparotomy device was installed under pneumoperitoneum, the resected liver maneuvered into a suitable sized plastic bag by endoscopic view. Extraction of the undivided specimen was performed, thus enabling histologic review. Operation time was 170 minutes and operative blood loss was 100 g. The tumor was a 15x12x9 cm in size. Oral intake and ambulation was on the first day; 7 days after the surgery patient was discharged with an uneventful postoperative course. Because of the specific characteristics of HCCs such as their high recurrence rate, the most important goals in HCC treatment are curability and minimal invasiveness. Laparoscopic hepatectomy in this case is beneficial for the patients' quality of life as a minimally invasive operation.
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Mamada Y, Yoshida H, Taniai N, Mizuguchi Y, Kakinuma D, Ishikawa Y, Yokomuro S, Arima Y, Akimaru K, Tajiri T. Usefulness of laparoscopic hepatectomy. J NIPPON MED SCH 2007; 74:158-62. [PMID: 17507792 DOI: 10.1272/jnms.74.158] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to investigate the advantages of laparoscopic hepatectomy over open surgery for liver tumors. PATIENTS AND METHOD A retrospective study was performed of 10 patients with liver tumors (9 with hepatocellular carcinoma and 1 with focal nodular hyperplasia) at our hospital. Five patients who had received laparoscopic hepatectomy (Lap-Hx group) were compared with 5 patients who had undergone open hepatectomy (O-Hx group) in the same period. The operative procedure was partial hepatectomy and cholecystectomy in both groups. For liver excision, a microwave coagulation device and an ultrasonically activated scalpel were used. RESULTS Mean patient age was 55.6 +/- 13.9 years in the Lap-Hx group and 51.8 +/- 14.1 years in the O-Hx group. Four patients in the Lap-Hx group had hepatocellular carcinoma with liver cirrhosis and 1 patient had focal nodular hyperplasia. All patients in the O-Hx group had hepatocellular carcinoma and 4 patients had associated liver cirrhosis. The mean tumor size was 2.6 +/- 1.5 cm in the Lap-Hx group and 3.0 +/- 1.8 cm in the O-Hx group. The two groups did not thus differ significantly in the preoperative background factors. Blood loss and duration of the postoperative hospital stay were significantly less in the Lap-Hx than in the O-Hx groups(213 +/- 82 vs 247 +/- 97 min; 154 +/- 128 vs 648 +/- 468 ml, p=0.05: and 10.4 +/- 2.3 vs 18.0 +/- 5.1 days, p=0.017), but operating time did not differ significantly. CONCLUSIONS Laparoscopic hepatectomy has the advantages of reducing the amount of operative blood loss because of the magnified view afforded by the laparoscope and shortening the hospital stay. The procedure is therefore recommended for patients with appropriate liver tumors, in particular, hepatocellular carcinoma in the cirrhotic liver.
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Affiliation(s)
- Yasuhiro Mamada
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
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20
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Chang S, Laurent A, Tayar C, Karoui M, Cherqui D. Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg 2007; 94:58-63. [PMID: 17054316 DOI: 10.1002/bjs.5562] [Citation(s) in RCA: 192] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Since 1997, the authors have performed laparoscopic left lateral sectionectomy of lesions of the liver in preference to open surgery. The aim of this study was to assess the outcome. METHODS Between October 1997 and March 2005, 36 laparoscopic left lateral sectionectomies were performed using five trocars and a small incision for specimen retrieval. Liver resection was performed mainly using a harmonic scalpel and staplers. The Pringle manoeuvre was used in 24 patients. RESULTS The mean patient age was 55.2 (range 31-80) years. Twelve patients had underlying cirrhosis. Surgery was performed for 20 malignant lesions and 16 benign lesions with a mean size of 42.7 (range 5-110) mm. Conversion to laparotomy occurred in one patient. The mean operating time was 171.5 (range 90-240) min. Operatiing time and use of the Pringle manoeuvre were significantly decreased in the second half of the series. Mean blood loss was 208 (range 50-600) ml. No transfusion was required. There were no deaths. Two patients had postoperative complications (one incisional hernia and one pneumonia). The median postoperative stay was 5.2 days. CONCLUSION The laparoscopic approach to left lateral sectionectomy was safe and feasible in this series and could be considered as a routine approach in selected patients.
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Affiliation(s)
- S Chang
- Department of Digestive Surgery, Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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Simillis C, Constantinides VA, Tekkis PP, Darzi A, Lovegrove R, Jiao L, Antoniou A. Laparoscopic versus open hepatic resections for benign and malignant neoplasms--a meta-analysis. Surgery 2006; 141:203-211. [PMID: 17263977 DOI: 10.1016/j.surg.2006.06.035] [Citation(s) in RCA: 284] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2006] [Revised: 06/01/2006] [Accepted: 06/12/2006] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic surgery for hepatic neoplasms aims to provide curative resection while minimizing complications. The present study compared laparoscopic versus open surgery for patients with hepatic neoplasms with regard to short-term outcomes. METHODS Comparative studies published between 1998 and 2005 were included. Evaluated endpoints were operative, functional, and adverse events. A random-effects model was used and sensitivity analysis performed to account for bias in patient selection. RESULTS Eight nonrandomized studies were included, reporting on 409 resections of hepatic neoplasms, of which 165 (40.3%) were laparoscopic and 244 (59.7%) were open. Operative blood loss (weighted mean difference = -123 mL; confidence interval = -179, -67 mL) and duration of hospital stay (weighted mean difference = -2.6 days; confidence interval = -3.8, -1.4 days) were significantly reduced after laparoscopic surgery. These findings remained consistent when considering studies matched for the presence of malignancy and segment resection. There was no difference in postoperative adverse events and extent of oncologic clearance. CONCLUSIONS Laparoscopic resection results in reduced operative blood loss and earlier recovery with oncologic clearance comparable with open surgery. When performed by experienced surgeons in selected patients it may be a safe and feasible option. Because of the potential of significant bias arising from the included studies, further randomized controlled trials should be undertaken to confirm this bias and to assess long-term survival rates.
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Affiliation(s)
- Constantinos Simillis
- Imperial College London, Department of Surgical Oncology and Technology, St Mary's Hospital, London, United Kingdom
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22
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Kaneko H. Laparoscopic hepatectomy: indications and outcomes. ACTA ACUST UNITED AC 2006; 12:438-43. [PMID: 16365815 DOI: 10.1007/s00534-005-1028-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 02/28/2005] [Indexed: 12/12/2022]
Abstract
We outline the indications, evaluate the degree of invasiveness, and analyze the outcomes of laparoscopic hepatectomy, mainly in the treatment of hepatocellular carcinoma (HCC). The important considerations in determining indications for laparoscopic hepatectomy include tumor size, type, and location. Nodular tumors smaller than 4 cm or pedunculated tumors smaller than 6 cm are suitable candidates. Concerning location, tumors in the lower segment or the left lateral segment are suitable. Regarding operative method, laparoscopic hepatectomy involving either partial hepatectomy or left lateral segmentectomy is a feasible, less invasive procedure. Operative time in our recent laparoscopic hepatectomy patients has decreased, with less bleeding. Furthermore, laparoscopic hepatectomy is less invasive than conventional hepatectomy on evaluation by the Estimation of Physiolic Ability and Surgical Stress (E-PASS) scoring system. Patients recovered more quickly after laparoscopic hepatectomy, which allowed shorter hospitalization. Both the 5-year survival rate for HCC and the survival rate without recurrence were nearly identical to those of open conventional hepatectomy, although further analysis will be necessary to reach definitive conclusions. In conclusion, laparoscopic hepatectomy avoids the disadvantages of standard hepatectomy in properly selected patients and is beneficial for patient quality of life, because it is a minimally invasive procedure when indications are strictly followed.
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Affiliation(s)
- Hironori Kaneko
- Department of Surgery, Omori Hospital, Toho University School of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-0015, Japan
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Kaneko H, Takagi S, Otsuka Y, Tsuchiya M, Tamura A, Katagiri T, Maeda T, Shiba T. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg 2005; 189:190-4. [PMID: 15720988 DOI: 10.1016/j.amjsurg.2004.09.010] [Citation(s) in RCA: 266] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Revised: 09/11/2004] [Accepted: 09/11/2004] [Indexed: 02/06/2023]
Abstract
BACKGROUND We have continued to develop laparoscopic hepatectomy as a means of surgical therapy for hepatocellular carcinoma (HCC). METHODS We evaluated the degree of invasiveness and analyzed the outcomes of laparoscopic hepatectomy compared with open hepatectomy for HCC. RESULTS There were notable differences with respect to blood loss and operating time compared with open hepatectomy cases. Patients started walking and eating significantly earlier in the laparoscopic hepatectomy group, and these more rapid recoveries allowed shorter hospitalizations. On the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system, there was no difference in preoperative risk. However, a significant difference was seen in the surgical stress and comprehensive risk scores between the open hepatectomy and laparoscopic hepatectomy groups. Concerning the survival rate and disease-free survival rate, there were no significant differences between procedures. CONCLUSIONS Laparoscopic hepatectomy avoids some of the disadvantages of open hepatectomy and is beneficial for patient quality of life (QOL) as a minimally invasive procedure if the operative indications are appropriately based on preoperative liver function and the location and size of HCC.
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Affiliation(s)
- Hironori Kaneko
- Department of Surgery, Omori Hospital, Toho University School of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo 143-0015, Japan.
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Abstract
BACKGROUND The current experience of laparoscopic liver resection is reviewed focusing on the role and limitations of resection of colorectal metastases. Surgical technique, outcome, and the main controversies regarding the procedures are described. METHODS Current literature on laparoscopic liver resection is reviewed based on reports identified following a specified PubMed search. RESULTS Available evidence indicates that laparoscopic liver resection can be made safely in selected patients with comparable duration of surgery, blood loss, tumour clearance, and mortality to that of open resection. Tumours localised peripherally in the left lateral segments of the liver or in segments IV-VI seem to be best suited for laparoscopic resection. The laparoscopic approach may be beneficial to the patients as compared to conventional resection but randomised trials are pending. Laparoscopic resection of colorectal liver metastases is described in a small number of patients only. The long-term outcome following such resections is not adequately documented. CONCLUSIONS Laparoscopic liver resection is a promising technique with a comparable short-term outcome to that of open procedures but with the potential advantages of minimal invasive treatment. The technique should be further evaluated in properly designed trials. Laparoscopic resection of colorectal liver metastases should not be performed on a regular basis until long-term results are defined.
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Affiliation(s)
- Tom Mala
- Surgical Department, Aker University Hospital, Oslo, Norway.
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25
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Kaneko H, Otsuka Y, Takagi S, Tsuchiya M, Tamura A, Shiba T. Hepatic resection using stapling devices. Am J Surg 2004; 187:280-4. [PMID: 14769320 DOI: 10.1016/j.amjsurg.2003.11.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2002] [Revised: 04/09/2003] [Indexed: 11/26/2022]
Abstract
BACKGROUND The progress and development of stapling devices has been remarkable. They have become indispensable for gastrointestinal diseases and are increasingly utilized in laparoscopic operations. Liver surgery applications for this technique are continuing to emerge, and in this study, we introduced the use of stapling devices to hepatic surgery. METHODS We examined the operative procedure and efficacy of hepatic resections using stapling devices as follows: transection of Glisson's pedicle and the hepatic vein using endolineal stapling devices in right and left lobectomies; bisegmentectomy II and III en masse using a stapling device; and application of endolineal stapling devices to vessel transections and dissections of the hepatic parenchyma in laparoscopic hepatectomies. RESULTS It was considered useful to tactfully apply stapling devices to vessel transections and dissections of the hepatic parenchyma in order to simplify the operative procedures of right or left lobectomies and lateral segmentectomies. Furthermore, the use of endoscopic stapling devices was an acceptable alternative to vessel transactions and dissections of the hepatic parenchyma in laparoscopic hepatectomies. CONCLUSIONS We believe that stapling devices will become utilized in liver surgery hereafter.
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Affiliation(s)
- Hironori Kaneko
- Second Department of Surgery, Toho University School of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo 143-0015, Japan.
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Abstract
The role of laparoscopic surgery in the management of benign cystic and solid liver tumours appears to differ according to each tumour type. As regards congenital liver cysts, laparoscopic treatment is now the gold standard for treating selected, huge, accessible, highly symptomatic or complicated cysts. In contrast, the laparoscopic approach is not useful for patients suffering from adult polycystic liver disease (PLD), except for type I PLD with large multiple hepatic cysts. For benign hepatocellular tumours, the surgical management has recently benefited from a better knowledge of the natural history of each type of tumour and from the improvement of imaging techniques in assuring a precise diagnosis of tumour nature. Thus the general tendency has led to a progressive restriction and tailoring of indications for resection in benign liver tumours, selecting only patients with huge, specifically symptomatic or compressive benign tumours or patients suffering from liver cell adenoma. Despite the enthusiastic use of the laparoscopic approach, selective indications for resection of benign liver tumours should indeed remain unchanged. For all types of benign liver tumours, the best indication remains small, superficial lesions, located in the anterior or the lateral segments of the liver. Deep, centrally located lesions or tumours in contact with major vascular or biliary trunks are not ideal candidates for laparoscopic liver resections. When performed by expert liver and laparoscopic surgeons using an adequate surgical technique, the laparoscopic approach is safe for performing minor liver resections and is accompanied by the usual postoperative benefits of laparoscopic surgery. When applied in selected patients and tumours, laparoscopic management of benign liver diseases appears to be a promising technique for hepatobiliary surgeons.
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Affiliation(s)
- Jean-François Gigot
- Unit of Hepato-Biliary-Pancreatic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL)BrusselsBelgium
| | - Catherine Hubert
- Unit of Hepato-Biliary-Pancreatic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL)BrusselsBelgium
| | - Radu Banice
- Unit of Hepato-Biliary-Pancreatic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL)BrusselsBelgium
| | - Michael L Kendrick
- Department of Gastroenterologic and General Surgery, Mayo Clinic and Mayo FoundationRochester MinnesotaUSA
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Kim JG. Laparoscopic Surgery. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2003. [DOI: 10.5124/jkma.2003.46.5.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jun-Gi Kim
- Department of General Surgery, The Catholic University of Korea, College of Medicine, St. Vincent's Hospital, Korea.
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