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Akhaladze DG, Rabaev GS, Tverdov IV, Merkulov NN, Uskova NG, Talypov SR, Krivonosov AA, Grachev NS. Central Liver Segments Resections vs Extended Hepatectomies in Children: Single-center Experience. J Pediatr Surg 2024:161927. [PMID: 39368854 DOI: 10.1016/j.jpedsurg.2024.161927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 08/26/2024] [Accepted: 09/07/2024] [Indexed: 10/07/2024]
Abstract
BACKGROUND Central liver segments resection (CLSR) still is not widely used in pediatric surgery due to its technical difficulty, whereas this procedure is widely spread as a parenchyma sparing approach of centrally located liver tumors in adults. The aim of this study is to analyze the outcomes of CLSR in comparison with extended hepatectomy (EH) in children with different liver tumors. METHODS A single-center retrospective analysis of patients who received CLSR (n = 14) and EH (n = 44) from June 2017 to December 2023 was applied. Patient's characteristics, preoperative, intra- and postoperative data were compared between 2 groups. RESULTS Preoperative CT-volumetry showed that future liver remnant volume was higher in CLSR group compared to EH (FLR-V; (54 ± 29 (40-91) % vs 40 ± 12 (17-73) %, p = 0.016). The intraoperative blood loss (200 [90-1150] (20-3000) ml vs 100 [30-275] (10-9000) ml, p = 0.088) and transfusion volume (310 [85-590] (0-1860) ml vs 150 [0-310] (0-4770) ml, p = 0.484) were similar in both groups, while operation time was longer in CLSR group (420 [320-595] (145-785) min vs 280 [203-390] (125-710) min), p = 0.011). There was no difference in biliary leakage (3 (21.4 %) vs 12 (27.3 %); p = 0.479), other complications (4 (28.6 %) vs 5 (11.4 %), p = 0.198) and complications ≥ IIIb by Clavien-Dindo (2 (14.3 %) vs 8 (18.2 %), p = 0.385) postoperatively. CONCLUSION CLSRs allow to preserve more healthy liver parenchyma compared to EH with similar intraoperative and postoperative outcomes. «Extended mesohepatectomy» allows to achieve R0 resection when central liver tumor extends on the left lateral and/or right posterior section. TYPE OF STUDY Retrospective Comparative Study (Level of Evidence III).
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Affiliation(s)
- Dmitry G Akhaladze
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 117997, Moscow, 1 Samory Mashela Str., Russian Federation
| | - Gavriil S Rabaev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 117997, Moscow, 1 Samory Mashela Str., Russian Federation; University Medical Centre Corporate Fund, National Research Center for Maternal and Child Health, 010000, Astana, 32 Turan Str., Kazakhstan.
| | - Ivan V Tverdov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 117997, Moscow, 1 Samory Mashela Str., Russian Federation
| | - Nikolay N Merkulov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 117997, Moscow, 1 Samory Mashela Str., Russian Federation
| | - Natalia G Uskova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 117997, Moscow, 1 Samory Mashela Str., Russian Federation
| | - Sergey R Talypov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 117997, Moscow, 1 Samory Mashela Str., Russian Federation
| | - Anatoliy A Krivonosov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 117997, Moscow, 1 Samory Mashela Str., Russian Federation
| | - Nikolay S Grachev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 117997, Moscow, 1 Samory Mashela Str., Russian Federation
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Costa AC, Mazzotta A, Santa-Cruz F, Coelho FF, Tribillon E, Gayet B, Herman P, Soubrane O. Short-term outcomes of laparoscopic extended hepatectomy versus major hepatectomy: a single-center experience. HPB (Oxford) 2024; 26:818-825. [PMID: 38485564 DOI: 10.1016/j.hpb.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 02/16/2024] [Accepted: 02/25/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION Laparoscopic major hepatectomy (LMH) remains restricted to a few specialized centers and poses a challenge to surgeons performing laparoscopic resections. Laparoscopic extended resections are even more complex and rarely conducted. METHODS From a single-institution database, we compared the short-term outcomes of patients who underwent major and extended laparoscopic resections, stratifying the entire retrospective cohort into four groups: right hepatectomy, left hepatectomy, right extended hepatectomy, and left extended hepatectomy. Patient demographics, tumor characteristics, operative variables, and especially postoperative outcomes were evaluated. RESULTS 250 patients underwent major and extended laparoscopic liver resections, including 160 right, 31 right extended, 36 left, and 23 left extended laparoscopic hepatectomies. The most common indication for resection was colorectal liver metastases (64%). Laparoscopic extended hepatectomy (LEH) showed significantly longer operative time, more blood loss, need for Pringle maneuver, conversion to open surgery, higher rates of liver failure, postoperative ascites, and intra-abdominal hemorrhage, R1 margins and length of stay when compared with the LMH group. Mortality rates were similar between groups. Multivariate analysis revealed intraoperative blood transfusion (OR = 5.1[CI-95%: 1.15-6.79]; p = 0.02) as an independent predictor for major complications. CONCLUSIONS LEH showed to be feasible, however with higher blood loss and significantly associated to major complications.
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Affiliation(s)
- Adriano C Costa
- Department of Digestive, Metabolic and Oncologic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, Paris, France; Department of Gastroenterology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, SP, Brazil.
| | - Alessandro Mazzotta
- Department of Digestive, Metabolic and Oncologic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, Paris, France
| | - Fernando Santa-Cruz
- Department of Gastroenterology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Fabricio F Coelho
- Department of Gastroenterology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Ecoline Tribillon
- Department of Digestive, Metabolic and Oncologic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, Paris, France
| | - Brice Gayet
- Department of Digestive, Metabolic and Oncologic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, Paris, France
| | - Paulo Herman
- Department of Gastroenterology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Olivier Soubrane
- Department of Digestive, Metabolic and Oncologic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, Paris, France
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Hongpeng C, Guannan W, Shangfei P, Zhengchao S, Yongyou W, Xiaoming W. Different Approaches of Laparoscopic Mesohepatectomy for Centrally Located Hepatocellular Carcinomas. Surg Laparosc Endosc Percutan Tech 2023; 33:351-356. [PMID: 37523507 DOI: 10.1097/sle.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/20/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND This study aimed to describe a simple and novel positional classification system for centrally located hepatocellular carcinoma (CL-HCC), based on which different surgical approaches for laparoscopic mesohepatectomy (LMH) were chosen. MATERIALS AND METHODS The data of patients with CL-HCC who underwent LMH between January 2017 and December 2021 were retrospectively analyzed. The positional classification method was used to locate tumors. In addition, different approaches were used during the surgery according to the classification type. RESULTS All 98 patients underwent LMH, of whom 4 were converted to open surgery. Types I, Ⅱ, and Ⅲ were 24, 37, and 37, respectively. Blood transfusions were performed in only 7 patients, of which the amount was 800 (600, 900) mL. All the patients underwent R0 resection. The complication rate was 9.2% in all cases. No deaths occurred. CONCLUSIONS Our proposed classification system and corresponding surgical approach in LMH is conducive to the successful completion of surgery.
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Affiliation(s)
- Chu Hongpeng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
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Long-Term Outcomes of Mesohepatectomy for Centrally Located Liver Tumors: Two-Decade Single-Center Experience. J Am Coll Surg 2022; 235:257-266. [PMID: 35839400 DOI: 10.1097/xcs.0000000000000209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Mesohepatectomy is a viable treatment option for patients diagnosed with centrally located liver tumors (CLLTs). There are several reports from Eastern centers, but few data are available on this topic from Western centers. STUDY DESIGN Data of 128 consecutive patients who underwent mesohepatectomy between September 2000 and September 2020 in our center were analyzed from a prospectively collected database. Patient demographic data, liver tumor characteristics, and intraoperative data were collected. In addition, posthepatectomy bile leakage (PHBL), posthepatectomy hemorrhage (PHH), posthepatectomy liver failure (PHLF), and 90-day mortality after mesohepatectomy were assessed. Long-term outcomes were also reported, and factors that may influence disease-free survival were evaluated. RESULTS Of 128 patients, 113 patients (88.3%) had malignant hepatic tumors (primary and metastatic tumors in 41 [32%] and 72 [56.3%] patients, respectively), and 15 patients suffered from benign lesions (11.7%). Among the relevant surgical complications (grade B or C), PHBL was the most common complication after mesohepatectomy and occurred in 11.7% of patients, followed by PHLF in 3.1% of patients and PHH in 2.3% of patients. Only four patients (3.1%) died within 90 days after mesohepatectomy. The 5-year overall survival and overall recurrence (for malignant lesion) rates were 76.5% and 45.1%, respectively. CONCLUSION Mesohepatectomy is a safe and feasible surgical treatment with low morbidity and mortality for patients with CLLT. Long-term outcomes can be improved by increased surgical expertise.
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Parenchyma-Sparing Central Hepatectomy Versus Extended Resections for Liver Tumors: a Value-Based Comparative Analysis. J Gastrointest Surg 2022; 26:1406-1415. [PMID: 35266098 DOI: 10.1007/s11605-022-05292-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/11/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Parenchyma-sparing (PS) liver resection is recommended for liver tumors. The value of PS-approaches as compared to more extended resections is unknown. We sought to examine value-based differences (quality/cost) of central hepatectomy (CH) versus more extended resections. METHODS A retrospective cohort study including consecutive patients having CH or right/extended hepatectomies (R/EH) at a high-volume cancer center was performed (2015-2019). The primary outcome was the value ratio, calculated as quality/cost. Quality was defined as the proportion of patients achieving a textbook outcome. Perioperative actual direct costs ($USD) for each patient were abstracted from institutional financial records spanning throughout the perioperative period. Value ratios were calculated and compared for each approach; sensitivity analysis was performed by modelling TO and cost thresholds. RESULTS Among 651 hepatobiliary operations (426 liver resections), 90 patients met inclusion criteria: 19 CH and 71 R/EH. TO occurred in 68% and 69% of CH and R/EH, respectively (P = 0.96). Mean direct costs were $21,826 for CH and $28,599 for R/EH (P = 0.008). CH provided a greater value (value ratio CH = 0.33 vs. R/EH = 0.26; P = 0.004) with a shift favoring R/EH only when the TO threshold for CH was below 51% (CH = 0.23 vs. R/EH = 0.24) or that of R/EH was over 90% (CH = 0.31 vs. R/EH = 0.32). CONCLUSIONS These findings support a PS approach for central liver tumors (central hepatectomy) as it offers higher value than more extended resections. In the context of high-volume centers with outcomes within established national benchmarks, patients with central tumors should be considered for CH over more extended non-PS approaches.
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Fischer A, Fuchs J, Stravodimos C, Hinz U, Billeter A, Büchler MW, Mehrabi A, Hoffmann K. Influence of diabetes on short-term outcome after major hepatectomy: an underestimated risk? BMC Surg 2020; 20:305. [PMID: 33256698 PMCID: PMC7708157 DOI: 10.1186/s12893-020-00971-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patient-related risk factors such as diabetes mellitus and obesity are increasing in western countries. At the same time the indications for liver resection in both benign and malignant diseases have been significantly extended in recent years. Major liver resection is performed more frequently in a patient population of old age, comorbidity and high rates of neoadjuvant chemotherapy. The aim of this study was to evaluate whether diabetes mellitus, obesity and overweight are risk factors for the short-term post-operative outcome after major liver resection. METHODS Four hundred seventeen major liver resections (≥ 3 segments) were selected from a prospective database. Exclusion criteria were prior liver resection in patient's history and synchronous major intra-abdominal procedures. Overweight was defined as BMI ≥ 25 kg/m2 and < 30 kg/m2 and obesity as BMI ≥ 30 kg/m2. Primary end point was 90-day mortality and logistic regression was used for multivariate analysis. Secondary end points included morbidity, complications according to Clavien-Dindo classification, unplanned readmission, bile leakage, and liver failure. Morbidity was defined as occurrence of a post-operative complication during hospital stay or within 90 days postoperatively. RESULTS Fifty-nine patients had diabetes mellitus (14.1%), 48 were obese (11.6%) and 147 were overweight (35.5%). There were no statistically significant differences in mortality rates between the groups. In the multivariate analysis, diabetes was an independent predictor of morbidity (OR = 2.44, p = 0.02), Clavien-Dindo grade IV complications (OR = 3.6, p = 0.004), unplanned readmission (OR = 2.44, p = 0.04) and bile leakage (OR = 2.06, p = 0.046). Obese and overweight patients did not have an impaired post-operative outcome compared patients with normal weight. CONCLUSIONS Diabetes has direct influence on the short-term postoperative outcome with an increased risk of morbidity but not mortality. Preoperative identification of high-risk patients will potentially decrease complication rates and allow for individual patient counseling as part of a shared decision-making process. For obese and overweight patients, major liver resection is a safe procedure.
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Affiliation(s)
- Alexander Fischer
- Department of General and Transplant Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Juri Fuchs
- Department of General and Transplant Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Christos Stravodimos
- Department of General and Visceral Surgery, Municipal Hospital Karlsruhe, Moltkestrasse 90, 76133, Karlsruhe, Germany
| | - Ulf Hinz
- Department of General and Transplant Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Adrian Billeter
- Department of General and Transplant Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus W Büchler
- Department of General and Transplant Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General and Transplant Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Katrin Hoffmann
- Department of General and Transplant Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Tsilimigras DI, Sahara K, Moris D, Mehta R, Paredes AZ, Ratti F, Marques HP, Soubrane O, Lam V, Poultsides GA, Popescu I, Alexandrescu S, Martel G, Workneh A, Guglielmi A, Hugh T, Aldrighetti L, Weiss M, Bauer TW, Maithel SK, Pulitano C, Shen F, Koerkamp BG, Endo I, Pawlik TM. Assessing Textbook Outcomes Following Liver Surgery for Primary Liver Cancer Over a 12-Year Time Period at Major Hepatobiliary Centers. Ann Surg Oncol 2020; 27:3318-3327. [DOI: 10.1245/s10434-020-08548-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Indexed: 12/14/2022]
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