1
|
Kulkarni S, Sondhi M, Gupta S, Bhalla A. Staging laparoscopy for assessing inoperability in gastrointestinal malignancies: Is it useful? MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2021. [DOI: 10.4103/mjdrdypu.mjdrdypu_23_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
2
|
Schmelzle M, Krenzien F, Schöning W, Pratschke J. Laparoscopic liver resection: indications, limitations, and economic aspects. Langenbecks Arch Surg 2020; 405:725-735. [PMID: 32607841 PMCID: PMC7471173 DOI: 10.1007/s00423-020-01918-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 12/13/2022]
Abstract
Background Minimally invasive techniques have increasingly found their way into liver surgery in recent years. A multitude of mostly retrospective analyses suggests several advantages of laparoscopic over open liver surgery. Due to the speed and variety of simultaneous technical and strategic developments, it is difficult to maintain an overview of the current status and perspectives in laparoscopic liver surgery. Purpose This review highlights up-to-date aspects in laparoscopic liver surgery. We discuss established indications with regard to their development over time as well as continuing limitations of applied techniques. We give an assessment based on the current literature and according to our own center experiences, not least with regard to a highly topical cost discussion. Conclusions While in the beginning mainly benign tumors were laparoscopically operated on, liver metastasis and hepatocellular carcinoma are now among the most frequent indications. Technical limitations remain and should be evaluated with the overall aim not to endanger quality standards in open surgery. Financial aspects cannot be neglected with the necessity of cost-covering reimbursement.
Collapse
Affiliation(s)
- Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Felix Krenzien
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| |
Collapse
|
3
|
Kampf S, Sponder M, Bergler-Klein J, Sandurkov C, Fitschek F, Bodingbauer M, Stremitzer S, Kaczirek K, Schwarz C. Physical recovery after laparoscopic vs. open liver resection – A prospective cohort study. Int J Surg 2019; 72:224-229. [DOI: 10.1016/j.ijsu.2019.10.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022]
|
4
|
Gallotta V, Conte C, D’Indinosante M, Capoluongo E, Minucci A, De Rose AM, Ardito F, Giuliante F, Di Giorgio A, Zannoni GF, Fagotti A, Margreiter C, Scambia G, Ferrandina G. Prognostic factors value of germline and somatic brca in patients undergoing surgery for recurrent ovarian cancer with liver metastases. Eur J Surg Oncol 2019; 45:2096-2102. [DOI: 10.1016/j.ejso.2019.06.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 12/13/2022] Open
|
5
|
Untereiner X, Cagnet A, Memeo R, De Blasi V, Tzedakis S, Piardi T, Severac F, Mutter D, Kianmanesh R, Marescaux J, Sommacale D, Pessaux P. Short-term and middle-term evaluation of laparoscopic hepatectomies compared with open hepatectomies: A propensity score matching analysis. World J Gastrointest Surg 2016; 8:643-650. [PMID: 27721928 PMCID: PMC5037338 DOI: 10.4240/wjgs.v8.i9.643] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/23/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To compare short-term results between laparoscopic hepatectomy and open hepatectomy using a propensity score matching.
METHODS A patient in the laparoscopic liver resection (LLR) group was randomly matched with another patient in the open liver resection (OLR) group using a 1:1 allocated ratio with the nearest estimated propensity score. Patients of the LLR group without matches were excluded. Matching criteria included age, gender, body mass index, American Society of Anesthesiologists score, potential co-morbidities, hepatopathies, size and number of nodules, preoperative chemotherapy, minor or major liver resections. Intraoperative and postoperative data were compared in both groups.
RESULTS From January 2012 to January 2015, a total of 241 hepatectomies were consecutively performed, of which 169 in the OLR group (70.1%) and 72 in the LLR group (29.9%). The conversion rate was 9.7% (n = 7). The mortality rate was 4.2% in the OLR group and 0% in the LLR group. Prior to and after propensity score matching, there was a statistically significant difference favorable to the LLR group regarding shorter operative times (185 min vs 247.5 min; P = 0.002), less blood loss (100 mL vs 300 mL; P = 0.002), a shorter hospital stay (7 d vs 9 d; P = 0.004), and a significantly lower rate of medical complications (4.3% vs 26.4%; P < 0.001).
CONCLUSION Laparoscopic liver resections seem to yield better short-term and mid-term results as compared to open hepatectomies and could well be considered a privileged approach and become the gold standard in carefully selected patients.
Collapse
|
6
|
Abstract
The nuances of determining resectability for liver tumors can be difficult to navigate, owing to the variety of primary and secondary malignancies involving the liver, the range of patient-specific factors to consider, and the hepatic anatomic and functional variability that seems inevitable. The basic principles, however, are simple;if surgery is deemed appropriate from an oncologic standpoint, the patient is in reasonably good health, and the tumor can be safely removed without compromising the integrity of the future remnant, nearly all patients will be candidates for resection.
Collapse
Affiliation(s)
- Cecilia G Ethun
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365C Clifton Road NE, Building C, 2nd Floor, Atlanta, GA 30322, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365C Clifton Road NE, Building C, 2nd Floor, Atlanta, GA 30322, USA.
| |
Collapse
|
7
|
Luo LX, Yu ZY, Bai YN. Laparoscopic Hepatectomy for Liver Metastases from Colorectal Cancer: A Meta-analysis. J Laparoendosc Adv Surg Tech A 2014; 24:213-22. [PMID: 24571350 DOI: 10.1089/lap.2013.0399] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Li-Xi Luo
- Department of Hepatobiliary Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Zhao-Yan Yu
- Department of Hepatobiliary Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Yan-Nan Bai
- Department of Hepatobiliary Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| |
Collapse
|
8
|
Slakey DP, Simms E, Drew B, Yazdi F, Roberts B. Complications of liver resection: laparoscopic versus open procedures. JSLS 2013; 17:46-55. [PMID: 23743371 PMCID: PMC3662744 DOI: 10.4293/108680812x13517013317716] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Complications appear to be lower in laparoscopic cases versus open cases for anterolateral and posterosuperior hepatic segment surgery. Background and Objective: Minimally invasive surgery for liver resection remains controversial. This study was designed to compare open versus laparoscopic surgical approaches to liver resection. Methods: We performed a single-center retrospective chart review. Results: We compared 45 laparoscopic liver resections with 17 open cases having equivalent resections based on anatomy and diagnosis. The overall complication rate was 25.8%. More open resection patients had complications (52.9% vs 15.5%, P < .008). The conversion rate was 11.1%. The mean blood loss was 667.1 ± 1450 mL in open cases versus 47.8 ± 89 mL in laparoscopic cases (P < .0001). Measures of intravenous narcotic use, intensive care unit length of stay, and hospital length of stay all favored the laparoscopic group. Patients were more likely to have complications or morbidity in the open resection group than in the laparoscopic group for both the anterolateral (P < .085) and posterosuperior (P < .002) resection subgroups. Conclusion: In this series comparing laparoscopic and open liver resections, there were fewer complications, more rapid recovery, and lower morbidity in the laparoscopic group, even for those resections involving the posterosuperior segments of the liver.
Collapse
Affiliation(s)
- Douglas P Slakey
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112-2699, USA.
| | | | | | | | | |
Collapse
|
9
|
Dunne DFJ, Gaughran J, Jones RP, McWhirter D, Sutton PA, Malik HZ, Poston GJ, Fenwick SW. Routine staging laparoscopy has no place in the management of colorectal liver metastases. Eur J Surg Oncol 2013; 39:721-5. [PMID: 23618549 DOI: 10.1016/j.ejso.2013.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/22/2013] [Accepted: 03/27/2013] [Indexed: 11/19/2022] Open
Abstract
AIMS Staging laparoscopy has been recommended in the management of patients with colorectal liver metastases prior to hepatectomy in order to reduce the incidence and associated morbidity of futile laparotomies. The utility of staging laparoscopy has not been assessed in patients undergoing CT, PET-CT and MRI as standard preoperative staging. METHODS All patients undergoing attempted open hepatectomy for colorectal liver metastases between 1/4/2008 and 31/3/2012 were identified from a prospectively maintained research database. All patients who underwent futile laparotomy were identified, with demographics and operative notes subsequently analysed. RESULTS A total of 274 patients underwent attempted open hepatectomy during the study period. At laparotomy 12 (4.4%) patients were found to have irresectable disease. There were no unifying demographic factors within the patients undergoing futile laparotomy. CONCLUSIONS With modern imaging, the potential yield of staging laparoscopy is low. Staging laparoscopy should not be used routinely, but may have a role in the case of specific clinical concerns.
Collapse
Affiliation(s)
- D F J Dunne
- Northwestern Hepatobiliary Unit, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, United Kingdom.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Laparoscopic Ultrasound for Hepatocellular Carcinoma and Colorectal Liver Metastasis. Surg Laparosc Endosc Percutan Tech 2013; 23:135-44. [DOI: 10.1097/sle.0b013e31828a0b9a] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
11
|
Blackham AU, Swett K, Levine EA, Shen P. Surgical management of colorectal cancer metastases to the liver: multimodality approach and a single institutional experience. COLORECTAL CANCER 2013; 2:73-88. [PMID: 25110522 DOI: 10.2217/crc.12.80] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Over the past 30 years, the treatment of metastatic colorectal cancer to the liver has undergone major changes. Once considered terminal and incurable, the prognosis of patients with colorectal hepatic metastases has seen dramatic improvements using modern multimodality therapy and now long-term survival and even cure are possible in some patients. Despite the advances seen in systemic therapy, hepatic resection offers the longest survival potential and remains the only curative option. Based on long-term outcomes and the improved safety of hepatic resection using modern operative techniques and critical care support, an aggressive locoregional approach to colorectal hepatic metastasis has become the standard of care. This article focuses on the management of colorectal hepatic metastases and highlights the importance of multimodality therapy. We also report our 18-year experience treating patients with hepatic resection for colorectal metastases.
Collapse
Affiliation(s)
- Aaron U Blackham
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Katrina Swett
- Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Perry Shen
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
12
|
Metrakos P, Kakiashvili E, Aljiffry M, Hassanain M, Chaudhury P. Role of Surgery in the Diagnosis and Management of Metastatic Cancer. EXPERIMENTAL AND CLINICAL METASTASIS 2013:381-399. [DOI: 10.1007/978-1-4614-3685-0_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
|
13
|
|
14
|
Bickenbach KA, Dematteo RP, Fong Y, Peter Kingham T, Allen PJ, Jarnagin WR, D'Angelica MI. Risk of occult irresectable disease at liver resection for hepatic colorectal cancer metastases: a contemporary analysis. Ann Surg Oncol 2012; 20:2029-34. [PMID: 23266582 DOI: 10.1245/s10434-012-2813-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Traditionally, rates of irresectable disease at laparotomy for colorectal liver metastases (CRLM) have ranged from 15 to 70%. Diagnostic laparoscopy has been shown to be effective at preventing nontherapeutic laparotomy in selected patients. The purpose of this study was to analyze the resectability rate and role of diagnostic laparoscopy in a contemporary cohort. METHODS Using a prospectively maintained database, we identified patients who were explored for presumed resectable CRLM. Clinical and pathologic data associated with the finding of irresectable disease were analyzed. RESULTS From 2008-2010, 455 patients were explored. Of these, 35 (7.7%) did not undergo a resection and/or ablation. Of the 35 patients with irresectable disease, 15 (43%) had disease limited to the liver, 17 (49%) had extrahepatic disease (EHD), and 3 (9%) had other reasons precluding resection. Of the whole cohort, 45 patients (9.9%) were found to have EHD, and 27 of these (60%) underwent complete resection or ablation. The only factor associated with irresectable disease was a prior history of EHD, which was present in 29% of those found irresectable versus 13% of those resected (p = 0.022). Diagnostic laparoscopy was performed in 55 patients. Four of these patients had irresectable disease, and three were spared unnecessary laparotomy. Therefore, the yield was 5% and the sensitivity 75%. CONCLUSIONS The finding of irresectable disease is a rare event with modern radiologic assessment and the expansion of indications for resection. Diagnostic laparoscopy has a low yield and should be considered if there is a history of EHD or suspicious findings on preoperative imaging.
Collapse
Affiliation(s)
- Kai A Bickenbach
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW The evaluation of liver histology is an important component of the diagnosis and staging of liver diseases. The most common technique employed to sample liver tissue for decades has been percutaneous liver biopsy. Although this is a relatively well tolerated technique in the early stages of liver disease, it carries a high risk of complications, particularly hemorrhage, in patients with advanced cirrhosis. Mini-laparoscopy allows macroscopic assessment and biopsy under direct vision and therefore is a well tolerated and effective technique. RECENT FINDINGS The major advantages of this technique are direct visualization of the liver surface, thereby allowing inspection for morphologic changes of cirrhosis as well as targeted biopsies, the ability to immediately treat potential complications (bleeding and bile leakage), furthermore the peritoneal cavity can be visualized to stage gastrointestinal (GI) malignancies. Additionally, 'blind' percutaneous liver biopsy fails to establish a diagnosis in about 25% of cases, largely because of sampling error. SUMMARY This technique presents the opportunity to visualize the surface of the liver and the peritoneal cavity, making it a valuable tool for liver biopsy. This review summarizes the technique of mini-laparoscopy and addresses its potential uses and limitations as a diagnostic modality.
Collapse
|
16
|
Mostaedi R, Milosevic Z, Han HS, Khatri VP. Laparoscopic liver resection: Current role and limitations. World J Gastrointest Oncol 2012; 4:187-92. [PMID: 22912914 PMCID: PMC3423509 DOI: 10.4251/wjgo.v4.i8.187] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 07/31/2012] [Accepted: 08/06/2012] [Indexed: 02/05/2023] Open
Abstract
Laparoscopic liver resection (LLR) for the treatment of benign and malignant liver lesions is often performed at specialized centers. Technological advances, such as laparoscopic ultrasonography and electrosurgical tools, have afforded surgeons simultaneous improvements in surgical technique. The utilization of minimally invasive techniques for liver resection has been reported to reduce operative time, decrease blood loss, and shorten length of hospital stay with equivalent postoperative mortality and morbidity rates compared to open liver resection (OLR). Non-anatomic liver resection and left lateral sectionectomy are now routinely performed laparoscopically at many institutions. Furthermore, major hepatic resections are performed by pure laparoscopy, hand-assisted technique, and the hybrid method. In addition, robotic surgery and single port surgery are revealing early promising results. The consensus recommendation for the treatment of benign liver disease and malignant lesions remains unchanged when considering a laparoscopic approach, except when comorbidities and anatomic limitations of the liver lesion preclude this technique. Disease free and survival rates after LLR for hepatocellular carcinoma and metastatic colon cancer correspond to OLR. Patient selection is a significant factor for these favorable outcomes. The limitations include LLR of superior and posterior liver lesions; however, adjustments in technique may now consider a laparoscopic approach as a viable option. As growing data continue to reveal the feasibility and efficacy of laparoscopic liver surgery, this skill is increasingly being adopted by hepatobiliary surgeons. Although the full scope of laparoscopic liver surgery remains infrequently used by many general surgeons, this technique will become a standard in the treatment of liver diseases as studies continue to show favorable outcomes.
Collapse
Affiliation(s)
- Rouzbeh Mostaedi
- Rouzbeh Mostaedi, Vijay P Khatri, Department of Surgery, University of California, Davis Cancer Center, University of California, Davis Medical Center, Sacramento, CA 95817, United States
| | | | | | | |
Collapse
|
17
|
Stoot JHMB, van Dam RM, Coelen RJS, Winkens B, Olde Damink SWM, Bemelmans MHA, Dejong CHC. The introduction of a laparoscopic liver surgery programme: a cost analysis of initial experience in a university hospital. Scand J Surg 2012; 101:32-7. [PMID: 22414466 DOI: 10.1177/145749691210100107] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS In the era of expanding costs of healthcare, this study was conducted to perform a cost analysis of introducing a laparoscopic liver surgery programme for left sided liver lesions. MATERIALS AND METHODS Consecutive patients treated by laparoscopic liver resections of left lateral segments were included. Controls were a group of 14 patients undergoing open resection for similar pathology. Primary outcomes were costs. Secondary outcomes were complications, conversions, blood loss, length of operation, and length of hospital stay. RESULTS The laparoscopic approach for hepatic left lateral resection (bisegmentectomy 2 and 3) was performed in fourteen patients (group I, median age 54 [range 26-82] years). In the open group, fourteen patients from a prospectively collected database with the same type of resection were selected (group II, median age 64 [range 29-76] years). Costs of theatre usage in the laparoscopic group were significantly lower (p=0.031). No significant differences in costs of disposable instruments, ward stay and total costs were observed between the two groups. There were three complications in the laparoscopic group compared with two complications in the open group. In the laparoscopic group there were 2 conversions (14%). Median blood loss was significantly lower in the laparoscopic group (50 mls [range 0-750], (p=0.001) versus the open group (500 mls [range 150-750]). Furthermore, operation time was also significantly lower in the laparoscopic group (116 [range 85-261] minutes) versus the open group (165 [range 96-217] minutes, p=0.016). Median length of stay was 6 [range 4-11] days in group I versus 6 [range 5-13] days in group II (p=0.508). CONCLUSION Costs of laparoscopic liver resections proved to be equivalent to open surgery. Furthermore, implementation of a laparoscopic liver resection programme seems feasible and safe with reduced blood loss and operation time and comparable morbidity and length of stay.
Collapse
Affiliation(s)
- J H M B Stoot
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
18
|
The role of laparoscopy and laparoscopic ultrasound in the preoperative staging of patients with resectable colorectal liver metastases: a meta-analysis. Am J Surg 2012; 204:84-92. [PMID: 22244586 DOI: 10.1016/j.amjsurg.2011.07.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 07/06/2011] [Accepted: 07/06/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND The role of staging laparoscopy (SL) with laparoscopic ultrasound (LUS) in patients with resectable colorectal liver metastases (CRLM) remains controversial. METHODS A meta-analysis of all studies (from 1998 to the present) on the effect of SL/LUS in patients with potentially resectable CRLM with respect to alteration in surgical management was performed. RESULTS Twelve studies satisfied the inclusion criteria. A total of 1,047 patients underwent SL/LUS. The true yield of SL/LUS for CRLM was 19% (95% confidence interval [CI], 16%-22%), with a diagnostic odds ratio of 132 (95% CI, 56-310) and an overall sensitivity of 59% (95% CI, 53%-65%). Subgroup analysis for detection of other liver and peritoneal lesions showed a sensitivity of 59% (95% CI, 49%-67%) and 75% (95% CI, 63%-85%) respectively. There was major between-study heterogeneity for all analyses, with no obvious cause revealed by meta-regression. CONCLUSIONS The true benefit of using SL/LUS universally seems limited. It appears more useful as an adjunct in patients when peritoneal disease is suspected.
Collapse
|
19
|
Kamel SI, de Jong MC, Schulick RD, Diaz-Montes TP, Wolfgang CL, Hirose K, Edil BH, Choti MA, Anders RA, Pawlik TM. The role of liver-directed surgery in patients with hepatic metastasis from a gynecologic primary carcinoma. World J Surg 2011; 35:1345-54. [PMID: 21452068 DOI: 10.1007/s00268-011-1074-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The management of patients with liver metastasis from a gynecologic carcinoma remains controversial, as there is currently little data available. We sought to determine the safety and efficacy of liver-directed surgery for hepatic metastasis from gynecologic primaries. METHODS Between 1990 and 2010, 87 patients with biopsy-proven liver metastasis from a gynecologic carcinoma were identified from an institutional hepatobiliary database. Fifty-two (60%) patients who underwent hepatic surgery for their liver disease and 35 (40%) patients who underwent biopsy only were matched for age, primary tumor characteristics, and hepatic tumor burden. Clinicopathologic, operative, and outcome data were collected and analyzed. RESULTS Of the 87 patients, 30 (34%) presented with synchronous metastasis. The majority of patients had multiple hepatic tumors (63%), with a median size of the largest lesion being 2.5 cm. Of those patients who underwent liver surgery (n=52), most underwent a minor hepatic resection (n=44; 85%), while 29 (56%) patients underwent concurrent lymphadenectomy and 45 (87%) patients underwent simultaneous peritoneal debulking. Postoperative morbidity and mortality were 37% and 0%, respectively. Median survival from time of diagnosis was 53 months for patients who underwent liver-directed surgery compared with 21 months for patients who underwent biopsy alone (n=35) (p=0.01). Among those patients who underwent liver-directed surgery, 5-year survival following hepatic resection was 41%. CONCLUSIONS Hepatic surgery for liver metastasis from gynecologic cancer can be performed safely. Liver surgery may be associated with prolonged survival in a subset of patients with hepatic metastasis from gynecologic primaries and therefore should be considered in carefully selected patients.
Collapse
Affiliation(s)
- Sarah I Kamel
- Department of Surgery, Johns Hopkins University School of Medicine, Harvey 611, 600 N Wolfe Street, Baltimore, MD 21287, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Ainsworth AP, Pless T, Nielsen HO. Potential impact of adding endoscopic ultrasound to standard imaging procedures in the preoperative assessment of resectability in patients with liver tumors. Scand J Gastroenterol 2011; 46:1020-3. [PMID: 21504382 DOI: 10.3109/00365521.2011.574727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The value of endoscopic ultrasonography (EUS) in patients with liver diseases is limitedly described. The aim of this study was to evaluate the potential impact of adding EUS to standard imaging procedures in the evaluation of resectability in patients with liver tumors. MATERIAL AND METHODS Patients who, based on the findings of CT and/or MRI, had been referred for curative resection of liver tumours were studied. Each patient underwent EUS before the final assessment of resectability, which was done by laparoscopic ultrasound or laparotomy. RESULTS Sixty-four patients were included. Intended curative resection was performed in 19 (30%) patients. Thirty-five (55%) patients were considered to have non-curative malignant disease. In 10 (15%) patients, the tumor was judged to be benign and surgery was not performed. There were no complications related to EUS. The sensitivity, specificity, positive predictive value, and negative predictive value of EUS regarding prediction of non-resectability were 0.24, 0.94, 0.80 and 0.56 (tumor in right lobe), 0.50, 1.0, 1.0 and 0.75 (tumor in left lobe), and 0.60, 0.67, 0.86 and 0.33 (tumors in both lobes), respectively. Sixteen patients (25%) would have had changed their further management, if decision regarding non-resectability had been taken after EUS. DISCUSSION Addition of EUS to a standard imaging set-up based on CT and/or MRI would have changed the management in 25% of the patients otherwise scheduled for resection of suspected liver tumors.
Collapse
|
21
|
Rocha FG, D'Angelica M. Treatment of liver colorectal metastases: role of laparoscopy, radiofrequency ablation, and microwave coagulation. J Surg Oncol 2011; 102:968-74. [PMID: 21166000 DOI: 10.1002/jso.21720] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Up to 50% of patients with colorectal cancer will develop metastatic disease in the liver. While surgical extirpation remains the best option for long-term survival, several complementary modalities such as laparoscopy, radiofrequency ablation, and microwave coagulation have gained wide acceptance as primary and adjunct therapies for both resectable and unresectable disease. This review will focus on the application and outcome of these techniques in patients with colorectal liver metastases.
Collapse
Affiliation(s)
- Flavio G Rocha
- Hepatopancreatobiliary Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
| | | |
Collapse
|
22
|
Cheung TH, Lo KWK, Yim SF, Ho S, Yu MMY, Yang WT. The technique of laparoscopic pelvic ultrasonography for metastatic lymph node. J Laparoendosc Adv Surg Tech A 2010; 21:61-5. [PMID: 21190479 DOI: 10.1089/lap.2010.0336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Many reports have provided evidence to support the effective use of diagnostic laparoscopy and laparoscopic ultrasonography (LUS) to determine if patients with upper abdominal malignant diseases are operable so that unnecessary laparotomy can be avoided. LUS is less frequently applied to patients with pelvic malignancies and this is probably related to the technical difficulties. We have developed the LUS technique in examining the pelvic nodes for metastasis systematically and have applied it to 241 cervical cancer patients. The procedure is safe and not associated with any major morbidity. The mean duration of pelvic node assessment by LUS is 14 minutes and the procedure can be satisfactorily completed in 98% of patients. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of LUS in detecting pelvic nodal metastasis were 81.2%, 55.6%, 88.4%, 57.7%, and 87.5%, respectively, in patients scheduled for radical hysterectomy. In this report, we describe the LUS technique in detail and demonstrate important landmarks that provide useful orientation during an LUS examination. The technical limitations and pitfalls are also discussed.
Collapse
Affiliation(s)
- Tak-Hong Cheung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
| | | | | | | | | | | |
Collapse
|
23
|
Feroci F, Fong Y. Use of clinical score to stage and predict outcome of hepatic resection of metastatic colorectal cancer. J Surg Oncol 2010; 102:914-21. [DOI: 10.1002/jso.21715] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
24
|
Abstract
Whereas in other fields of surgery minimally invasive techniques have replaced the open surgery approach, liver resection is still a domain of conventional surgery. However, it is internationally emerging that laparoscopic hepatic surgery will become more important by conceptional improvements. This article describes the technical aspects of laparoscopic liver resection, in particular the procedure with respect to the individual liver segments. The advantages and disadvantages of the minimally invasive technique and also the indications for laparoscopic liver resection will be discussed.
Collapse
|
25
|
Gaujoux S, Allen PJ. Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy. World J Gastrointest Surg 2010; 2:283-90. [PMID: 21160897 PMCID: PMC2999692 DOI: 10.4240/wjgs.v2.i9.283] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 09/18/2010] [Accepted: 09/24/2010] [Indexed: 02/06/2023] Open
Abstract
Even after extensive preoperative assessment, staging laparoscopy may allow avoidance of non-therapeutic laparotomy in patients with radiographically occult metastatic or locally unresectable disease. Staging laparoscopy is associated with decreased postoperative pain, a shorter hospital stay and a higher likelihood of receiving systemic therapy compared to laparotomy but its yield has decreased with improvements in imaging techniques. Current uses of staging laparoscopy include the following: (1) In the staging of pancreatic adenocarcinoma, laparoscopic staging allows for the identification of sub-radiographic metastatic disease in locally advanced cancer in approximately 30% of patients and, in radiographically resectable cancer, may identify metastatic disease in 10%-15% of cases; (2) In colorectal liver metastases, selective use of laparoscopic staging in patients with a clinical risk score of over 2 identifies unresectable disease in approximately 20% of patients; (3) In hepatocellular carcinoma, laparoscopic staging could be selectively used in high-risk patients such as those with clinically apparent liver cirrhosis and in patients with major vascular invasion or bilobar tumors; and (4) In biliary tract malignancy, staging laparoscopy may be used in all patients with potentially resectable primary gallbladder cancer and in selected patients with T2/T3 hilar cholangiocarcinoma. Because of the decreasing yield of SL secondary to improvements in imaging techniques, staging laparoscopy should be used selectively for patients with pancreatic and hepatobiliary malignancy to avoid unnecessary non-therapeutic laparotomy and to improve resource utilization. Each individual surgeon should apply his or her threshold as to whether staging laparoscopy is indicated according to the quality of preoperative imaging studies and the availability of resources at their own institution.
Collapse
Affiliation(s)
- Sebastien Gaujoux
- Sebastien Gaujoux, Peter J Allen, Hepatobiliary Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, C-887, New York, NY 10021, United States
| | | |
Collapse
|
26
|
Piccolboni D, Ciccone F, Settembre A, Corcione F. Laparoscopic intra-operative ultrasound in liver and pancreas resection: Analysis of 93 cases. J Ultrasound 2010; 13:3-8. [PMID: 23396978 DOI: 10.1016/j.jus.2010.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Laparoscopic inspection before pancreatic and liver surgery is a widely accepted approach and has changed the surgical strategy in a growing number of patients for the last 10 years. The addition of intra-operative ultrasound to laparoscopy has further refined surgical judgments. The aim of this study was to evaluate the impact of open (IOUS) or laparoscopic (LIOUS) ultrasound in patients undergoing hepatic or pancreatic resection for benign or malignant lesions. MATERIALS AND METHODS In the years 2005-2008, 45 patients (aged 42-75 years) were selected for liver resection, and 48 others (aged 14-72 years) were selected for partial pancreatic resection. Intra-operative ultrasound was performed for surgical staging. An Aloka SSD-5500 scanner (Aloka, Tokyo, Japan) was used with a flexible laparoscopic multifrequency linear and an electronic T-shaped linear probe. RESULTS LIOUS prevented useless laparotomies in six patients (13.3%) with liver tumors and, coupled with IOUS, revealed previously undetected tumors that required a change in the surgical strategy in 5 others (11.1%). In patients with pancreatic disease, LIOUS excluded the possibility of radical surgery in 7 patients (14.4%) due to the presence of mesenteric vein infiltration, involvement of the celiac or para-aortic nodes, or the presence of liver or peritoneal micro-metastases. In 11 patients with benign lesions, it defined the lesions' relation to the Wirsung duct and splenic vessels, and in 6 others it provided guidance for aspiration of fluid for chemical and cytologic analysis. CONCLUSIONS LIUOS and IOUS can play fundamental roles in selecting patients for resective surgery and in planning the surgical approach. They provided information that affected surgical strategies in 11 patients with liver disease (24.4%) and 13 with pancreas disease (27%).
Collapse
Affiliation(s)
- D Piccolboni
- General and Laparoscopic Surgery Department - Monaldi Hospital - Naples, Italy
| | | | | | | |
Collapse
|
27
|
Clinical Risk Score Can be Used to Select Patients for Staging Laparoscopy and Laparoscopic Ultrasound for Colorectal Liver Metastases. World J Surg 2010; 34:2141-5. [DOI: 10.1007/s00268-010-0630-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
28
|
Techniques for performing laparoscopic liver resection in various hepatic locations. ACTA ACUST UNITED AC 2009; 16:427-32. [PMID: 19475331 DOI: 10.1007/s00534-009-0118-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 03/31/2009] [Indexed: 01/22/2023]
Abstract
Many studies have recently reported on laparoscopic liver resection, although its development has been slow compared to laparoscopy in other fields. The indications for the location of laparoscopic liver resection have previously been limited to easily accessible lesions. Performing laparoscopic liver resection in the posterior and superior parts of the liver has been considered difficult due to inadequate exposure, the poor operative field and the difficulty with parenchymal dissection. Flexible endoscopy, high definition imaging and various kinds of equipment for parenchymal transection have been introduced for clinical use. In addition, much experience with this procedure has been accumulated at many centers. Accordingly, there are an increasing number of reports on laparoscopic liver resection in difficult locations. At our institution, the location of the tumor is no longer a limitation to laparoscopic liver resection. However, for safer laparoscopic liver resection, the patient positioning and trocar placement should be individualized according to the tumor location. The type of resection also may depend on the remaining liver's functional capacity. We describe here the technical considerations for performing laparoscopic liver resection, including the technical considerations for performing laparoscopic liver resection for lesions located in the postero-superior segments of the liver.
Collapse
|
29
|
Azagra JS, Goergen M, Brondello S, Calmes MO, Philippe P, Schmitz B. Laparoscopic liver sectionectomy 2 and 3 (LLS 2 and 3): towards the "gold standard". ACTA ACUST UNITED AC 2009; 16:422-6. [PMID: 19466378 DOI: 10.1007/s00534-009-0117-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 03/31/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND The purpose of this article is to define the state of the art in laparoscopic liver sectionectomy 2 and 3 (LLS 2 and 3) in order to advance the good option towards the "gold standard". METHODS Based on a large review of the literature as well as on our personal experience the authors define clearly: the feasibility and the effectiveness of LLS 2 and 3. RESULTS In this review the conversion rate was <4%, the histological positive margins was <0.8%, and the mortality was inferior to 0.8%. CONCLUSION The LLS 2 and 3 seem equivalent or perhaps better option compared with the same intervention performed by laparotomy and can be proposed as primary with a grade C recommendation.
Collapse
Affiliation(s)
- J S Azagra
- Digestive and Endocrine Multidisciplinary Unit (UMADE), Centre Hospitalier de Luxembourg, 4, rue Barblé, 1210, Luxembourg, Luxembourg.
| | | | | | | | | | | |
Collapse
|
30
|
Pawlik TM, Assumpcao L, Vossen JA, Buijs M, Gleisner AL, Schulick RD, Choti MA. Trends in nontherapeutic laparotomy rates in patients undergoing surgical therapy for hepatic colorectal metastases. Ann Surg Oncol 2008; 16:371-8. [PMID: 19020939 DOI: 10.1245/s10434-008-0230-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 10/06/2008] [Accepted: 10/08/2008] [Indexed: 11/18/2022]
Abstract
Surgery is the treatment of choice in selected patients with hepatic colorectal metastases. Despite improvements in preoperative imaging, patients can undergo unnecessary nontherapeutic laparotomy. The aim of this study was to examine trends in nontherapeutic laparotomy rates in patients undergoing planned surgical therapy for hepatic colorectal metastases. Data from 530 operations (461 patients) undergoing potentially curative surgical therapy for colorectal liver metastases between 1994 and 2005 were analyzed. The incidence of nontherapeutic laparotomy was determined and factors associated with nontherapeutic laparotomy were identified. Overall, 49 nontherapeutic laparotomies were performed (9.2%). Higher nontherapeutic laparotomy rates were seen in patients with multiple metastases and tumor size >5 cm (both P < 0.05). Preoperative positron emission tomography (PET) imaging was associated with lower risk of nontherapeutic laparotomy [5.6% versus 12.4%, P = 0.009, odds ratio (OR) = 0.42]. At laparotomy, extrahepatic findings were the reason for nontherapeutic laparotomy in 44.9% of cases. The nontherapeutic laparotomy rate significantly decreased over time (14.9% for 1994-1997 versus 9.6% for 1998-2001 versus 4.7% for 2002-2005; P = 0.003). While patients in each time period were similar with regard to tumor specific factors, utilization of PET imaging (P < 0.001) as well as resection plus ablation (P = 0.004) increased over time. We conclude that prevalence of nontherapeutic laparotomy for patients undergoing surgical exploration for hepatic colorectal metastases has decreased significantly in recent years to less than 5%. The reasons for this trend are probably multifactorial and may include improved preoperative assessment, such as PET imaging, as well as salvage surgical options.
Collapse
Affiliation(s)
- Timothy M Pawlik
- Department of Surgery, The Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD 22187, USA
| | | | | | | | | | | | | |
Collapse
|
31
|
Chang L, Stefanidis D, Richardson WS, Earle DB, Fanelli RD. The role of staging laparoscopy for intraabdominal cancers: an evidence-based review. Surg Endosc 2008; 23:231-41. [PMID: 18813972 DOI: 10.1007/s00464-008-0099-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 07/08/2008] [Indexed: 02/06/2023]
Abstract
Diagnostic laparoscopy is minimally invasive surgery for the diagnosis of intraabdominal diseases. The aim of this review is a critical examination of the available literature on the role of laparoscopy for the staging of intraabdominal cancers. A systematic literature search of English-language articles on MEDLINE, the Cochrane database of evidence-based reviews, and the Database of Abstracts of Reviews of Effects was performed for the period 1995-2006. The level of evidence in the identified articles was graded. The search identified and reviewed seven main categories that have received attention in the literature: esophageal cancer, gastric cancer, pancreatic cancer, hepatocellular carcinoma, biliary tract cancer, colorectal cancer, and lymphoma. The indications, contraindications, risks, benefits, diagnostic accuracy of the procedure, and its associated morbidity are discussed. The limitations of the available literature are highlighted, and evidence-based recommendations for the use of laparoscopy to stage intraabdominal cancers are provided.
Collapse
Affiliation(s)
- L Chang
- Department of General Surgery, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101, USA.
| | | | | | | | | |
Collapse
|
32
|
Riffat F, Niu R, Zhu C, Chu F, Morris DL. Impact of preoperative positron emission tomography scans on survival after liver resection for metastatic colorectal cancer. SURGICAL PRACTICE 2008. [DOI: 10.1111/j.1744-1633.2008.00399.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
33
|
Lupinacci R, Penna C, Nordlinger B. Hepatectomy for resectable colorectal cancer metastases--indicators of prognosis, definition of resectability, techniques and outcomes. Surg Oncol Clin N Am 2008; 16:493-506, vii-viii. [PMID: 17606190 DOI: 10.1016/j.soc.2007.04.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The field of surgery for liver metastases is evolving rapidly. The proportion of patients viewed as amenable to resection is increasing with surgeons becoming more aggressive and systemic therapy more effective. Surgical resection is associated with low mortality and overall 5-year survival approaching 40%. Best candidates for resection are those with stage I or II colorectal cancer, fewer than 4 hepatic lesions, no lesions larger than 5 cm in diameter, no evidence of extra-hepatic disease, CEA level less than 5 ng/mL, and a disease-free interval of at least 2 years. Perioperative chemotherapy with or without biotherapies, in-situ ablation techniques, portal vein embolization, and staged hepatectomy have extended the indications without lessening the results of liver resection for colorectal metastases.
Collapse
Affiliation(s)
- Renato Lupinacci
- Hôpital Ambroise-Paré, Service de Chirurgie Digestive, 9 av Charles De Gaulle, 92100 Boulogne Billancourt, France
| | | | | |
Collapse
|
34
|
Bretagnol F, Hatwell C, Farges O, Alves A, Belghiti J, Panis Y. Benefit of laparoscopy for rectal resection in patients operated simultaneously for synchronous liver metastases: preliminary experience. Surgery 2008; 144:436-41. [PMID: 18707042 DOI: 10.1016/j.surg.2008.04.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Accepted: 04/16/2008] [Indexed: 12/27/2022]
Abstract
BACKGROUND Resection of the rectal primary neoplasm with synchronous liver metastases (LM) is warranted, because this is the only strategy with curative potential. Combined resection remains controversial because of the risk of morbidity and necessity of a curative abdominal approach to warrant liver resection. Laparoscopic colorectal resection may be beneficial and could facilitate this procedure. METHODS Between February 2006 and June 2007, 10 patients underwent 1-step laparoscopic resection for primary rectal cancer combined with open resection of synchronous LM. RESULTS All patients underwent a laparoscopic mesorectal excision (n = 10). Liver resections included right hepatectomy (n = 1), bi- or trisegmentectomy (n = 3), and metastasectomy (n = 6). The rectosigmoid specimen was extracted through the right subcostal or a short midline incision used for open liver resection, except in 3 patients who underwent a 1-step totally laparoscopic resection of both the colorectal and hepatic neoplasms. The overall morbidity was 40%. The median hospital stay was 12 days (range, 5-40). Overall morbidity (29% vs 40%) and hospital stay (12 vs 12 days) were similar to those observed in a previous cohort of 27 patients undergoing laparoscopic mesorectal excision only. CONCLUSION This pilot study suggests that laparoscopic rectal resection with synchronous resection of LM is feasible with low morbidity and short hospital stay. Moreover, laparoscopy facilitates the operation approach for synchronous major hepatectomy.
Collapse
|
35
|
Experiences of laparoscopic liver resection including lesions in the posterosuperior segments of the liver. Surg Endosc 2008; 22:2344-9. [PMID: 18528623 DOI: 10.1007/s00464-008-9966-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 03/17/2008] [Accepted: 04/05/2008] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is a growing interest in laparoscopic liver resection because of its minimal invasiveness, the increased experience with laparoscopic procedures, and the advances of the laparoscopic devices. The authors describe their experience with laparoscopic liver resection, including its use for lesions in the posterosuperior segments of the liver (segments 1, 7, and 8, and the superior part of segment 4). METHODS A retrospective analysis was performed for the clinical data of 128 patients who underwent laparoscopic liver resection between January 2004 and December 2007. The patients were classified into two groups according to the location of the lesion: the anterolateral (AL) group (n = 92) and the posterosuperior (PS) group (n = 36). RESULTS The study enrolled 76 men and 52 women with a mean age of 57 years. The indications for resection were hepatocellular carcinoma (n = 57), hepatolithiasis (n = 39), liver metastasis from colorectal cancer (n = 21), and benign liver tumor (n = 11). There were no differences between the groups in terms of preoperative patient demographic characteristics or indications for liver resection. Major liver resection was performed more frequently for the PS group than for the AL group (p < 0.001). The mean operative time and the rate of intraoperative transfusion were significantly greater in the PS group than in the AL group (p = 0.009 and 0.015, respectively). However, the mean postoperative hospital stay and the complication rate were similar in the two groups (p = 0.345 and 0.733, respectively). Four patients underwent conversion to open hepatectomy (3.1%), with no difference in the rate of conversion between the two groups (p = 0.323). The complication rate was 18%, and all the patients were managed conservatively without the need for additional surgery. CONCLUSIONS Laparoscopic liver resection, including that for lesions in the posterosuperior part of the liver, is technically feasible and safe.
Collapse
|
36
|
Cho JY, Han HS, Yoon YS, Shin SH. Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location. Surgery 2008; 144:32-8. [PMID: 18571582 DOI: 10.1016/j.surg.2008.03.020] [Citation(s) in RCA: 205] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 03/24/2008] [Indexed: 01/02/2023]
Abstract
BACKGROUND Laparoscopic liver resection is usually limited to the anterolateral segments of the liver (AL; Segments II, III, V, VI, and the inferior part of IV). We evaluated the feasibility of laparoscopic liver resection in the posterosuperior segments (PS; Segments I, VII, VIII, and the superior part of IV). METHOD We analyzed retrospectively the clinical data of 82 patients who underwent laparoscopic liver resection for tumors from September 2003 to September 2007. Patients were classified into 2 groups according to tumor location: group AL (n=54) and group PS (n=28). RESULTS There was no mortality, reoperation, or major complications. Four (5%) conversions to open procedures were necessary. There were no differences in tumor characteristics, including mean tumor size and number of tumors between 2 groups (P = .427 and .611); however, there was a greater proportion of deeply seated tumors in group PS than group AL (P < .001). The predominant type of resection was a minor liver resection (left lateral sectionectomy, segmentectomy, or tumorectomy) in group AL, and a major liver resection (hemihepatectomy or right posterior sectionectomy) in group PS (P < .001). The median operative time in group PS was greater than that in group AL (320 vs 210 min; P < .001). There were no differences in the conversion rate (P = .113), median blood loss (P = .214), rate of intraoperative transfusion (P = .061), median tumor-free margin (P = .613), median hospital stay (P = .166), and rate of complications (P = .148) between the 2 groups. CONCLUSION Laparoscopic liver resection for tumors located in PS is more difficult than in AL but is feasible in selected patients.
Collapse
Affiliation(s)
- Jai Young Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | |
Collapse
|
37
|
Piccolboni D, Ciccone F, Settembre A, Corcione F. Liver resection with intraoperative and laparoscopic ultrasound: report of 32 cases. Surg Endosc 2008; 22:1421-6. [DOI: 10.1007/s00464-008-9886-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 01/18/2008] [Accepted: 02/02/2008] [Indexed: 12/17/2022]
|
38
|
|
39
|
Li Destri G, Di Benedetto F, Torrisi B, Portale TR, Mosca F, Vecchio R, Di Cataldo A, Puleo S. Metachronous liver metastases and resectability: Fong's score and laparoscopic evaluation. HPB (Oxford) 2008; 10:13-7. [PMID: 18773094 PMCID: PMC2507751 DOI: 10.1080/13651820701851384] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The aim of this retrospective study was to establish whether Fong's risk score can predict rate of resectability and whether laparoscopic exploration with ultrasonography can reduce the number of useless laparotomies to any extent. MATERIAL AND METHODS Fong's score was calculated for each of the 43 potential resectable patients. We analysed: the relation between score and resectability; the probability of unnecessary laparotomy with respect to each level of score; and which of the five Fong parameters was the most indicative of non-resectability. None of our patients was submitted to preoperative laparoscopic staging. RESULTS All patients with Fong's score 0 were submitted to liver resection, whereas only 76.9% with score 1, 58.3% with score 2, and 66.6% with score 3. No patients had score 4 and 5. "CEA level" is the parameter that best predicts the "non-resectability" of metastases. In the subgroup with score 0-1, laparoscopy would have spared 12% of unnecessary laparotomies, whereas in subgroup 2-3 this percentage would have risen to 38.9. CONCLUSIONS The above data allowed us to quantify statistically the risk associated with non-resectability of liver metastases in a directly proportional manner as the score progresses.
Collapse
Affiliation(s)
- G. Li Destri
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of CataniaCataniaItaly
| | - F. Di Benedetto
- Liver and Multivisceral Transplant Centre, University of Modena and Reggio EmiliaModenaItaly
| | - B. Torrisi
- Department of Economy and Territory, Unit of Statistics, University of CataniaCataniaItaly
| | - T. R. Portale
- Department of Surgery, University of CataniaCataniaItaly
| | - F. Mosca
- Department of Surgery, University of CataniaCataniaItaly
| | - R. Vecchio
- Department of Surgery, University of CataniaCataniaItaly
| | - A. Di Cataldo
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of CataniaCataniaItaly
| | - S. Puleo
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of CataniaCataniaItaly
| |
Collapse
|
40
|
Mazzoni G, Napoli A, Mandetta S, Miccini M, Cassini D, Gregori M, Colace L, Tocchi A. Intra-operative ultrasound for detection of liver metastases from colorectal cancer. Liver Int 2008; 28:88-94. [PMID: 17971094 DOI: 10.1111/j.1478-3231.2007.01583.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the accuracy of intra-operative ultrasound (IOUS) imaging in detecting liver secondaries at the time of primary colorectal surgery and to evaluate the impact of IOUS on patient management. METHODS Data from 167 patients with primary colorectal cancer who were admitted for elective surgery between January 1995 and December 2003 were prospectively evaluated and analysed. All patients underwent pre-operative abdominal ultrasonography (US) and computed tomography (CT), as well as IOUS. The final diagnosis of liver metastases was made by means of histological examination of either biopsy or surgical specimens. The sensitivities of pre-operative US and CT were compared with the sensitivity of IOUS, referred to histology. Changes in surgical management owing to IOUS findings were noted. RESULTS IOUS supplied additional information in the case of 31 patients. In 28 of these patients, this information had a major impact on the intra-operative strategy, in that the procedure was altered. CONCLUSIONS IOUS is safe, simple to perform and more accurate than pre-operative imaging. It reduces the number of patients subjected to superfluous surgery. The use of IOUS is therefore encouraged during colorectal cancer surgery.
Collapse
Affiliation(s)
- Gianluca Mazzoni
- Department of Surgery, 'La Sapienza' University Medical School, Rome, Italy
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Karuna ST, Thirlby R, Biehl T, Veenstra D. Cost-effectiveness of laparoscopy versus laparotomy for initial surgical evaluation and treatment of potentially resectable hepatic colorectal metastases: a decision analysis. J Surg Oncol 2008; 97:396-403. [DOI: 10.1002/jso.20964] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
42
|
Dede K, Mersich T, Nagy P, Baranyai Z, Zaránd A, Ifj Besznyák I, Faludi S, Jakab F. [The role of laparoscopy assessing the resectability of hepatic malignancies]. Magy Seb 2007; 60:248-52. [PMID: 17984015 DOI: 10.1556/maseb.60.2007.5.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Regarding the prognosis of hepatic malignancies, surgical resection can provide a 40% 5-year survival, however liver transplantation (OLTX) shows even better results. Unfortunately, many patients have non-resectable disease due to either the number and the position of the tumours or its distant spread. It is relatively frequent that it turns out only at the time of the surgical exploration that the patient is inoperable. Hence, in addition to preoperative clinical evaluation and imaging, laparoscopy can be valuable in further staging and assessment of resectability in selected cases. METHODS AND PATIENTS 310 patients underwent hepatic resection between 1 January 2000 and 31 March 2006. A retrospective analysis was carried out of 39 patients, who underwent laparoscopy prior to the planned hepatectomy. 22 patients (56%) were diagnosed with hepatocellular carcinoma (HCC), while 17 patients (44%) had hepatic metastases. RESULTS Altogether 70% of the patients were found to have non-resectable tumour on laparoscopy. However, when these patients underwent laparotomy, non-resectable disease was found in 50% of them. Laparoscopy was helpful to demonstrate non-resectability of the tumour when carcinosis peritonei or multifocal lesions were present, but central or venous invasion could not be assessed adequately with this technique. CONCLUSION Laparoscopy can be an important component of the preoperative staging of malignant hepatic tumours. Further, it can help to avoid unnecessary laparotomies. However, this procedure is recommended in selected patients only, and its general use is not indicated.
Collapse
Affiliation(s)
- Kristóf Dede
- Fovárosi Onkormányzat Uzsoki utcai Kórház, Sebészeti-Ersebészeti Osztály, 1145 Budapest, Uzsoki u. 29.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Belli G, D'Agostino A, Fantini C, Cioffi L, Belli A, Russolillo N, Langella S. Laparoscopic radiofrequency ablation combined with laparoscopic liver resection for more than one HCC on cirrhosis. Surg Laparosc Endosc Percutan Tech 2007; 17:331-4. [PMID: 17710062 DOI: 10.1097/sle.0b013e31806d9c65] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The management of patients affected by more than one hepatocellular carcinoma (HCC) is still controversial but nowadays a multimodal approach to this pathology seems to be the most effective and versatile therapeutic option. When orthotopic liver transplantation is not indicated, survival-time and quality of life improvement is the goal for patients who will have a long metabolic and oncologic disease history. Combined use of minimally invasive nonsurgical treatments [percutaneous ethanol injection, radiofrequency ablation, transcutaneous arterial chemioembolization (TACE)] allows to offer to the patients the advantages of each therapeutic procedure reducing their individual side effects and complications. We consider laparoscopy as a minimally invasive procedure, which can offer the benefits of surgical treatment, by tumor removing, but with an improved postoperative course. If recurrence risk factors are present, the costs/benefits rapport can be decreased by the laparoscopic approach which offers, in addition to a radical resection, a decreased postoperative pain, reduced trauma to the abdominal wall, smaller incisions, reduced peritoneal adhesions and, in selected cases, an earlier beginning of chemiotherapy. We report the case of a patient affected by more than one HCC with a bigger lesion of 50 mm protruding from hepatic segment III, one subcapsular lesion located at segment V, and one deep lesion located at segment VII-VIII. The patient was submitted to a double laparoscopic liver resection in association with laparoscopic radiofrequency ablation. Five months later, the patient presented an early recurrence of malignancy that was treated by TACE. At 8 months from the treatment, the patient presented another multifocal recurrence and was submitted to another TACE. At 2 years from the laparoscopic procedure, the patient is in apparent good conditions with an acceptable quality of life. We think that laparoscopic resection could gain a considerable place in the multimodal treatment of cirrhotic liver with more than one HCC because, by tumor removing, it offers the benefits of surgical treatment with a lower complications rate.
Collapse
Affiliation(s)
- Giulio Belli
- Department of General and Hepato-Pancreato-Biliary Surgery, S.M. Loreto Nuovo Hospital Naples, Italy.
| | | | | | | | | | | | | |
Collapse
|
44
|
|
45
|
Abstract
Colorectal cancer is the fourth most common type of cancer in the West and the second leading cause of cancer-related deaths in the United States. Approximately 35 to 55% of patients with colorectal cancer develop hepatic metastases during the course of their disease. Surgical resection of colorectal liver metastases represents the only chance at potential cure, and long-term survival can be achieved in 35 to 58% of patients after resection. The goal of hepatic resection should be to resect all metastases with negative histologic margins while preserving sufficient functional hepatic parenchyma. In patients with extensive metastatic disease who would otherwise be unresectable, ablative approaches can be used instead of or combined with hepatic resection. The use of portal vein embolization and preoperative chemotherapy may also expand the population of patients who are candidates for surgical treatment. Despite these advances, many patients still experience a recurrence after hepatic resection. More active systemic chemotherapy agents are now available and are being increasingly employed as adjuvant therapy either before or after surgery. Modern treatment of colorectal liver metastasis requires a multidisciplinary approach in an effort to increase the number of patients who may benefit from surgical treatment of colorectal cancer liver metastasis.
Collapse
Affiliation(s)
- Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 22187-6681, USA
| | | |
Collapse
|
46
|
Asbun HJ, Straznicka M, Strong VE. The role of minimal access surgery for metastasectomy and cytoreduction. Surg Oncol Clin N Am 2007; 16:607-25, ix. [PMID: 17606196 DOI: 10.1016/j.soc.2007.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This article summarizes findings about the applicability of minimal-access techniques for thoracic and upper gastrointestinal cancers, including those affecting the lung, liver, stomach, and adrenal gland. If metastasectomy and cytoreductive surgery are rapidly evolving, minimal-access surgery in this setting is in its introductory stages. Nevertheless, minimal-access metastasectomy and cytoreductive surgery harbor great potential for selected patients, but further clinical studies are needed.
Collapse
Affiliation(s)
- Horacio J Asbun
- John Muir Health, 401 Gregory Lane, # 204, Walnut Creek, CA 94523, USA.
| | | | | |
Collapse
|
47
|
Yang YYL, Fleshman JW, Strasberg SM. Detection and management of extrahepatic colorectal cancer in patients with resectable liver metastases. J Gastrointest Surg 2007; 11:929-44. [PMID: 17593417 DOI: 10.1007/s11605-006-0067-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The presence of extrahepatic disease has a great effect on the management of patients with metastatic colorectal cancer in the liver. FDG-PET scanning is currently the most sensitive way of detecting extrahepatic metastases in such patients. This is supported by 10 studies, which show that FDG-PET scan will discover extrahepatic disease in about one in six patients who have completed standard imaging. Staging laparoscopy is another means of detecting extrahepatic disease. Its role remains undefined especially in patients who have had FDG-PET scans. It should probably be restricted to patients with high clinical risk scores. In terms of treatment, patients with recurrence at the primary colorectal site as well as resectable liver metastases appear to benefit from resection of both sites provided that R0 resections can be obtained. Resection of involved hepatic pedicle lymph nodes in patients with resectable liver metastases is associated with poor outcome. The situation regarding patients with peritoneal and liver metastases bears a strong resemblance to that of primary site recurrence and liver metastases. Very acceptable survival can be expected if the peritoneal disease can be eradicated. Information regarding treatment of lung and liver metastases is the most complete of any of these areas. Good results may be expected if all the disease can be cleared. Caution is required in interpreting claims of good survival when study numbers are small and confidence intervals of data are not provided.
Collapse
Affiliation(s)
- Yolanda Y L Yang
- The Permanente Medical Group, Kaiser, South San Francisco, San Francisco, CA, USA
| | | | | |
Collapse
|
48
|
Kim HJ, D'Angelica M, Hiotis SP, Shoup M, Weber SM. Laparoscopic staging for liver, biliary, pancreas, and gastric cancer. Curr Probl Surg 2007; 44:228-69. [PMID: 17467404 DOI: 10.1067/j.cpsurg.2007.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Hong Jin Kim
- Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, USA
| | | | | | | | | |
Collapse
|
49
|
Abstract
Patients with metastatic disease from colorectal cancer are now living twice as long as they were one decade ago. With this increasing life expectancy, we are beginning to see these patients strive for an acceptable and improved quality of life. Medical advances have led to unanswered questions regarding the role of surgery in metastatic colorectal cancer. Despite the increasing application of laparoscopy for primary treatment of colorectal cancer, the appropriate role for laparoscopy in patients with stage IV disease has yet to be defined. This review addresses this topic and suggests treatment algorithms for patients with metastatic colorectal cancer. While unresectable, metastatic colorectal cancer remains incurable at the current time, continued advances will inevitably challenge this presumption and it is crucial to outline the role of laparoscopy in this patient population.
Collapse
Affiliation(s)
- Bradley J Champagne
- Division of Colorectal Surgery, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106-5047, USA
| | | |
Collapse
|
50
|
Mann CD, Neal CP, Metcalfe MS, Pattenden CJ, Dennison AR, Berry DP. Clinical Risk Score predicts yield of staging laparoscopy in patients with colorectal liver metastases. Br J Surg 2007; 94:855-9. [PMID: 17380479 DOI: 10.1002/bjs.5730] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abstract
Background
Resection offers the only realistic chance of cure for hepatic colorectal metastases. The aim of this study was to examine the potential of laparoscopy and laparoscopic intraoperative ultrasonography (IOUS) for detecting incurable disease, and to determine whether the Clinical Risk Score (CRS) is useful in selecting patients for laparoscopy before hepatic resection.
Methods
All patients with potentially curable colorectal liver metastases who underwent staging laparoscopy and laparoscopic IOUS before planned hepatic resection between January 2000 and December 2004 were included. A preoperative CRS was determined for each patient and correlated with curability.
Results
Two hundred patients were identified, of whom 133 were found to have resectable disease at laparotomy. Laparoscopy detected 39 (58 per cent) of 67 patients with incurable disease, changing the management in 19·5 per cent of the 200 patients. The CRS correlated with the likelihood of detecting incurable disease; incurable disease was present in two of 31 patients with a CRS of 0–1, 35 of 129 with a score of 2–3 and 30 of 40 with a score of 4–5. The potential benefit of laparoscopy increased progressively with increasing CRS, changing management in none of 31 patients with a CRS of 0–1, 18 of 129 with a score of 2–3 and 21 of 40 with a score of 4–5.
Conclusion
Staging laparoscopy and IOUS detected more than half of the incurable disease in this cohort. Laparoscopy had a low diagnostic yield in patients with a CRS of 0–1 and its routine use in this group of patients is therefore not recommended.
Collapse
Affiliation(s)
- C D Mann
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, UK.
| | | | | | | | | | | |
Collapse
|