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Delvecchio A, Conticchio M, Casella A, Ratti F, Gelli M, Anelli FM, Laurent A, Vitali GC, Magistri P, Felli E, Wakabayashi T, Pessaux P, Piardi T, Di Benedetto F, de'Angelis N, Briceño-Delgado J, Rampoldi A, Adam R, Cherqui D, Aldrighetti L, Memeo R. Open, laparoscopic liver resection and percutaneous thermal ablation in elderly patients with hepatocellular carcinoma: outcomes and therapeutic strategy. Surg Endosc 2024:10.1007/s00464-024-11269-w. [PMID: 39317909 DOI: 10.1007/s00464-024-11269-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 09/11/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Liver resection and percutaneous thermal ablation (PTA) are considered curative option for hepatocellular carcinoma (HCC). This study aims to compare short- and long-term outcomes between open liver resection (OLR), laparoscopic liver resection (LLR), and PTA in elderly patients with single HCC and to define a liver map for therapeutic strategy according to HCC location and size. METHODS A multicenter retrospective study was conducted in 10 European Hospital Center, including 239 consecutive liver resection (OLR and LLR) and PTA in elderly patients ≥ 70 years old with single HCC ≤ 30 mm. Perioperative data and long-term oncological outcomes were collected and compared between groups before and after propensity score matching. RESULTS A total of 239 patients were enrolled, distributed as follows: 61 in the ORL group, 88 in the LLR group, and 90 in the PTA group. The hospital stay was longer in OLR and LLR groups compared to the PTA group (6, 5 and 3 days, respectively, p < 0.05). Morbidity was lower in the PTA group compared to the OLR group (11 vs. 26%, respectively, p < 0.05). Overall survival (OS) at 5 years was significantly higher in the OLR and LLR groups compared to the PTA group (82, 81, and 34%, respectively, p < 0.001). Disease-free survival (DFS) at 5 years was also significantly higher in the ORL and LLR groups compared to the PTA group (66, 50 and 20%, respectively, p < 0.001). These results were also confirmed after a propensity score matching analysis between surgery group (OLR and LLR) and the PTA group. PTA was the most used treatment for subcapsular and deep HCC not in contact with vascular structures compared to OLR and LLR. CONCLUSION PTA in elderly patients ensures a shorter hospital stay and lower morbidity but worst survival compared to liver resection.
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Affiliation(s)
- Antonella Delvecchio
- Unit of Hepato-Pancreato-Biliary Surgery, Miulli Hospital, Strada Prov. 127 Acquaviva-Santeramo Km.,4, Acquaviva delle Fonti, 70021, Bari, Italy.
| | - Maria Conticchio
- Unit of Hepato-Pancreato-Biliary Surgery, Miulli Hospital, Strada Prov. 127 Acquaviva-Santeramo Km.,4, Acquaviva delle Fonti, 70021, Bari, Italy
| | - Annachiara Casella
- Unit of Hepato-Pancreato-Biliary Surgery, Miulli Hospital, Strada Prov. 127 Acquaviva-Santeramo Km.,4, Acquaviva delle Fonti, 70021, Bari, Italy
| | - Francesca Ratti
- Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Maximiliano Gelli
- Department of Surgical Oncology, Institute of Oncology Gustave Roussy, 94800, Villejuif, France
| | - Ferdinando Massimiliano Anelli
- Department of General Surgery and Liver and Pancreas Transplantation, University Hospital Reina Sofía, 14004, Córdoba, Spain
| | - Alexis Laurent
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor University Hospital, AP-HP, UPEC University, 94000, Créteil, France
| | - Giulio Cesare Vitali
- Division of Transplantation, Department of Surgery, Geneva University Hospitals, 44041, Geneva, Switzerland
- Department of General and HPB Surgery, Poliambulanza Hospital, 25124, Brescia, Italy
| | - Paolo Magistri
- Unit of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Modena and Reggio Emilia, 42121, Modena, Italy
| | - Emanuele Felli
- Department of Digestive Surgery, Strasbourg University Hospital, IRCAD, 67000, Strasbourg, France
| | - Taiga Wakabayashi
- Department of Digestive Surgery, Strasbourg University Hospital, IRCAD, 67000, Strasbourg, France
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
| | - Patrick Pessaux
- Department of Digestive Surgery, Strasbourg University Hospital, IRCAD, 67000, Strasbourg, France
| | - Tullio Piardi
- Department of HBP and Digestive Oncological Surgery, Robert Debré University Hospital, 51092, Reims, France
- Department of Surgery, HPB Unit, Troyes Hospital, 10420, Troyes, France
| | - Fabrizio Di Benedetto
- Unit of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Modena and Reggio Emilia, 42121, Modena, Italy
| | - Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), University Paris Cité, 92110, Clichy, France
| | - Javier Briceño-Delgado
- Department of General Surgery and Liver and Pancreas Transplantation, University Hospital Reina Sofía, 14004, Córdoba, Spain
| | - Antonio Rampoldi
- Unit of Interventional Radiology, Niguarda Hospital, 20162, Milan, Italy
| | - Rene Adam
- Hepatobiliary Centre, Paul Brousse University Hospital, Villejuif, France
| | - Daniel Cherqui
- Hepatobiliary Centre, Paul Brousse University Hospital, Villejuif, France
| | - Luca Aldrighetti
- Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, Miulli Hospital, Strada Prov. 127 Acquaviva-Santeramo Km.,4, Acquaviva delle Fonti, 70021, Bari, Italy
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Muaddi H, Gudmundsdottir H, Cleary S. Current Status of Laparoscopic Liver Resection. Adv Surg 2024; 58:311-327. [PMID: 39089784 DOI: 10.1016/j.yasu.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
The evolution of laparoscopic liver surgery, originating in the 1990s, has been marked by significant advancements and milestones, overcoming initial technical hurdles and gaining widespread acceptance within the surgical community as a precise and safe alternative to open procedures. Along this journey, numerous challenges emerged, leading to the accumulation of evidence and the development of guidelines aimed at assisting surgeons in determining the safety, suitability, and complexity of laparoscopic liver resection. This chapter provides a thorough examination of key aspects of laparoscopic liver resection, including difficulty scoring systems, criteria for patient selection, technical considerations, outcomes across different types of liver lesions, and the innovative solutions developed to address challenges, thus offering a comprehensive overview of laparoscopic liver resection, and highlighting its evolving significance in modern hepatobiliary surgery.
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Affiliation(s)
- Hala Muaddi
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Sean Cleary
- Division of Hepatobiliary and Pancreas Surgery, University of Toronto, Toronto, Ontario, Canada.
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Yu YD, Halazun KJ, Chandwani R, Samstein B. Minimally invasive tools are necessary for the modern practice of liver surgery. J Minim Access Surg 2024:01413045-990000000-00059. [PMID: 38958005 DOI: 10.4103/jmas.jmas_377_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/15/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION Minimally invasive liver resection (MILR) is performed for other gastrointestinal applications. At our centre, all liver resections are systematically performed using a minimally invasive approach. This study aimed to describe our experience in minimising open surgery and emphasised the importance of minimally invasive surgery. PATIENTS AND METHODS We retrospectively reviewed 260 patients who underwent liver surgery and compared the surgical outcomes between the open and MILR groups. RESULTS A total of 154 patients (68%) underwent MILR. The proportion of patients who underwent prior abdominal surgery and resection was higher in the open surgery group. However, the proportion of patients with liver cirrhosis was similar between the two groups. The MILR group was superior in terms of operative time, blood loss, Pringle manoeuvre rate and mean hospital stay. In addition, major complication and bile leak rates were lower in the MILR group. No significant differences in the tumour size, number of lesions or underlying liver pathology were observed between the two groups. CONCLUSION Acceptable outcomes can be achieved even when the minimally invasive approach is considered the primary option for all patients who require liver resection. Minimally invasive tools are necessary for the modern practice of liver surgery; therefore, laparoscopic or robotic surgery should be included in the armamentarium of liver surgeons.
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Affiliation(s)
- Young-Dong Yu
- Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Weill Cornell Medical College, New York, NY, USA
- Department of Surgery, Division of HBP Surgery and Liver Transplantation, Korea University College of Medicine, Seoul, Korea
| | - Karim J Halazun
- Department of Surgery, Division Hepatobiliary and Pancreatic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Rohit Chandwani
- Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Benjamin Samstein
- Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Weill Cornell Medical College, New York, NY, USA
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Paro A, Hyer JM, Avery BS, Tsilimigras DI, Bagante F, Guglielmi A, Ruzzenente A, Alexandrescu S, Poultsides G, Sasaki K, Aucejo F, Pawlik TM. Using the win ratio to compare laparoscopic versus open liver resection for colorectal cancer liver metastases. Hepatobiliary Surg Nutr 2023; 12:692-703. [PMID: 37886182 PMCID: PMC10598303 DOI: 10.21037/hbsn-22-36] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/10/2022] [Indexed: 10/28/2023]
Abstract
Background We sought to assess the overall benefit of laparoscopic versus open hepatectomy for treatment of colorectal liver metastases (CRLMs) using the win ratio, a novel methodological approach. Methods CRLM patients undergoing curative-intent resection in 2001-2018 were identified from an international multi-institutional database. Patients were paired and matched based on age, number and size of lesions, lymph node status and receipt of preoperative chemotherapy. The win ratio was calculated based on margin status, severity of postoperative complications, 90-day mortality, time to recurrence, and time to death. Results Among 962 patients, the majority underwent open hepatectomy (n=832, 86.5%), while a minority underwent laparoscopic hepatectomy (n=130, 13.5%). Among matched patient-to-patient pairs, the odds of the patient undergoing laparoscopic resection "winning" were 1.77 [WR: 1.77, 95% confidence interval (CI): 1.42-2.34]. The win ratio favored laparoscopic hepatectomy independent of low (WR: 2.94, 95% CI: 1.20-6.39), medium (WR: 1.56, 95% CI: 1.16-2.10) or high (WR: 7.25, 95% CI: 1.13-32.0) tumor burden, as well as unilobar (WR: 1.71, 95% CI: 1.25-2.31) or bilobar (WR: 4.57, 95% CI: 2.36-8.64) disease. The odds of "winning" were particularly pronounced relative to short-term outcomes (i.e., 90-day mortality and severity of postoperative complications) (WR: 4.06, 95% CI: 2.33-7.78). Conclusions Patients undergoing laparoscopic hepatectomy had 77% increased odds of "winning". Laparoscopic liver resection should be strongly considered as a preferred approach to resection in CRLM patients.
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Affiliation(s)
- Alessandro Paro
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - J. Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Brandon S. Avery
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Diamantis I. Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | | | | | | | | | | | | | | | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
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Zhou Y, Wang Y, Ma J, Zhang C. "Hooking method" for hepatic inflow control: a new approach for laparoscopic Pringle maneuver. World J Surg Oncol 2023; 21:254. [PMID: 37605259 PMCID: PMC10463780 DOI: 10.1186/s12957-023-03149-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The laparoscopic Pringle maneuver is crucial for controlling bleeding during laparoscopic hepatectomy. In this study, we introduce a new laparoscopic Pringle maneuver and preliminarily investigate its application in laparoscopic hepatectomy. METHODS We collected and analyzed the clinical data of 17 consecutive patients who underwent laparoscopic hepatectomy at the Department of Hepatic Surgery, the First Affiliated Hospital of the University of Science and Technology of China, from January 2022 to January 2023. All patients underwent the hooking method for intermittent occlusion of hepatic inflow. Intraoperative and postoperative clinical indices were observed and recorded. RESULTS All 17 patients underwent laparoscopic hepatectomy with hepatic inflow control using the hooking method. Four patients with adhesions under the hepatoduodenal ligament successfully had occlusion loops placed using the hooking method combined with Zhang's modified method during surgery. The median occlusion time for the 17 patients was 34 (12-60) min, and the mean operation time was 210 ± 70 min. The mean intraoperative blood loss was 145 ± 86 ml, and no patients required intraoperative blood transfusion. The patients' postoperative peak AST was 336 ± 183 U/L, and the postoperative peak ALT was 289 ± 159 U/L. Postoperative complications occurred in 2 patients (11.8%), including 1 Clavien-Dindo grade I and 1 Clavien-Dindo grade II complication. No Clavien-Dindo grade IIIa or higher complications or deaths occurred in any patient. None of the patients developed portal vein thrombosis or hepatic artery aneurysm formation. The median postoperative hospital stay was 6 (4-14) days. CONCLUSION The hooking method combines the advantages of both intracorporeal Pringle maneuver and extracorporeal Pringle maneuver. It is a simple, safe, and effective method for controlling hepatic inflow and represents a promising approach for performing totally intracorporeal laparoscopic Pringle maneuver.
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Affiliation(s)
- Yi Zhou
- Department of Hepatic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
- Department of Emergency Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Yifan Wang
- Department of Hepatic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Jinliang Ma
- Department of Hepatic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Chuanhai Zhang
- Department of Hepatic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China.
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Chen YC, Lee YH, Lin HH, Kuo TL, Lee MC. Previous nonhepatectomy abdominal surgery did not increase the difficulty in laparoscopic hepatectomy for hepatocellular carcinoma: A case–control study in 100 consecutive patients. Tzu Chi Med J 2023. [PMID: 37545796 PMCID: PMC10399838 DOI: 10.4103/tcmj.tcmj_293_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Objectives Laparoscopic hepatectomy (LH) is still technically challenging for patients with previous nonhepatectomy abdominal surgery (AS). Therefore, this study aimed to assess the difficulty of performing LH for patients with hepatocellular carcinoma (HCC) and a history of nonhepatectomy AS during the initial developing period of LH. Materials and Methods The retrospective study enrolled patients who were newly diagnosed with HCC receiving LH from January 2013 to June 2021. Demographic characteristics, perioperative variables, and surgical complications were prospectively collected. Results One hundred patients were reviewed consecutively, comprising 23 in the AS group and 77 in the non-AS group. No significant differences were observed in median IWATE score (5 vs. 5, P = 0.194), operative time (219 vs. 200 min, P = 0.609), blood loss (100.0 vs. 200.0 mL, P = 0.734), transfusion rate (4.3% vs. 10.4%, P = 0.374), duration of parenchyma transection (90.0 vs. 72.4 min, P = 0.673), and mean nonparenchymal transection time (191.0 vs. 125.0 min, P = 0.228), without increasing the conversion rate (0.0% vs. 3.9%, P = 0.336), postoperative complications (30.3% vs. 33.8%, P = 0.488), and postoperative hospital stay (6 vs. 7 days, P = 0.060) in AS group and non-AS groups. Conclusion History of previous nonhepatectomy AS can lead to longer nonparenchymal transection time instead of conversion and did not increase the difficulty. Prolonged nonparenchymal transection time did not increase the surgical complications, prolong the postoperative hospital stay, and compromise the survival outcomes.
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Yang Y, Peng Y, Chen K, Wei Y, Li B, Liu F. Laparoscopic liver resection with "ultrasonic scalpel mimic CUSA" technique. Surg Endosc 2022; 36:8927-8934. [PMID: 35672503 DOI: 10.1007/s00464-022-09341-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/13/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Liver parenchymal transection is the most critical step for laparoscopic liver resection (LLR). Ultrasonic scalpel (Harmonic) is a common used energy instrument in LLR; however, it is only recommended for superficial layer transection and the Cavitron Ultrasonic Surgical Aspirator (CUSA) is recommended for deep layer dissection. We herein introduce the "Harmonic mimic CUSA" technique for LLR. METHODS We retrospectively reviewed the medical records of the patients who underwent LLR using CUSA or the "Harmonic mimic CUSA" for parenchymal transection between July 2018 and October 2020 at West China Hospital of Sichuan University. Observation indicators included general demographic information, operative time, intraoperative blood loss, blood transfusion volume, complication rate, hospital stay, and the costs. Perioperative data was compared between the two groups by propensity score matching analysis (PSM). RESULTS A total of 298 patients, including 192 in Harmonic group and 106 in CUSA group, were enrolled in this study. After a 1:1 PSM, 99 patients using "Harmonic mimic CUSA" were matched with 99 patients via CUSA for parenchymal transection in LLRs. The Harmonic group had significantly less intraoperative blood loss (mean, 150 ml vs. 250 ml, P < 0.001), shorter operative time (mean 170 min vs. 250 min, P < 0.001) and less costs (mean 6723$ vs. 8307$, P < 0.001). The conversion to laparotomy, length of postoperative hospital stay, complications were comparable between the two groups. There perioperative mortality was nil. CONCLUSION The "Harmonic mimic CUSA" technique is safe, simple and feasible for LLR, which may be an alternative to CUSA for LLR.
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Affiliation(s)
- Yubo Yang
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - Yufu Peng
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - Kefei Chen
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - YongGang Wei
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - Bo Li
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - Fei Liu
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan Province, China.
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D’Silva M, Han HS, Liu R, Kingham TP, Choi GH, Syn NLX, Prieto M, Choi SH, Sucandy I, Chiow AKH, Marino MV, Efanov M, Lee JH, Sutcliffe RP, Chong CCN, Tang CN, Cheung TT, Pratschke J, Wang X, Park JO, Chan CY, Scatton O, Rotellar F, Troisi RI, D’Hondt M, Fuks D, Goh BKP, Gastaca M, Schotte H, De Meyere C, Lai EC, Krenzien F, Schmelzle M, Kadam P, Giglio M, Montalti R, Liu Q, Lee KF, Lee LS, Jang JY, Lim C, Labadie KP. Limited liver resections in the posterosuperior segments: international multicentre propensity score-matched and coarsened exact-matched analysis comparing the laparoscopic and robotic approaches. Br J Surg 2022; 109:1140-1149. [DOI: 10.1093/bjs/znac270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/22/2022] [Accepted: 07/14/2022] [Indexed: 12/07/2022]
Abstract
Abstract
Background
Limited liver resections (LLRs) for tumours located in the posterosuperior segments of the liver are technically demanding procedures. This study compared outcomes of robotic (R) and laparoscopic (L) LLR for tumours located in the posterosuperior liver segments (IV, VII, and VIII).
Methods
This was an international multicentre retrospective analysis of patients who underwent R-LLR or L-LLR at 24 centres between 2010 and 2019. Patient demographics, perioperative parameters, and postoperative outcomes were analysed; 1 : 3 propensity score matching (PSM) and 1 : 1 coarsened exact matching (CEM) were performed.
Results
Of 1566 patients undergoing R-LLR and L-LLR, 983 met the study inclusion criteria. Before matching, 159 R-LLRs and 824 L-LLRs were included. After 1 : 3 PSM of 127 R-LLRs and 381 L-LLRs, comparison of perioperative outcomes showed that median blood loss (100 (i.q.r. 40–200) versus 200 (100–500) ml; P = 0.003), blood loss of at least 500 ml (9 (7.4 per cent) versus 94 (27.6 per cent); P < 0.001), intraoperative blood transfusion rate (4 (3.1 per cent) versus 38 (10.0 per cent); P = 0.025), rate of conversion to open surgery (1 (0.8 per cent) versus 30 (7.9 per cent); P = 0.022), median duration of Pringle manoeuvre when applied (30 (20–46) versus 40 (25–58) min; P = 0.012), and median duration of operation (175 (130–255) versus 224 (155–300); P < 0.001) were lower in the R-LLR group compared with the L-LLR group. After 1 : 1 CEM of 104 R-LLRs with 104 L-LLRs, R-LLR was similarly associated with significantly reduced blood loss and a lower rate of conversion to open surgery.
Conclusion
Based on a matched analysis of well selected patients, both robotic and laparoscopic access could be undertaken safely with good outcomes for tumours in the posterosuperior liver segments.
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Affiliation(s)
- Mizelle D’Silva
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seoul , Korea
| | - Ho Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seoul , Korea
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery , First Medical Centre of Chinese People’s Liberation Army General Hospital, Beijing , China
| | - Thomas Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center , New York, New York , USA
| | - Gi Hong Choi
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine , Seoul , Korea
| | - Nicholas Li Xun Syn
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore , Singapore
| | - Mikel Prieto
- Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country , Bilbao , Spain
| | - Sung Hoon Choi
- Department of General Surgery, CHA Bundang Medical Centre, CHA University School of Medicine , Seongnam , Korea
| | - Iswanto Sucandy
- AdventHealth Tampa, Digestive Health Institute , Tampa, Florida , USA
| | - Adrian Kah Heng Chiow
- Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital , Singapore
| | - Marco Vito Marino
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy and Oncologic Surgery Department, P. Giaccone University Hospital , Palermo , Italy
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Centre , Moscow , Russia
| | - Jae Hoon Lee
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Centre, University of Ulsan College of Medicine , Seoul , Korea
| | - Robert Peter Sutcliffe
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - Charing Ching Ning Chong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong , New Territories Hong Kong , China
| | - Chung Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital , Hong Kong , China
| | - Tan To Cheung
- Department of Surgery, Queen Mary Hospital, University of Hong Kong , Hong Kong , China
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Xiaoying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University , Shanghai , China
| | - James Oh Park
- Department of Surgery, University of Washington Medical Center and Fred Hutchinson Cancer Center, Seattle , Washington , USA
| | - Chung Yip Chan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and Duke-National University Singapore Medical School , Singapore
| | - Olivier Scatton
- Department of Digestive, Hepatobiliary–Pancreatic and Liver Transplantation, Hôpital Pitie-Salpetriere, AP-HP, Sorbonne Université , Paris , France
| | - Fernando Rotellar
- Hepatopancreatobiliary and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, Universidad de Navarra and Institute of Health Research of Navarra (IdisNA) , Pamplona , Spain
| | - Roberto Ivan Troisi
- Department of Clinical Medicine and Surgery, Division of Hepatopancreatobiliary, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples , Naples , Italy
| | - Mathieu D’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital , Kortrijk , Belgium
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes , Paris , France
| | - Brian Kim Poh Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and Duke-National University Singapore Medical School , Singapore
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Use of a Urinary Catheter for the Intracorporeal Pringle Maneuver During Laparoscopic Liver Resection: Detailed Surgical Technique with Video. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02853-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lopez-Lopez V, López-Conesa A, Brusadin R, Perez-Flores D, Navarro-Barrios Á, Gomez-Valles P, Cayuela V, Robles-Campos R. Pure laparoscopic vs. hand-assisted liver surgery for segments 7 and 8: propensity score matching analysis. Surg Endosc 2022; 36:4470-4478. [PMID: 34697682 DOI: 10.1007/s00464-021-08800-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Laparoscopic liver resection of tumors located in segments 7 and 8 are considered a complex resection. The aim of this study was to compare the intraoperative and early postoperative outcomes of patients operated by pure laparoscopic (PLS) vs hand-assisted laparoscopic surgery (HALS). METHODS From January 2003 to January 2021, we included patients with minimally invasive surgery for lesions located in segments 7 and 8. To overcome selection bias, we performed 1:1 propensity score matching (PSM) between HALS and PLS cohorts, including 30 patients in each of the groups. Of the 60 patients who underwent PSM, we compared the first 30 patients with the following 30 patients. RESULTS A total of 79 LLRs were performed, 46 by HALS and 33 by PLS. After PSM, in the PLS cohort, cirrhosis was more frequent (33.3% vs. 13.3%, p = 0.02). The surgical time, blood loss, Pringle maneuver, clamping time, and morbidity were similar between both groups, but with a lower hospital stay in the PLS group (3 days vs. 4 days, p < 0.01). In the first 30 patients who underwent LLR, the use of PLS was lower than the use of HALS, increasing due to the learning curve (16.7% in the first period vs. 83.3% in the second period; p < 0.01). The hospital stay was lower in the second period due to the more frequent use of PLS (3 vs. 4 days, p < 0.01). CONCLUSION PLS presents similar intraoperative and early postoperative results with lower hospital stay for lesions located in segments 7 and 8 compared to HALS. In centers with experience in LLRs, PLS could be performed safely in these segments.
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Affiliation(s)
- Víctor Lopez-Lopez
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
| | - Asunción López-Conesa
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
| | - Roberto Brusadin
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
| | | | - Álvaro Navarro-Barrios
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
| | - Paula Gomez-Valles
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
| | - Valentín Cayuela
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
| | - Ricardo Robles-Campos
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain.
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11
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Outcomes of simultaneous laparoscopic, hybrid, and open resection in colorectal cancer with synchronous liver metastases: a propensity score-matched study. Sci Rep 2022; 12:8867. [PMID: 35614070 PMCID: PMC9132984 DOI: 10.1038/s41598-022-12372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/27/2022] [Indexed: 11/08/2022] Open
Abstract
We aimed to compare the short- and long-term outcomes of simultaneous laparoscopic, hybrid, and open resection for colorectal cancer and synchronous liver metastases. We retrospectively analyzed the data of 647 patients with simultaneous resection of colorectal cancer and liver metastases between January 2006 and December 2018 at three tertiary referral hospitals. Patient’s baseline characteristics, perioperative outcomes, pathological examination results, liver-specific recurrence rate and survivals were compared between the propensity score-matched groups. Forty-two and 81 patients were selected for the laparoscopic vs. hybrid groups, and 48 and 136 patients for laparoscopic vs. open groups, respectively. The laparoscopic group had fewer wound complications (2.1 vs. 13.2%; p = 0.028) than the open group, and a shorter postoperative hospital stay than the hybrid and open groups (8 vs. 11 days, p < 0.001 for both). The 5-year liver-specific recurrence rates were 38.7% and 46.0% in the laparoscopic and hybrid groups, respectively (p = 0.270), and 34.0% and 37.0% in the laparoscopic and open groups, respectively (p = 0.391). Simultaneous laparoscopic resection for colorectal cancer and liver metastases can be performed safely with significantly enhanced postoperative recovery and comparable long-term outcomes compared to hybrid and open resection.
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12
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Taillieu E, De Meyere C, Nuytens F, Vanneste G, Libbrecht L, Alaerts H, Parmentier I, Verslype C, D’Hondt M. Laparoscopic liver resection for colorectal liver metastases: retrospective analysis of prognostic factors and oncological outcomes in a single-center cohort. Langenbecks Arch Surg 2022; 407:2399-2414. [DOI: 10.1007/s00423-022-02534-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/24/2022] [Indexed: 12/07/2022]
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13
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Ayabe RI, Azimuddin A, Tran Cao HS. Robot-assisted liver resection: the real benefit so far. Langenbecks Arch Surg 2022; 407:1779-1787. [PMID: 35488913 DOI: 10.1007/s00423-022-02523-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Minimally invasive liver resection is associated with lower perioperative morbidity and shorter hospital stay. However, the added benefit of the robotic platform over conventional laparoscopy is a matter of ongoing investigation. PURPOSE The purpose of this narrative review is to provide an up-to-date and balanced evaluation of the benefits and shortcomings of robotic liver surgery for the modern hepatobiliary surgeon. CONCLUSIONS Advantages of a robotic approach to liver resection include a shortened learning curve, the ability to complete more extensive or complex minimally invasive operations, and integrated fluorescence guidance. However, the robotic platform remains limited by a paucity of parenchymal transection devices, complete lack of haptic feedback, and added operating time associated with docking and instrument exchange. Like laparoscopic hepatectomy, robotic hepatectomy may provide patients with more rapid recovery and a shorter hospital stay, which can help offset the substantial costs of robot acquisition and maintenance. The oncologic outcomes of robotic hepatectomy appear to be equivalent to laparoscopic and open hepatectomy for appropriately selected patients.
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Affiliation(s)
- Reed I Ayabe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
| | - Ahad Azimuddin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA.
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14
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Choi YJ, Jo HS, Kim DS, Yu YD. Single-port robot plus one port (SP + 1) distal pancreatectomy using the new da Vinci SP system. Langenbecks Arch Surg 2022; 407:1271-1276. [DOI: 10.1007/s00423-022-02477-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/16/2022] [Indexed: 02/06/2023]
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15
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Li L, Xu L, Wang P, Zhang M, Li B. The risk factors of intraoperative conversion during laparoscopic hepatectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 2022; 407:469-478. [PMID: 35039922 DOI: 10.1007/s00423-022-02435-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/05/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE Intraoperative conversion to laparotomy is a challenge during laparoscopic hepatectomy; however, the risk factors of conversion have been poorly elucidated. METHODS In this systematic review and meta-analysis, we computed pooled odds ratios (ORs) with 95% confidence intervals (CIs) for each risk factor and evaluated heterogeneity using a L'Abbe plot, Galbraith radial plot, Cochran's Q test, and I2. An extended funnel plot was used to evaluate the robustness of the results of meta-analysis. Sensitivity analysis and subgroup analysis were performed to determine sources of heterogeneity. Egger's test and Begg's test were used to assess publication bias. RESULTS A total of 25 eligible studies were enrolled in the meta-analysis. Higher body mass index (OR 1.346, 95% CI 1.055-1.717), hypertension (OR 1.387, 95% CI 1.100-1.749), male sex (OR 1.278, 95% CI 1.072-1.523), cirrhosis (OR 1.378, 95% CI 1.062-1.788), major resection (OR 2.041, 95% CI 1.748-2.382), posterosuperior tumor location (OR 2.420, 95% CI 1.923-3.044), and larger tumor diameter (OR 1.618, 95% CI 1.270-2.061) were found to be significantly related to intraoperative conversion during laparoscopic hepatectomy. Malignant tumor (OR 1.253, 95% CI 0.970-1.619), higher American Society of Anesthesiologists stage (OR 1.186, 95% CI 0.863-1.631), multiple tumors (OR 1.273, 95% CI 0.866-1.871), and abdominal surgery history (OR 1.236, 95% CI 0.589-2.597) were not associated with conversion. A history of abdominal surgery showed significant heterogeneity with an I2 of 80.8% (p < 0.001). Subgroup analysis indicated that heterogeneity was caused by the different number of patients among enrolled studies. CONCLUSIONS In this systematic review and meta-analysis, we identified a number of factors associated with intraoperative conversion during laparoscopic hepatectomy. Our findings can help patient risk evaluation to reduce the laparotomy conversion rate in laparoscopic hepatectomy.
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Affiliation(s)
- Lian Li
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China
| | - Liangliang Xu
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China
| | - Peng Wang
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China
| | - Ming Zhang
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China.
| | - Bo Li
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, China.
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16
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Cherqui D. Pure laparoscopic living donor liver transplantation: Prowess or progress? Am J Transplant 2022; 22:5-6. [PMID: 34514708 DOI: 10.1111/ajt.16839] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Daniel Cherqui
- Surgical Director of Liver Transplantation, APHP - Paul Brousse Hospital - Paris Saclay University, Villejuif, France
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17
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Kamel MK, Tuma F, Keane CA, Blebea J. National Trends and Perioperative Outcomes of Robotic-assisted Hepatectomy in the USA: A Propensity-score Matched Analysis from the National Cancer Database. World J Surg 2022. [PMID: 34528104 DOI: 10.1007/s00268-021-06315-w/tables/6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND A paucity of data exists on the national use of robotic hepatectomy. We assessed national trends and perioperative outcomes of robotic hepatectomy in the USA. In addition, factors associated with use of the robotic approach were analyzed. METHODS The National Cancer Database (NCDB) was queried for patients undergoing hepatectomy from 2010 to 2016. Patients undergoing total hepatectomy for transplant were excluded. Factors associated with the use of the robotic approach were assessed using logistic regression multivariable analysis. Propensity-score analysis was performed (robotic vs. laparoscopic and robotic vs. open approaches), and perioperative outcomes were compared between the matched groups. RESULTS The robotic approach was used in 287 patients (110 hospitals). Utilization of the robotic approach increased significantly on the national level from 0.8% in 2010 to 4.1% in 2016 (P<0.001). The number of hospitals performing a minimum of one robotic hepatectomy per year increased from 8 in 2010 to 35 in 2016. The median hospital length of stay was 4 days (IQR 3-6), 30-day readmission rate was 5%, and 30-day/90-day mortality rates were 3%/4%. Factors associated with using robotic approach were African-American race (95% CI 1.02-2.11), recent year of surgery (95% CI 1.11-1.32), HCC histology (95% CI 1.01-52.03), tumor size (95% CI 0.87-0.96), and early-stage tumor (Stage I-II, 95% CI 1.27-3.99). On propensity-matched analysis, there were no differences between robotic and open approaches (n=184 each group) in 30-day readmission (5% vs. 7%, P=0.651), 30-day mortality (2% vs. 4%, P=0.106), 90-day mortality (3% vs. 7%, P=0.080), or 5-year overall survival (58% vs. 43%, P=0.211). However, the robotic approach was associated with a significantly shorter hospital stay (median: 4 vs. 6 days, P<0.001). There were no differences between matched groups of patients undergoing robotic and laparoscopic approaches (n=182 in each group) in perioperative outcomes or length of hospital stay. CONCLUSION National use of robotic-assisted hepatectomy has increased by fivefold over the seven-year study period. It was associated with a shorter hospital length of stay compared to the open approach without compromising perioperative outcomes or survival.
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Affiliation(s)
- Mohamed K Kamel
- Department of Surgery, Central Michigan University College of Medicine, 912 S Washington Ave, Suite #1, Saginaw, MI, USA.
| | - Faiz Tuma
- Department of Surgery, Central Michigan University College of Medicine, 912 S Washington Ave, Suite #1, Saginaw, MI, USA
| | - Charles A Keane
- Department of Surgery, Central Michigan University College of Medicine, 912 S Washington Ave, Suite #1, Saginaw, MI, USA
| | - John Blebea
- Department of Surgery, Central Michigan University College of Medicine, 912 S Washington Ave, Suite #1, Saginaw, MI, USA
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18
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Conticchio M, Delvecchio A, Ratti F, Gelli M, Anelli FM, Laurent A, Vitali GC, Magistri P, Assirati G, Felli E, Wakabayashi T, Pessaux P, Piardi T, Di Benedetto F, de'Angelis N, Javier Briceno DF, Rampoldi AG, Adam R, Cherqui D, Aldrighetti L, Memeo R. Laparoscopic surgery versus radiofrequency ablation for the treatment of single hepatocellular carcinoma ≤3 cm in the elderly: a propensity score matching analysis. HPB (Oxford) 2022; 24:79-86. [PMID: 34167892 DOI: 10.1016/j.hpb.2021.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) and radiofrequency ablation (RFA) represented potential treatments for patients with a single hepatocellular carcinoma (HCC) smaller than 3 cm. As the aging population soared, our study aimed to examine the advantage/drawback balance for these treatments, which should be reassessed in elderly patients. METHODS A multicentric retrospective study compared 184 elderly patients (aged >70 years) (86 patients underwent LLR and 98 had RFA) with single ≤3 cm HCC, observed from January 2009 to January 2019. RESULTS After propensity score matching (PSM), the estimated 1- and 3-year overall survival rates were 96.5 and 87.9% for the LLR group, and 94.6 and 68.1% for the RFA group (p = 0.001) respectively. The estimated 1- and 3-year disease-free survival rates were 92.5 and 67.4% for the LLR group, and 68.5 and 36.9% for the RFA group (p = 0.001). Patients with HCC of anterolateral segments were more often treated with laparoscopic resection (47 vs. 36, p = 0.04). The median operative time in the resection group was 205 min and 25 min in the RFA group (p = 0.01). Length of hospital stay was 5 days in the resection group and 3 days in the RFA group (p = 0.03). CONCLUSION Despite a longer length of hospital stay and operative time, LLR guarantees a comparable postoperative course and a better overall and disease-free survival in elderly patients with single HCC (≤3 cm), located in anterolateral segments.
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Affiliation(s)
- Maria Conticchio
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Antonella Delvecchio
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | | | - Maximiliano Gelli
- Département de Chirurgie Viscérale, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Ferdinando M Anelli
- Unit of Oncologic and Pancreatic Surgery, Hospital University Reina Sofía, Córdoba, Spain
| | - Alexis Laurent
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Digestive and Hepatobiliary Surgery, Centre hospitalier universitaire Henri Mondor, Créteil, France
| | - Giulio C Vitali
- Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Giacomo Assirati
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Emanuele Felli
- Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France
| | - Taiga Wakabayashi
- Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France
| | - Patrick Pessaux
- Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France
| | - Tullio Piardi
- Department of Surgery, Hôpital Robert Debré, Reims, France
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola de'Angelis
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Digestive and Hepatobiliary Surgery, Centre hospitalier universitaire Henri Mondor, Créteil, France
| | | | | | - René Adam
- Department of Surgery, Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France
| | - Daniel Cherqui
- Department of Surgery, Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France
| | | | - Riccardo Memeo
- Division of Hepato-Pancreato-Biliary Surgery, "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy.
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19
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Abu-Zaydeh O, Sawaied M, Berger Y, Mahamid A, Goldberg N, Sadot E, Haddad R. Hand-Assisted Laparoscopic Surgery Is Superior to Open Liver Resection for Colorectal Liver Metastases in the Posterosuperior Segments. Front Surg 2021; 8:746427. [PMID: 34901138 PMCID: PMC8654808 DOI: 10.3389/fsurg.2021.746427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/31/2021] [Indexed: 12/07/2022] Open
Abstract
Introduction: Laparoscopic liver resections (LLR) of colorectal metastasis located in posterosuperior segments (1, 4A, 7 and 8) are challenging and highly demanding. The aim of our study is to determine the safety and feasibility of hand-assisted laparoscopic surgery (HALS) in the resections of the posterosuperior lesions and to compare the peri-operative, short-term and long-term outcomes with the open liver resection (OLR) approach. Methods and Results: A retrospective study of patients who underwent either HALS or OLR for metastatic colorectal cancer (mCRC) located in the posterosuperior segments of the liver between 2008 and 2018 in two university affiliated medical centers. Results: A total of 187 patients were identified, of whom 78 underwent HALS and 109 underwent OLR. There was no difference between the HALS and OLR with regard to preoperative factors (age, primary CRC tumor location, number and anatomical distribution of liver metastasis, pre-operative neo-adjuvant treatment, operative time, blood transfusion rate, and resection margins positivity). On the other hand, HALS compared to OLR had a significantly shorter mean hospital stay (4 vs. 6 days; P = 0.003), and a lower total complications rate (25 vs. 47% P = 0.006). Both groups had no 30-day mortality. Also, patients who underwent HALS vs. OLR had similar liver metastases recurrence (55 vs. 51%. P = 0.65) and 5-year survival (47 vs. 45%. P = 0.72). Conclusions: HALS for mCRC located in posterosuperior liver segments is safe and feasible and it is a preferable approach due to its lower complication rate and shorter hospital stay while not compromising survival and disease recurrence.
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Affiliation(s)
| | - Muneer Sawaied
- Department of Surgery, Carmel Medical Center, Haifa, Israel
| | - Yael Berger
- Department of Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ahmad Mahamid
- Department of Surgery, Carmel Medical Center, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Natalia Goldberg
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Department of Radiology, Carmel Medical Center, Haifa, Israel
| | - Eran Sadot
- Department of Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Riad Haddad
- Department of Surgery, Carmel Medical Center, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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20
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Long-term outcomes of laparoscopic liver resection for hepatocellular carcinoma: A propensity score matched analysis of a high-volume North American center. Surgery 2021; 171:982-991. [PMID: 34742570 DOI: 10.1016/j.surg.2021.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laparoscopic liver resections for malignancy are increasing worldwide, and yet data from North America are lacking. We aimed to assess the long-term outcomes of patients undergoing laparoscopic liver resection and open liver resection as a treatment for hepatocellular carcinoma. METHODS Patients undergoing liver resection for hepatocellular carcinoma between January 2008 and December 2019 were retrospectively studied. A propensity score matching was performed using patient demographics, laboratory parameters, etiology of liver disease, liver function, and tumor characteristics. Primary outcomes included overall survival and cumulative incidence of recurrence. Kaplan-Meier and competing risk cumulative incidence were used for survival analyses. Multivariable Cox regression and Fine-Gray proportional hazard regression were performed to determine hazard for death and recurrence, respectively. RESULTS Three hundred and ninety-one patients were identified (laparoscopic liver resection: 110; open liver resection: 281). After propensity score matching, 149 patients remained (laparoscopic liver resection: 57; open liver resection: 92). There were no significant differences between groups with regard to extent of hepatectomy performed and tumor characteristics. The laparoscopic liver resection group experienced a lower proportion of ≥Clavien-Dindo grade III complications (14% vs 29%; P = .01). In the matched cohort, the 1-, 3-, and 5-year overall survival rate in the laparoscopic liver resection versus open liver resection group was 90.9%, 79.3%, 70.5% vs 91.3%, 88.5%, 83.1% (P = .26), and the cumulative incidence of recurrence 31.1%, 59.7%, 62.9% vs 18.9%, 40.6%, 49.2% (P = .06), respectively. CONCLUSION This study represents the largest single institutional study from North America comparing long-term oncologic outcomes of laparoscopic liver resection and open liver resection as a treatment for primary hepatocellular carcinoma. The combination of reduced short-term complications and equivalent long-term oncologic outcomes favor the laparoscopic approach when feasible.
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21
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National Trends and Perioperative Outcomes of Robotic-assisted Hepatectomy in the USA: A Propensity-score Matched Analysis from the National Cancer Database. World J Surg 2021; 46:189-196. [PMID: 34528104 DOI: 10.1007/s00268-021-06315-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND A paucity of data exists on the national use of robotic hepatectomy. We assessed national trends and perioperative outcomes of robotic hepatectomy in the USA. In addition, factors associated with use of the robotic approach were analyzed. METHODS The National Cancer Database (NCDB) was queried for patients undergoing hepatectomy from 2010 to 2016. Patients undergoing total hepatectomy for transplant were excluded. Factors associated with the use of the robotic approach were assessed using logistic regression multivariable analysis. Propensity-score analysis was performed (robotic vs. laparoscopic and robotic vs. open approaches), and perioperative outcomes were compared between the matched groups. RESULTS The robotic approach was used in 287 patients (110 hospitals). Utilization of the robotic approach increased significantly on the national level from 0.8% in 2010 to 4.1% in 2016 (P<0.001). The number of hospitals performing a minimum of one robotic hepatectomy per year increased from 8 in 2010 to 35 in 2016. The median hospital length of stay was 4 days (IQR 3-6), 30-day readmission rate was 5%, and 30-day/90-day mortality rates were 3%/4%. Factors associated with using robotic approach were African-American race (95% CI 1.02-2.11), recent year of surgery (95% CI 1.11-1.32), HCC histology (95% CI 1.01-52.03), tumor size (95% CI 0.87-0.96), and early-stage tumor (Stage I-II, 95% CI 1.27-3.99). On propensity-matched analysis, there were no differences between robotic and open approaches (n=184 each group) in 30-day readmission (5% vs. 7%, P=0.651), 30-day mortality (2% vs. 4%, P=0.106), 90-day mortality (3% vs. 7%, P=0.080), or 5-year overall survival (58% vs. 43%, P=0.211). However, the robotic approach was associated with a significantly shorter hospital stay (median: 4 vs. 6 days, P<0.001). There were no differences between matched groups of patients undergoing robotic and laparoscopic approaches (n=182 in each group) in perioperative outcomes or length of hospital stay. CONCLUSION National use of robotic-assisted hepatectomy has increased by fivefold over the seven-year study period. It was associated with a shorter hospital length of stay compared to the open approach without compromising perioperative outcomes or survival.
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22
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Laparoscopic Caudal Approach of the Inferior Vena Cava for Isolated Segment 1 Liver Resection. J Gastrointest Cancer 2021; 52:1180-1182. [PMID: 34251591 DOI: 10.1007/s12029-021-00665-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Isolated laparoscopic resection of the hepatic caudate lobe (segment 1) is a very challenging procedure. Very few references are available on this technique, and the aim of this paper is to show the main technical aspects of laparoscopic caudal approach for segment 1. MATERIAL AND METHODS The subject was a 64-year-old woman with a past medical history of surgically treated breast cancer (pT1N0M0, with positive hormonal receptors). Adjuvant treatment was administered as well as radiotherapy and hormone therapy (tamoxifen). After 12 months of follow-up, an 18-mm single liver metastasis was detected in segment 1, suggestive of metastatic disease. A complementary study was conducted with magnetic resonance imaging, computed tomography and positron emission tomography, and no other lesions were identified. RESULTS Isolated laparoscopic resection of segment 1 of the liver was performed with a caudal approach of the inferior vena cava. All the steps are extensively described. The surgery time was 120 min, and blood loss was less than 100 ml. No postoperative complications were registered. The patient was discharged on the third postoperative day. CONCLUSION Isolated laparoscopic resection of the hepatic caudate lobe with a caudal approach of the inferior vena cava is a safe technique in selected patients and should be performed in centres with experience in liver surgery and advanced laparoscopy, because of its high complexity.
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Zhu M, Li H, Wang C, Yang B, Wang X, Hou F, Yang S, Wang Y, Guo X, Qi X. Focal nodular hyperplasia mimicking hepatocellular adenoma and carcinoma in two cases. Drug Discov Ther 2021; 15:112-117. [PMID: 33952777 DOI: 10.5582/ddt.2021.01033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Focal nodular hyperplasia (FNH) is a solid benign tumor of the liver, predominantly in young women. A correct diagnosis of FNH is essential for making appropriate clinical decisions and avoiding unnecessary liver resection. Herein, we reported that two male cases with FNH, who initially presented with persistent abdominal discomfort, were misdiagnosed with hepatocellular adenoma (HCA) and hepatocellular carcinoma (HCC) on contrast-enhanced magnetic resonance imaging and computed tomography scans, respectively. After surgery, a histological diagnosis of FNH was finally established. In this paper, we also reviewed the knowledge regarding diagnosis and differential diagnosis of FNH on imaging examinations, which are helpful for avoiding misdiagnoses and guiding clinical interventions.
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Affiliation(s)
- Menghua Zhu
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Jinzhou Medical University, Jinzhou, China
| | - Hongyu Li
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Chunhui Wang
- Department of Hepatobiliary Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Benqiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xuehan Wang
- Department of Pathology, General Hospital of Northern Theater Command, Shenyang, China
| | - Feifei Hou
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Shengye Yang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yuye Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Jinzhou Medical University, Jinzhou, China
| | - Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
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International multicenter propensity score matched study on laparoscopic versus open left lateral sectionectomy. HPB (Oxford) 2021; 23:707-714. [PMID: 33039275 DOI: 10.1016/j.hpb.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 07/07/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite a lack of high-level evidence, current guidelines recommend laparoscopic left lateral sectionectomy (LLLS) as the routine approach over open LLS (OLLS). Randomized studies and propensity score matched studies on LLLS vs OLLS for all indications, including malignancy, are lacking. METHODS This international multicenter propensity score matched retrospective cohort study included consecutive patients undergoing LLLS or OLLS in six centers from three European countries (January 2000-December 2016). Propensity scores were calculated based on nine preoperative variables and LLLS and OLLS were matched in a 1:1 ratio. Short-term operative outcomes were compared using paired tests. RESULTS A total of 560 patients were included. Out of 200 LLLS, 139 could be matched to 139 OLLS. After matching, baseline characteristics were well balanced. LLLS was associated with shorter operative time (144 (110-200) vs 199 (138-283) minutes, P < 0.001), less blood loss (100 (50-300) vs 350 (100-750) mL, P = 0.005) and a 3-day shorter postoperative hospital stay (4 (3-7) vs 7 (5-9) days, P < 0.001). CONCLUSION This international multicenter propensity score matched study confirms the superiority of LLLS over OLLS based on shorter postoperative hospital stay, operative time, and less blood loss thus validating current guideline advice.
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Laparoscopic Liver Resection Using a Silicone Band Retraction Method (With Video). Surg Laparosc Endosc Percutan Tech 2021; 31:378-384. [PMID: 33605678 PMCID: PMC8168932 DOI: 10.1097/sle.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/29/2020] [Indexed: 12/07/2022]
Abstract
Supplemental Digital Content is available in the text. The success of laparoscopic liver resection (LLR) depends on stable and full exposure of the parenchymal transection plane. We evaluated the efficacy of LLR using a silicone band retraction method for lesions in the anterolateral and posterosuperior segments.
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Heise D, Bednarsch J, Kroh A, Schipper S, Eickhoff R, Lang S, Neumann U, Ulmer F. Operative Time, Age, and Serum Albumin Predict Surgical Morbidity After Laparoscopic Liver Surgery. Surg Innov 2021; 28:714-722. [PMID: 33568020 PMCID: PMC8649428 DOI: 10.1177/1553350621991223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background. Laparoscopic liver resection (LLR) has emerged as a
considerable alternative to conventional liver surgery. However, the increasing
complexity of liver resection raises the incidence of postoperative
complications. The aim of this study was to identify risk factors for
postoperative morbidity in a monocentric cohort of patients undergoing LLR.
Methods. All consecutive patients who underwent LLR between
2015 and 2019 at our institution were analyzed for associations between
complications with demographics and clinical and operative characteristics by
multivariable logistic regression analyses. Results. Our cohort
comprised 156 patients who underwent LLR with a mean age of 60.0 ± 14.4 years.
General complications and major perioperative morbidity were observed in 19.9%
and 9.6% of the patients, respectively. Multivariable analysis identified
age>65 years (HR = 2.56; P = .028) and operation
time>180 minutes (HR = 4.44; P = .001) as significant
predictors of general complications (Clavien ≥1), while albumin<4.3 g/dl (HR
= 3.66; P = .033) and also operative time (HR = 23.72;
P = .003) were identified as predictors of major
postoperative morbidity (Clavien ≥3). Conclusion. Surgical
morbidity is based on patient- (age and preoperative albumin) and
procedure-related (operative time) characteristics. Careful patient selection is
key to improve postoperative outcomes after LLR.
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Affiliation(s)
- Daniel Heise
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Germany
| | - Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Germany
| | - Andreas Kroh
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Germany
| | - Sandra Schipper
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Germany
| | - Roman Eickhoff
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Germany
| | - Sven Lang
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Germany
| | - Ulf Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Germany.,Department of Surgery, 199236Maastricht University Medical Centre (MUMC), Netherlands
| | - Florian Ulmer
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Germany
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SteinbrÜck K, Fernandes R, D'Oliveira M, Capelli R, Cano R, Vasconcelos H, Basilio L, Enne M. EXTERNAL PRINGLE MANEUVER IN LAPAROSCOPIC LIVER RESECTION: A SAFE, CHEAP AND REPRODUCIBLE WAY TO PERFORM IT. ACTA ACUST UNITED AC 2021; 33:e1555. [PMID: 33503115 PMCID: PMC7836078 DOI: 10.1590/0102-672020200004e1555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Tourniquet for right hepatectomy tightened and secured with forceps (arrow). Laparoscopic liver resection is performed worldwide. Hemorrhage is a major complication and bleeding control during hepatotomy is an important concern. Pringle maneuver remains the standard inflow occlusion technique. AIM Describe an extracorporeal, efficient, fast, cheap and reproducible way to execute the Pringle maneuver in laparoscopic surgery, using a chest tube. METHODS From January 2014 to March 2020, our team performed 398 hepatectomies, 63 by laparoscopy. We systematically encircle the hepatoduodenal ligament and prepare a tourniquet to perform Pringle maneuver. In laparoscopy, we use a 24 Fr chest tube, which is inserted in the abdominal cavity through a small incision. We thread the cotton tape through the tube, pulling it out through the external end, outside the abdomen. To perform the tourniquet, we just need to push the tube as we hold the tape, clamping both with one forceps. RESULTS The 24 Fr chest tube is firm and works perfectly to occlude blood inflow as the cotton band is tightened. It has an internal diameter of 5,5 mm, sufficient for a laparoscopic grasper pass through it to catch the cotton band, and an external diameter of 8 mm, which allows to be inserted in the abdomen through a tiny incision. The cost of this tube and the cotton band is less than US$ 1. No complications related to the method were identified in our patients. CONCLUSIONS The extracorporeal Pringle maneuver presented here is a safe, cheap and reproducible method, that can be used for bleeding control in laparoscopic liver surgery.
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Affiliation(s)
- Klaus SteinbrÜck
- Hepatobiliary Multidisciplinary Group, Rio de Janeiro, RJ, Brazil.,Bonsucesso Federal Hospital - Health Ministry, Hepatobiliary Surgery, Rio de Janeiro, RJ, Brazil
| | - Reinaldo Fernandes
- Hepatobiliary Multidisciplinary Group, Rio de Janeiro, RJ, Brazil.,Bonsucesso Federal Hospital - Health Ministry, Hepatobiliary Surgery, Rio de Janeiro, RJ, Brazil
| | | | - Rafaela Capelli
- Hepatobiliary Multidisciplinary Group, Rio de Janeiro, RJ, Brazil
| | - Renato Cano
- Hepatobiliary Multidisciplinary Group, Rio de Janeiro, RJ, Brazil.,Ipanema Federal Hospital - Health Ministry, Hepatobiliary Surgery, Rio de Janeiro, RJ, Brazil
| | - Hanna Vasconcelos
- Hepatobiliary Multidisciplinary Group, Rio de Janeiro, RJ, Brazil.,Ipanema Federal Hospital - Health Ministry, Hepatobiliary Surgery, Rio de Janeiro, RJ, Brazil
| | - Luiza Basilio
- Hepatobiliary Multidisciplinary Group, Rio de Janeiro, RJ, Brazil.,Ipanema Federal Hospital - Health Ministry, Hepatobiliary Surgery, Rio de Janeiro, RJ, Brazil
| | - Marcelo Enne
- Hepatobiliary Multidisciplinary Group, Rio de Janeiro, RJ, Brazil.,Ipanema Federal Hospital - Health Ministry, Hepatobiliary Surgery, Rio de Janeiro, RJ, Brazil
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Fichtner-Feigl S. [Robot-Assisted Right Hemihepatectomy for Hepatocellular Carcinoma]. Zentralbl Chir 2020; 146:547-551. [PMID: 33285577 DOI: 10.1055/a-1293-9225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Since the introduction of robot-assisted surgery, increasingly complex operations have been performed with this technique. Robot-assisted operations are also of increasing importance in hepatobiliary surgery. With articulated and scaled movements in a three-dimensional surgical field, permit precise preparation, as is needed for major hepatic resection. This video demonstrates the feasibility and precision of completely robotic surgery in right hemihepatectomy in hepatocellular carcinoma (HCC) of segments V - VIII in non-alcoholic steatohepatitis (NASH). The patient was 72 years old for the operation, with concomitant marked metabolic syndrome.
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Affiliation(s)
- Stefan Fichtner-Feigl
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Deutschland
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Gumbs AA, Hilal MA, Croner R, Gayet B, Chouillard E, Gagner M. The initiation, standardization and proficiency (ISP) phases of the learning curve for minimally invasive liver resection: comparison of a fellowship-trained surgeon with the pioneers and early adopters. Surg Endosc 2020; 35:5268-5278. [PMID: 33174100 DOI: 10.1007/s00464-020-08122-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/21/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Using the Ideal Development Exploration Assessment and Long-term study (IDEAL) paradigm, Halls et al. created risk-adjusted cumulative sum (RA-CUSUM) curves concluding that Pioneers (P) and Early Adopters (EA) of minimally invasive (MI) liver resection obtained similar results after fewer cases. In this study, we applied this framework to a MI Hepatic-Pancreatic and Biliary fellowship-trained surgeon (FT) in order to assess where along the curves this generation fell. METHODS The term FT was used to designate surgeons without previous independent operative experience who went from surgical residency directly into fellowship. Three phases of the learning curve were defined using published data on EAs and Ps of MI Hepatectomy, including phase 1 (initiation) (i.e., the first 17 or 50), phase 2 (standardization) (i.e., cases 18-46 or 1-50) and phase 3 (proficiency) (i.e., cases after 46, 50 or 135). Data analysis was performed using the Social Science Statistics software ( www.socscistatistics.com ). Statistical significance was defined as p < .05. RESULTS From November 2007 until April 2018, 95 MI hepatectomies were performed by a FT. During phase 1, the FT approached larger tumors than the EA group (p = 0.002), that were more often malignant (94.1%) when compared to the P group (52.5%) (p < 0.001). During phase 2, the FT operated on larger tumors and more malignancies (93.1%) when compared to the Ps (p = 0.004 and p = 0.017, respectively). However, there was no difference when compared to the EA. In the phase 3, the EAs tended to perform more major hepatectomies (58.7) when compared to either the FT (30.6%) (p = 0.002) or the P's cases 51-135 and after 135 (35.3% and 44.3%, respectively) (both p values < 0.001). When compared to the Ps cases from 51-135, the FT operated on more malignancies (p = 0.012), but this was no longer the case after 135 cases by the Ps (p = 0.164). There were no statistically significant differences when conversions; major complications or 30- and 90-day mortality were compared among these 3 groups. DISCUSSION Using the IDEAL framework and RA-CUSUM curves, a FT surgeon was found to have curves similar to EAs despite having no previous independent experience operating on the liver. As in our study, FTs may tend to approach larger and more malignant tumors and do more concomitant procedures in patients with higher ASA classifications than either of their predecessors, without statistically significant increases in major morbidity or mortality. CONCLUSION It is possible that the ISP (i.e., initiation, standardization, proficiency) model could apply to other innovative surgical procedures, creating different learning curves depending on where along the IDEAL paradigm surgeons fall.
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Affiliation(s)
- Andrew A Gumbs
- Departement de Chirurgie Digestive, Centre Hospitalier Intercommunal, de Poissy/Saint-Germain-en-Laye, 10, Rue du Champ Gaillard, 78300, Poissy, France
| | - Mohamed Abu Hilal
- Unità Chirurgia Epatobiliopancreatica, Robotica e Mininvasiva, Fondazione Poliambulanza Istituto Ospedaliero, via Bissolati, 57, 25124, Brescia, Italy
| | - Roland Croner
- Department of General-, Visceral-, Vascular- and Transplantation Surgery, University of Magdeburg, Haus 60a, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Brice Gayet
- Department of Digestive Diseases, Institut Mutaliste Montsouris, 42, Boulevard Jourdan, 75004, Paris, France
| | - Elie Chouillard
- Departement de Chirurgie Digestive, Centre Hospitalier Intercommunal, de Poissy/Saint-Germain-en-Laye, 10, Rue du Champ Gaillard, 78300, Poissy, France
| | - Michel Gagner
- Department of Surgery, Hôpital du Sacre Coeur, Montreal, QC, H4J 1C5, Canada.
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Annie Lo HY, Young S, Andrew DiFronzo L. Laparoscopic Liver Resection: A 7-Year Experience of 123 Resections in a Single Institution. Am Surg 2020; 86:1330-1336. [PMID: 33124880 DOI: 10.1177/0003134820964442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
There has been a significant increase in the use of laparoscopic liver resection (LLR) over the past 2 decades. This study aimed to analyze the outcomes associated with LLR at a single tertiary care hospital. Patients with benign or malignant tumors who underwent LLR by a single surgeon from January 2012 to November 2019 were identified. There were 123 patients who underwent LLR in the study period; 52% were men, and the median age was 61 (24-90) years. Five patients (4.1%) had unplanned conversion to open resection. Ninety-five patients (77.2%) had a wedge resection or single segmentectomy, and 28 (22.8%) underwent resection of 2+ liver segments. Seventy-one cases (57.7%) were for hepatocellular carcinoma (HCC), 24 (19.5%) for colorectal metastasis, and 28 (22.8%) were for other benign and malignant tumors. Median operative time was 239 (range 89-526) minutes. Mean estimated blood loss was 192 (range 0-1800) mL. The median length of stay (LOS) overall was 2 (range 0-9) days. From 2017 to 2019, the mean LOS was 1.2 days, compared to a mean LOS of 3.3 days from 2012 to 2016. More cases were performed as same-day surgery from 2017 onward; 19 patients (33.9%) had same-day surgery from 2017 to 2019, in comparison to only 1 patient (1.5%) in the period of 2012-2016 (P < .0001). Overall, 28 patients (22.8%) experienced postoperative morbidity; major postoperative morbidity occurred in 4 patients (3.3%). The 90-day mortality was .8%, and the 30-day readmission rate was 5.7%. In conclusion, LLR can be performed safely to treat liver tumors, and LOS decreased over time. Although overall morbidity is moderate, serious morbidity is low, as was the readmission rate. Laparoscopic wedge resection may be a feasible option as an outpatient procedure in select patients.
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Affiliation(s)
- Hoi Y Annie Lo
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Stephanie Young
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
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Ziogas IA, Giannis D, Esagian SM, Economopoulos KP, Tohme S, Geller DA. Laparoscopic versus robotic major hepatectomy: a systematic review and meta-analysis. Surg Endosc 2020; 35:524-535. [DOI: 10.1007/s00464-020-08008-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/16/2020] [Indexed: 02/08/2023]
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Wei Chieh AK, Chan A, Rotellar F, Kim KH. Laparoscopic major liver resections: Current standards. Int J Surg 2020; 82S:169-177. [PMID: 32652295 DOI: 10.1016/j.ijsu.2020.06.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/28/2020] [Accepted: 06/30/2020] [Indexed: 01/22/2023]
Abstract
Laparoscopic liver resection was slow to be adopted in the surgical arena at the beginning as there were major barriers including the fear of gas embolism, risk of excessive blood loss from the inability to control bleeding vessels effectively, suboptimal surgical instruments to perform major liver resection and the concerns about oncological safety of the procedure. However, it has come a long way since the early 1990s when the first successful laparoscopic liver resection was performed, spurring liver surgeons worldwide to start exploring the roles of laparoscopy in major liver resections. Till date, more than 9000 cases have been reported in the literature and the numbers continue to soar as the hepatobiliary surgical communities quickly learn and apply this technique in performing major liver resection. Large bodies of evidence are available in the literature showing that laparoscopic major liver resection can confer improved short-term outcomes in terms of lesser operative morbidities, lesser operative blood loss, lesser post-operative pain and faster recovery with shorter length of hospitalization. On the other hand, there is no compromise in the long-term and oncological outcomes in terms of comparable R0 resection rate and survival rates of this approach. Many innovations in laparoscopic major hepatectomies for complex operations have also been reported. In this article, we highlight the journey of laparoscopic major hepatectomies, summarize the technical advancement and lessons learnt as well as review the current standards of outcomes for this procedure.
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Affiliation(s)
- Alfred Kow Wei Chieh
- Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, National University of Singapore, Singapore
| | - Albert Chan
- State Key Laboratory for Liver Research, Division of Liver Transplantation, Department of Surgery, The University of Hong Kong, China
| | - Fernando Rotellar
- HPB and Liver Transplantation Unit, General and Digestive Surgery, Clinica Universidad de Navarra, Pamplona, Spain
| | - Ki-Hun Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center and Ulsan University, Seoul, Republic of Korea.
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Ding Z, Huang Y, Liu L, Xu B, Xiong H, Luo D, Huang M. Comparative analysis of the safety and feasibility of laparoscopic versus open caudate lobe resection. Langenbecks Arch Surg 2020; 405:737-744. [PMID: 32648035 DOI: 10.1007/s00423-020-01928-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/02/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Laparoscopic hepatectomy has been used widely in liver disease due to its advantages as a minimally invasive surgery. However, laparoscopic caudate lobe resection (LCLR) has been reported rarely. We aimed to investigate the safety and feasibility of LCLR by comparing it with open liver surgery. METHODS A retrospective study was performed including all patients who underwent LCLR and open caudate lobe resection (OCLR) between January 2015 and August 2019. Twenty-two patients were involved in this study and divided into LCLR (n = 10) and OCLR (n = 12) groups based on preoperative imaging, tumor characteristics, and blood and liver function test. Patient demographic data and intraoperative and postoperative outcomes were compared between the two groups. RESULTS There were no significant inter-group differences between gender, age, preoperative liver function, American Society of Anesthesiologists (ASA) grade, and comorbidities (P > 0.05). The LCLR showed significantly less blood loss (50 vs. 300 ml, respectively; P = 0.004), shorter length of hospital stay (15 vs. 16 days, respectively; P = 0.034), and shorter operative time (216.50 vs. 372.78 min, respectively; P = 0.012) than OCLR, but hospital expenses (5.02 vs. 6.50 WanRMB, respectively; P = 0.208) showed no statistical difference between groups. There was no statistical difference in postoperative bile leakage (P = 0.54) and wound infection (P = 0.54) between LCLR and OCLR. Neither LCLR nor OCLR resulted in bleeding or liver failure after operation. There were no deaths. CONCLUSION LCLR is a very useful technology, and it is a feasible choice in selected patients with benign and malignant tumors in the caudate lobe.
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Affiliation(s)
- Zigang Ding
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Yong Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Lingpeng Liu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Bangran Xu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Hu Xiong
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Dilai Luo
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Mingwen Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
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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.
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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
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Pekolj J, Clariá Sánchez R, Salceda J, Maurette RJ, Schelotto PB, Pierini L, Cánepa E, Moro M, Stork G, Resio N, Neffa J, Mc Cormack L, Quiñonez E, Raffin G, Obeide L, Fernández D, Pfaffen G, Salas C, Linzey M, Schmidt G, Ruiz S, Alvarez F, Buffaliza J, Maroni R, Campi O, Bertona C, de Santibañes M, Mazza O, Belotto de Oliveira M, Diniz AL, Enne de Oliveira M, Machado MA, Kalil AN, Pinto RD, Rezende AP, Ramos EJB, Talvane T Oliveira A, Torres OJM, Jarufe Cassis N, Buckel E, Quevedo Torres R, Chapochnick J, Sanhueza Garcia M, Muñoz C, Castro G, Losada H, Vergara Suárez F, Guevara O, Dávila D, Palacios O, Jimenez A, Poggi L, Torres V, Fonseca GM, Kruger JAP, Coelho FF, Russo L, Herman P. Laparoscopic Liver Resection: A South American Experience with 2887 Cases. World J Surg 2020; 44:3868-3874. [PMID: 32591841 DOI: 10.1007/s00268-020-05646-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers. METHODS From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results. RESULTS Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%. CONCLUSIONS This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers.
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Affiliation(s)
- J Pekolj
- HPB Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - R Clariá Sánchez
- HPB Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Salceda
- Hospital Ramón Santamarina, Tandil, Argentina
| | | | | | - L Pierini
- Clínica Nefrología, Clínica Uruguay, Hospital Iturraspe, Santa Fe, Argentina
| | - E Cánepa
- Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - M Moro
- Hospital Italiano - Regional Sur, Bahía Blanca, Argentina
| | - G Stork
- Hospital Italiano - Regional Sur, Bahía Blanca, Argentina
| | - N Resio
- Unidad HPB Sur, General Roca, Argentina
| | - J Neffa
- Hospital Italiano de Mendoza, Mendoza, Argentina
| | | | - E Quiñonez
- Hospital El Cruce, Buenos Aires, Argentina
| | - G Raffin
- Hospital Argerich, Buenos Aires, Argentina
| | - L Obeide
- Hospital Universitario Privado, Córdoba, Argentina
| | - D Fernández
- Clínica Pueyrredón, Mar del Plata, Argentina
| | - G Pfaffen
- Sanatorio Güemes, Buenos Aires, Argentina
| | - C Salas
- Sanatorio 9 de Julio, Santiago del Estero, Argentina, Hospital Centro de Salud, San Miguel de Tucumán, Argentina
| | - M Linzey
- Hospital Angel C. Padilla, San Miguel de Tucumán, Argentina
| | - G Schmidt
- Hospital Escuela Gral, Corrientes, Argentina
| | - S Ruiz
- Clínica Colón, Mar del Plata, Argentina
| | - F Alvarez
- Clínica Reina Fabiola, Hospital Italiano, Córdoba, Argentina
| | | | - R Maroni
- Hospital Papa Francisco, Salta, Argentina
| | - O Campi
- Clínica Regional General Pico, Santa Rosa, Argentina
| | - C Bertona
- Hospital Español, Mendoza, Argentina
| | - M de Santibañes
- HPB Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - O Mazza
- HPB Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - A L Diniz
- A.C. Camargo Cancer Center, São Paulo, Brazil
| | | | | | - A N Kalil
- Santa Casa de Porto Alegre, Universidade Federal de Ciências da Saúde, Porto Alegre, Brazil
| | - R D Pinto
- Hospital Santa Catarina de Blumenau, Blumenau, Brazil
| | | | - E J B Ramos
- Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | | | - O J M Torres
- Hospital Universitario HUUFMA, Hospital São Domingos, UDI Hospital, Fortaleza, Brazil
| | | | - E Buckel
- Clínica Las Condes, Santiago, Chile
| | | | | | | | - C Muñoz
- Hospital de Talca, Talca, Chile
| | | | - H Losada
- Hospital de Temuco, Temuco, Chile
| | - F Vergara Suárez
- Clínica Vida - Fundación Colombiana de Cancerología, Medellin, Colombia
| | - O Guevara
- Instituto Nacional de Cancerologia, Bogotá, Colombia
| | | | | | - A Jimenez
- Hospital Clínicas, Asunción, Paraguay
| | - L Poggi
- Clínica Anglo Americana, Lima, Peru
| | - V Torres
- Hospital Guillermo Almenara ESSALUD, Lima, Peru
| | - G M Fonseca
- Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil
| | - J A P Kruger
- Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil
| | - F F Coelho
- Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil
| | - L Russo
- Hospital Maciel, Casmu, Montevideo, Uruguay
| | - P Herman
- Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil.
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Learning Curve Under Proctorship of Pure Laparoscopic Living Donor Left Lateral Sectionectomy for Pediatric Transplantation. Ann Surg 2020; 271:542-548. [PMID: 29995683 DOI: 10.1097/sla.0000000000002948] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the learning curve of an expert liver transplantation surgeon approaching fully laparoscopic living donor left lateral sectionectomy (L-LLS) under proctorship. BACKGROUND Laparoscopic liver resections necessitate a long learning curve trough a stepwise fulfillment of difficulties. L-LLS requires expertise in both living donor liver transplantation and advanced laparoscopic liver surgery. There is currently no data about the learning curve of L-LLS. METHODS A total of 72 pure L-LLS were included in this study. A Broken line model was used to identify the periods of the learning curve. A CUSUM analysis of the operative time was performed to evaluate improvements of outcomes with time. To evaluate the relationship between operative time and progressive number of procedures, a linear regression model was applied. A receiver operating characteristic (ROC) curve was carried out to identify the cutoff for completion of the learning curve. RESULTS Operative time decreased with the progressive increase of procedures. Two cutoffs and 3 different periods were identified: cases 1 to 22, cases 23 to 55, and cases 56 to 72. A significant decrease in blood loss and operative time was noted. The CUSUM analysis showed an increase in operative time in the first period, a stable duration in the second period, and a decrease in the last. Blood loss was significantly associated with an increase in operative time (P = 0.003). According to the ROC curve, the learning curve was completed after 25 procedures. CONCLUSIONS L-LLS is a safe procedure that can be standardized and successfully taught to surgeons with large experience in donor hepatectomy through a proctored learning curve.
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Mosteanu BI, Han HS, Cho JY, Lee B. When should we choose a laparoscopic approach? A high-volume center recommendation score. Surg Oncol 2020; 34:208-211. [PMID: 32891332 DOI: 10.1016/j.suronc.2020.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/19/2020] [Accepted: 04/25/2020] [Indexed: 02/07/2023]
Abstract
Laparoscopic liver resection is a demanding procedure that is undergoing continuous development. The surgeon's skill is constantly improving, new surgical instruments are being introduced, and the indications for this procedure are expanding. However, there is still great concern about patient safety during the procedure and it is not commonly performed in many centers, although numerous studies have confirmed the safety and feasibility of laparoscopic liver techniques. Our center tries to use laparoscopy routinely for most cases and we do not consider conversion to open surgery to be a complication. We present our current opinion on patient selection for laparoscopic liver resection in the hope of encouraging more centers to adopt and develop this technique. Although laparoscopic liver resection is not an official standard of care, it should be considered according to the surgeon's experience and available resources.
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Affiliation(s)
- Benone-Iulian Mosteanu
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea; Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - Ho-Seong Han
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
| | - Jai Young Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Boram Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
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Laparoscopic Liver Resection of Segments 7 and 8: from the Initial Restrictions to the Current Indications. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2020; 23:5-16. [PMID: 35600734 PMCID: PMC8985615 DOI: 10.7602/jmis.2020.23.1.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 12/27/2022]
Abstract
Since the beginning of laparoscopic liver surgery, resection of the posterosuperior segments has been considered one of the most challenging procedure due to its difficult access. The main drawbacks of the laparoscopic approach to dome lesions are poor visualization, the difficulty of instrumentation and the greater complexity in the control of bleeding. In the evolution of minimally invasive techniques from hybrid techniques to the current purely laparoscopic approaches, the different authors have established gradually the currents indications and surgical techniques to operate these segments with a similar feasibility and safety than open approach. The standardization in the patient position, the use of intercostal trocars, the learning curve in laparoscopic liver surgery, the management of the hepatic blood flow and the refinement of the technique in the extrahepatic and intrahepatic Glissonean pedicle approaches, has allowed to leave behind the initial contraindications about the laparoscopic approach in these segments. In the present review of the literature, the accumulated experience of the different groups in minimally invasive liver surgery together with the technological advances in the different laparoscopic devices have facilitated the resection of tumors in segments 7 and 8 with similar and even better results than open surgery.
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Abstract
Robotic surgery has rapidly evolved. It is particularly attractive as an alternative minimally invasive approach in liver surgery because of improvements in visualization and articulated instruments. Limitations include increased operative times and lack of tactile feedback, but these have not been shown in studies. Considerations unique to robotic surgery, including safety protocols, must be put in place and be reviewed at the beginning of every procedure to ensure safety in the event of an emergent conversion. Despite the lack of early adoption by many hepatobiliary surgeons, robotic liver surgery continues to evolve and find its place within hepatobiliary surgery.
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Affiliation(s)
- Kelly J Lafaro
- Department of Surgery, Johns Hopkins University School of Medicine, Blalock Building, 600 N. Wolfe St, Baltimore, MD 21205, USA
| | - Camille Stewart
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Abigail Fong
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA; Department of Surgery, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
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Araujo RLC, Sanctis MA, Barroti LC, Coelho TRV. Robotic approach as a valid strategy to improve the access to posterosuperior hepatic segments-Case series and review of literature. J Surg Oncol 2020; 121:873-880. [PMID: 31912515 DOI: 10.1002/jso.25831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/28/2019] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Although the laparoscopy liver resection (LLR) has become a useful approach for minor resections, it seems that lesions in posterosuperior (PS) segments still represent technical challenges. We report a series of robotic approach as an alternative option for these lesions, and a systematic review of the literature to show its feasibility. METHODS Consecutive patients who underwent liver resection for solitary lesions in PS segments by da Vinci SI robot, and by the same team. A systematic review of the literature was made to evaluate the feasibility of a robotic approach for PS hepatectomies. RESULTS From April 2016 to April 2017, five cases of robotic nonanatomical PS resections of colorectal liver metastases (CRLM) were performed. A systematic review encountered five articles plus this series reporting outcomes for this approach. Briefly, a total of five patients in our series underwent this approach, all females, and one patient presented a grade 2 complication. CONCLUSION Robotic hepatectomy seems to be a useful and valid strategy to resect lesions on PS hepatic segments simplifying liver-sparing hepatectomies. Even though the operative time is still high, the short length of stay, low number of complications and the low need for blood transfusions seems to surpass the intrinsic cost of robotic surgery.
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Affiliation(s)
- Raphael L C Araujo
- Barretos Cancer Hospital, São Paulo, SP, Brazil.,Escola Paulista de Medicina-UNIFESP, São Paulo, SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | - Tomás R V Coelho
- Hospital Municipal Vereador José Storopolli, São Paulo, SP, Brazil
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Robles-Campos R, Lopez-Lopez V, Brusadin R, Lopez-Conesa A, Gil-Vazquez PJ, Navarro-Barrios Á, Parrilla P. Open versus minimally invasive liver surgery for colorectal liver metastases (LapOpHuva): a prospective randomized controlled trial. Surg Endosc 2019. [PMID: 30701365 DOI: 10.1007/s00464-019-06679-0/tables/3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To present surgical and oncological outcomes using a prospective and randomized trial (LapOpHuva, NCT02727179) comparing minimally invasive liver resection (LLR) versus open liver resection (OLR) in patients with colorectal liver metastases (CRLM). METHODS Between February 2005 and March 2016, 204 selected patients with CRLM were randomized and 193 were included: LLR (n = 96) and OLR (n = 97). The primary endpoint was to compare postoperative morbidity. Other secondary endpoints were oncological outcomes, use of the Pringle maneuver, surgical time, blood losses, transfusions, hospital stay, mortality and OS, and disease-free survival (DFS) at 3, 5, and 7 years. RESULTS LLR presented with lower global morbidity (11.5% vs. 23.7%, p = 0.025) but with similar severe complications. Long-term survival outcomes were similar in both groups. The cumulative 1-, 3-, 5-, 7-year OS for LLR and OLR were 92.5%, 71.5%, 49.3%, 35.6% versus 93.6%, 69.7%, 47.4%, 35.5%, respectively (log-rank = 0.047, p = 0.82). DFS for LLR and OLR was 72.7%, 33.5%, 22.7%, and 20.8% versus 61.6%, 27.2%, 23.9%, and 17.9%, respectively (log-rank = 1.427, p = 0.23). LLR involved more use of the Pringle maneuver (15.5% vs. 30.2%, p = 0.025) and a shorter hospital stay (4 vs. 6 days, p < 0.001). There were no differences regarding surgical time, blood losses, transfusion, and mortality. CONCLUSIONS In selected patients with CRLM, LLR presents similar oncological outcomes with the advantages of the short-term results associated with LLR.
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Affiliation(s)
- Ricardo Robles-Campos
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain.
| | - Víctor Lopez-Lopez
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
| | - Roberto Brusadin
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
| | - Asunción Lopez-Conesa
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
| | - Pedro José Gil-Vazquez
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
| | - Álvaro Navarro-Barrios
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
| | - Pascual Parrilla
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
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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]
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Wabitsch S, Kästner A, Haber PK, Benzing C, Krenzien F, Andreou A, Kamali C, Lenz K, Pratschke J, Schmelzle M. Laparoscopic Versus Open Liver Resection for Benign Tumors and Lesions: A Case Matched Study with Propensity Score Matching. J Laparoendosc Adv Surg Tech A 2019; 29:1518-1525. [PMID: 31670608 DOI: 10.1089/lap.2019.0427] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and Aim: In recent years, minimally invasive surgical approaches have gained an increasingly important role in hepatobiliary surgery. The aim of this study was to investigate the safety and potential benefits of laparoscopic liver resection (LLR) compared with open liver resection (OLR) for benign liver tumors and lesions. Patients and Methods: Between January 2009 and December 2017, 182 patients underwent liver resection for benign liver tumors and lesions at our center. After exclusion of 15 patients, the remaining 167 patients were divided into LLR group (n = 54) and OLR group (n = 113) and were compared with regard to perioperative outcomes. To overcome selection bias, a 1:1 propensity score matching (PSM) was performed. In addition, patients undergoing major hepatectomy were divided into major-LLR and major-OLR groups and perioperative outcomes evaluated. Results: After PSM, 35 patients were included in the OLR group and 35 patients in the LLR group. The LLR group had a significantly shorter median intensive care unit (ICU) stay (LLR: 1 [0-4] days; OLR: 1 [0-3] days; P = .009) and median hospital stay (length of stay [LOS]) (LLR: 7 [4-14] days; OLR: 10 [5-16] days; P < .001). There were no statistically significant differences in postoperative complications graded as Clavien-Dindo ≥III (LLR: 11.4%; OLR: 2.9%; P = .375) in both groups. Postoperative 90-day mortality was 0% in both groups. When comparing major-LLR (n = 8) with major-OLR (n = 59), patients in the major-LLR group had a significantly longer median operation time (major-LLR: 403 [240-501] minutes; major-OLR: 221.5 [111-529] minutes; P < .001), but a significantly shorter median LOS (major-LLR: 7 [5-14] days; major-OLR: 9 [7-129] days; P = .013). The rate of major complications (Dindo Classification ≥III) for major-LLR was 0% and for major-OLR it was 16.9% (P = .207). Conclusion: Our case-matched study demonstrates shorter ICU and hospital stay using laparoscopic techniques while maintaining high-quality perioperative outcomes. Based on our findings, we suggest preferring the LLR over OLR for benign liver tumors and lesions regardless of the resection extent.
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Affiliation(s)
- Simon Wabitsch
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Anika Kästner
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Philipp K Haber
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Christian Benzing
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Felix Krenzien
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Andreas Andreou
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Can Kamali
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Klaus Lenz
- Department of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
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Wilson GC, Geller DA. Evolving Surgical Options for Hepatocellular Carcinoma. Surg Oncol Clin N Am 2019; 28:645-661. [DOI: 10.1016/j.soc.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Chen TH, Yang HR, Jeng LB, Hsu SC, Hsu CH, Yeh CC, Yang MD, Chen WTL. Laparoscopic Liver Resection: Experience of 436 Cases in One Center. J Gastrointest Surg 2019; 23:1949-1956. [PMID: 30421118 DOI: 10.1007/s11605-018-4023-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/18/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND To report experience of laparoscopic liver resection (LLR) in one center. METHODS We retrospectively reviewed 436 consecutive LLRs in 411 patients between December 2010 and December 2016. On the basis of the 2008 Louisville Statement, we divided the 436 cases into two groups: Simple Group (n = 203) and Difficult Group (n = 233). RESULTS The indications were HCC (n = 194), colorectal cancer liver metastasis (n = 156), benign tumors (n = 62), hepatolithiasis (n = 2), and other malignant lesions (n = 22). The median tumor size was 24 mm (range 3 to 130). Procedures of LLR included wedge resection (n = 230), one segmentectomy (n = 8), two segmentectomies (n = 12), left lateral sectionectomy (n = 75), right hepatectomy (n = 52), left hepatectomy (n = 31), extended right hepatectomy (n = 2), extended left hepatectomy (n = 5), central bisectionectomy (n = 3), right posterior sectionectomy (n = 12), and right anterior sectionectomy (n = 6). The median operative time was 228 min (range 9-843) and median blood loss was 150 ml (range 2-3500). Twenty-five cases required blood transfusion (5.7%). Conversion to open surgery was required in six cases (1.4%). The mean length of stay was 6.4 ± 2.9 days. Overall complication rate was 9.4% and major complication rate was 5%. One patient died of liver failure on the thirtieth postoperative day after a right hepatectomy. We had higher median blood loss (200 vs. 100 ml; p < 0.001), higher transfusion rate (8.2 vs. 2.9%; p = 0.020), longer median operative time (297 vs. 164 min; p < 0.001), higher conversion rate (2.6 vs. 0%; p = 0.021), higher complication rate (14.2 vs. 3.9%; p < 0.001), and longer mean postoperative hospital stay (6.8 ± 2.9 vs. 5.9 ± 3.0 days; p < 0.001) in the Difficult Group. CONCLUSIONS Laparoscopic liver resection is safe for selected patients in the Difficult Group. On the basis of the 2008 Louisville Statement, selection criteria of LLR are helpful to predict the difficulty of the operation and the postoperative outcomes of LLR.
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Affiliation(s)
- Te-Hung Chen
- School of Medicine, China Medical University, No.2, Yude Rd., North Dist, Taichung City, 404, Taiwan.,Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Horng-Ren Yang
- School of Medicine, China Medical University, No.2, Yude Rd., North Dist, Taichung City, 404, Taiwan.,Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Long-Bin Jeng
- School of Medicine, China Medical University, No.2, Yude Rd., North Dist, Taichung City, 404, Taiwan. .,Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan.
| | - Shih-Chao Hsu
- School of Medicine, China Medical University, No.2, Yude Rd., North Dist, Taichung City, 404, Taiwan.,Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chia-Hao Hsu
- School of Medicine, China Medical University, No.2, Yude Rd., North Dist, Taichung City, 404, Taiwan.,Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Chieh Yeh
- School of Medicine, China Medical University, No.2, Yude Rd., North Dist, Taichung City, 404, Taiwan.,Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Mei-Due Yang
- School of Medicine, China Medical University, No.2, Yude Rd., North Dist, Taichung City, 404, Taiwan.,Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - William Tzu-Liang Chen
- School of Medicine, China Medical University, No.2, Yude Rd., North Dist, Taichung City, 404, Taiwan.,Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Yoshioka M, Taniai N, Kawano Y, Shimizu T, Kondo R, Kaneya Y, Aoki Y, Yoshida H. Effectiveness of Laparoscopic Repeat Hepatectomy for Recurrent Liver Cancer. J NIPPON MED SCH 2019; 86:222-229. [DOI: 10.1272/jnms.jnms.2019_86-410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Masato Yoshioka
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital
| | - Nobuhiko Taniai
- Department of Gastroenterological Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Youichi Kawano
- Department of Gastroenterological Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Tetsuya Shimizu
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital
| | - Ryota Kondo
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital
| | - Yohei Kaneya
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital
| | - Yuto Aoki
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital
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Alesina PF, Walz MK. A New Minimally Invasive Approach to the Posterior Right Segments of the Liver: Report of the First Two Cases. J Laparoendosc Adv Surg Tech A 2019; 29:943-948. [DOI: 10.1089/lap.2018.0809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Pier Francesco Alesina
- Department of Surgery and Center of Minimally Invasive Surgery, Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany
| | - Martin K. Walz
- Department of Surgery and Center of Minimally Invasive Surgery, Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany
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Yoon YI, Kim KH, Cho HD, Kwon JH, Jung DH, Park GC, Song GW, Ha TY, Lee SG. Long-term perioperative outcomes of pure laparoscopic liver resection versus open liver resection for hepatocellular carcinoma: a retrospective study. Surg Endosc 2019; 34:796-805. [PMID: 31161292 DOI: 10.1007/s00464-019-06831-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/14/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic treatment for hepatocellular carcinoma (HCC) has increased. We retrospectively compared the perioperative and long-term oncological outcomes of laparoscopic liver resection (LLR) with those of open liver resection (OLR) for hepatocellular carcinoma (HCC) in well-matched patient groups using propensity score matching (PSM). METHODS We reviewed medical records of patients with HCC who underwent liver resection between July 2007 and April 2016 at our center. In total, 2335 patients were included in this study and divided into LLR (n = 264) and OLR (n = 2071) groups. For group comparisons, 1:2 PSM was used with covariates of baseline characteristics, including tumor characteristics and surgical liver resection procedures. RESULTS After PSM, there were 217 and 434 patients in the LLR and OLR groups, respectively. The LLR group had shorter hospital stays (8.9 vs. 14.8 days; P < 0.001) and lower postoperative morbidity (6.5% vs. 12.0%; P = 0.022). The 1-, 3-, and 5-year overall survival rates were 98.1%, 87.0%, and 78.6%, respectively, for the LLR group, and 98.3%, 90.8%, and 84.3%, respectively, for the OLR group (P = 0.570). The 1-, 3-, and 5-year disease-free survival rates were 81.0%, 62.0%, and 49.1%, respectively, for the LLR group, and 85.3%, 64.7%, and 56.2%, respectively, for the OLR group (P = 0.563). CONCLUSIONS Long-term oncological outcomes were comparable between LLR and OLR for selected patients. LLR was associated with multiple benefits, even for selected patients with cirrhosis who underwent major hepatectomy. LLR for HCC performed by an experienced surgeon could be considered a safe and feasible alternative to OLR for selected patients.
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Affiliation(s)
- Young-In Yoon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Ki-Hun Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea.
| | - Hwui-Dong Cho
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Jae-Hyun Kwon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Dong-Hwan Jung
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Gil-Chun Park
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Gi-Won Song
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Tae-Yong Ha
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Sung Gyu Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
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Al-Saif FA, Aldekhayel MK, Al-Alem F, Hassanain MM, Mattar RE, Alsharabi A. Comparison study between open and laparoscopic liver resection in a Saudi tertiary center. Saudi Med J 2019; 40:452-457. [PMID: 31056621 PMCID: PMC6535162 DOI: 10.15537/smj.2019.5.24086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objectives: To compare King Saud University Medical City experience in laparoscopic liver resection with our previously established database for open resections. Methods: A retrospective study was conducted at King Saud University Medical City, Riyadh, Saudi Arabia. All adult patients who underwent liver resection from 2006 to 2017 were included. Patients who had their procedure converted to open were excluded. Results: Among the 111 liver resections included, 22 (19.8%) were performed laparoscopically and 89 (80.1%) were performed using the open technique. Malignancy was the most common indication in both groups (78.5%). The mean operative time was 275 min (SD 92.2) in the laparoscopic group versus 315 min (SD 104.3) in the open group. Intraoperative blood transfusion was required in the laparoscopic (9%) and open groups (31.4%). The morbidity rate was 13.6% in the laparoscopic group and 31.4% in the open group, and the mortality rate was 0% in the laparoscopic group and 5.6% in the open group. Conclusion: Laparoscopic liver resection appears to be a safe technique and can be performed in various benign and malignant cases.
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Affiliation(s)
- Faisal A Al-Saif
- Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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50
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Berardi G, Igarashi K, Wakabayashi G. Laparoscopic liver resection-education and training. Transl Gastroenterol Hepatol 2019; 4:11. [PMID: 30976714 DOI: 10.21037/tgh.2019.01.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/25/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Giammauro Berardi
- Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Tokyo, Japan.,Department of Structure and Recovery of Man, Gent University Hospital, Belgium
| | - Kazuharu Igarashi
- Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Tokyo, Japan
| | - Go Wakabayashi
- Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Tokyo, Japan
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