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Aghayan DL, d'Albenzio G, Fretland ÅA, Pelanis E, Røsok BI, Yaqub S, Palomar R, Edwin B. Laparoscopic parenchyma-sparing liver resection for large (≥ 50 mm) colorectal metastases. Surg Endosc 2023; 37:225-233. [PMID: 35922606 PMCID: PMC9839797 DOI: 10.1007/s00464-022-09493-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/16/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Traditionally, patients with large liver tumors (≥ 50 mm) have been considered for anatomic major hepatectomy. Laparoscopic resection of large liver lesions is technically challenging and often performed by surgeons with extensive experience. The current study aimed to evaluate the surgical and oncologic safety of laparoscopic parenchyma-sparing liver resection in patients with large colorectal metastases. METHODS Patients who primarily underwent laparoscopic parenchyma-sparing liver resection (less than 3 consecutive liver segments) for colorectal liver metastases between 1999 and 2019 at Oslo University Hospital were analyzed. In some recent cases, a computer-assisted surgical planning system was used to better visualize and understand the patients' liver anatomy, as well as a tool to further improve the resection strategy. The surgical and oncologic outcomes of patients with large (≥ 50 mm) and small (< 50 mm) tumors were compared. Multivariable Cox-regression analysis was performed to identify risk factors for survival. RESULTS In total 587 patients met the inclusion criteria (large tumor group, n = 59; and small tumor group, n = 528). Median tumor size was 60 mm (range, 50-110) in the large tumor group and 21 mm (3-48) in the small tumor group (p < 0.001). Patient age and CEA level were higher in the large tumor group (8.4 μg/L vs. 4.6 μg/L, p < 0.001). Operation time and conversion rate were similar, while median blood loss was higher in the large tumor group (500 ml vs. 200 ml, p < 0.001). Patients in the large tumor group had shorter 5 year overall survival (34% vs 49%, p = 0.027). However, in the multivariable Cox-regression analysis tumor size did not impact survival, unlike parameters such as age, ASA score, CEA level, extrahepatic disease at liver surgery, and positive lymph nodes in the primary tumor. CONCLUSION Laparoscopic parenchyma-sparing resections for large colorectal liver metastases provide satisfactory short and long-term outcomes.
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Affiliation(s)
- Davit L Aghayan
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway.
- Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia.
| | - Gabriella d'Albenzio
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Åsmund A Fretland
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Egidijus Pelanis
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Bård I Røsok
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Sheraz Yaqub
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Rafael Palomar
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Department of Computer Science, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Bjørn Edwin
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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Lo WM, Tohme ST, Geller DA. Recent Advances in Minimally Invasive Liver Resection for Colorectal Cancer Liver Metastases-A Review. Cancers (Basel) 2022; 15:cancers15010142. [PMID: 36612137 PMCID: PMC9817853 DOI: 10.3390/cancers15010142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/28/2022] Open
Abstract
Minimally invasive surgical (MIS) approaches to liver resection have been increasingly adopted into use for surgery on colorectal cancer liver metastases. The purpose of this review is to evaluate the outcomes when comparing laparoscopic liver resection (LLR), robotic liver resection (RLR), and open liver resection (OLR) for colorectal cancer liver metastases (CRLM) in 39 studies (2009-2022) that include a case-matched series, propensity score analyses, and three randomized clinical trials. LLR is associated with less intraoperative blood loss and shorter hospital stay compared with OLR. LLR can be performed with comparable operative time. LLR has similar rates of perioperative complications and mortality as OLR. There were no significant differences in 5-year overall or disease-free survival between approaches. Robotic liver resection (RLR) has comparable perioperative safety to LLR and may improve rates of R0 resection in certain patients. Finally, MIS approaches to the hepatic resection of CRLM reduce the time from liver resection to initiation of adjuvant chemotherapy. Thus, MIS liver surgery should be considered in the array of options for patients with CRLM, though thoughtful patient selection and surgeon experience should be part of that decision.
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Affiliation(s)
| | | | - David A. Geller
- Correspondence: ; Tel.: +1-412-692-2001; Fax: +1-412-602-2002
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Ozair A, Collings A, Adams AM, Dirks R, Kushner BS, Sucandy I, Morrell D, Abou-Setta AM, Vreeland T, Whiteside J, Cloyd JM, Ansari MT, Cleary SP, Ceppa E, Richardson W, Alseidi A, Awad Z, Ayloo S, Buell JF, Orthopoulos G, Sbayi S, Wakabayashi G, Slater BJ, Pryor A, Jeyarajah DR. Minimally invasive versus open hepatectomy for the resection of colorectal liver metastases: a systematic review and meta-analysis. Surg Endosc 2022; 36:7915-7937. [PMID: 36138246 DOI: 10.1007/s00464-022-09612-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/05/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND While surgical resection has a demonstrated utility for patients with colorectal liver metastases (CRLM), it is unclear whether minimally invasive surgery (MIS) or an open approach should be used. This review sought to assess the efficacy and safety of MIS versus open hepatectomy for isolated, resectable CRLM when performed separately from (Key Question (KQ) 1) or simultaneously with (KQ2) the resection of the primary tumor. METHODS PubMed, Embase, Google Scholar, Cochrane CENTRAL, International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov databases were searched to identify both randomized controlled trials (RCTs) and non-randomized comparative studies published during January 2000-September 2020. Two independent reviewers screened literature for eligibility, extracted data from included studies, and assessed internal validity using the Cochrane Risk of Bias 2.0 Tool and the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed using risk ratios (RR) and mean differences (MD). RESULTS From 2304 publications, 35 studies were included for meta-analysis. For staged resections, three RCTs and 20 observational studies were included. Data from RCTs indicated MIS having similar disease-free survival (DFS) at 1-year (RR 1.03, 95%CI 0.70-1.50), overall survival (OS) at 5-years (RR 1.04, 95%CI 0.84-1.28), fewer complications of Clavien-Dindo Grade III (RR 0.62, 95%CI 0.38-1.00), and shorter hospital length of stay (LOS) (MD -6.6 days, 95%CI -10.2, -3.0). For simultaneous resections, 12 observational studies were included. There was no evidence of a difference between MIS and the open group for DFS-1-year, OS-5-year, complications, R0 resections, blood transfusions, along with lower blood loss (MD -177.35 mL, 95%CI -273.17, -81.53) and shorter LOS (MD -3.0 days, 95%CI -3.82, -2.17). CONCLUSIONS Current evidence regarding the optimal approach for CRLM resection demonstrates similar oncologic outcomes between MIS and open techniques, however MIS hepatectomy had a shorter LOS, lower blood loss and complication rate, for both staged and simultaneous resections.
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Affiliation(s)
- Ahmad Ozair
- Faculty of Medicine, King George's Medical University, Uttar Pradesh, Lucknow, India
| | - Amelia Collings
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Centre, Fort Sam Houston, San Antonio, TX, USA
| | - Rebecca Dirks
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Bradley S Kushner
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Iswanto Sucandy
- Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA
| | - David Morrell
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ahmed M Abou-Setta
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Timothy Vreeland
- Department of Surgery, Brooke Army Medical Centre, Fort Sam Houston, San Antonio, TX, USA
| | - Jake Whiteside
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sean P Cleary
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eugene Ceppa
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | | | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Subhashini Ayloo
- Department of Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Joseph F Buell
- Division of Surgery, Mission Healthcare System, HCA Healthcare, Asheville, NC, USA
| | - Georgios Orthopoulos
- Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA
| | - Samer Sbayi
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, New York, NY, USA
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Department of Surgery, Ageo Central General Hospital, Ageo City, Japan
| | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Aurora Pryor
- Department of Surgery, Stony Brook University, Stony Brook, NY, USA
| | - D Rohan Jeyarajah
- Department of Surgery, TCU School of Medicine, and Methodist Richardson Medical Center, 2805 East President George Bush Highway, Fort Worth, TX, USA.
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FINOTTI M, D’AMICO F, TESTA G. The current and future role of robotic surgery in liver surgery and transplantation. Minerva Surg 2022; 77:380-390. [DOI: 10.23736/s2724-5691.22.09629-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mahamid A, Abu-Zaydeh O, Sawaied M, Goldberg N, Haddad R. The Role of Preoperative Platelet-to-Lymphocyte Ratio as a Predictor for Incisional Hernias after Hand-Assisted Laparoscopic Liver Surgery for Metastatic Colorectal Cancer. J Pers Med 2022; 12:jpm12030492. [PMID: 35330491 PMCID: PMC8950596 DOI: 10.3390/jpm12030492] [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: 11/08/2021] [Revised: 02/09/2022] [Accepted: 03/17/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: Hand-assisted laparoscopic surgery for liver resection is a globally established technique. In this study, we report on the incidence and risk factors for postoperative incisional hernia (IH) after hand-assisted laparoscopic surgery for colorectal liver metastasis. (2) Methods: This was retrospective analysis of 89 consecutive hand-assisted laparoscopic surgery for colorectal liver metastasis. (3) Results: Participants were 39 females and 50 males. Median age was 65 years, and in 63%, the BMI was ≥25. Postoperative complications were encountered in 18% of the patients. Seven patients (7.8%) had postoperative incisional hernia in the hand port site. There was significantly higher incidence of incisional hernia in overweight patients (BMI ≥ 25) (p = 0.04), and in cases with simultaneous liver and colon resection (p = 0.02). In univariant and multivariant analyses, simultaneous liver and colon resection (p = 0.004 and 0.03, respectively), and platelet-to-lymphocyte ratio ≤ 200 (p = 0.03, 0.04, respectively) were both independent risk factors for developing postoperative incisional hernia. (4) Conclusions: Both simultaneous liver and colon resection, and platelet-to-lymphocyte ratio ≤ 200 are independent risk factors for postoperative incisional hernia after hand-assisted laparoscopic surgery for colorectal liver metastasis.
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Affiliation(s)
- Ahmad Mahamid
- Department of Surgery, Carmel Medical Center, Haifa 3436212, Israel; (A.M.); (O.A.-Z.); (M.S.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525433, Israel;
| | - Omar Abu-Zaydeh
- Department of Surgery, Carmel Medical Center, Haifa 3436212, Israel; (A.M.); (O.A.-Z.); (M.S.)
| | - Muneer Sawaied
- Department of Surgery, Carmel Medical Center, Haifa 3436212, Israel; (A.M.); (O.A.-Z.); (M.S.)
| | - Natalia Goldberg
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525433, Israel;
- Department of Radiology, Carmel Medical Center, Haifa 3436212, Israel
| | - Riad Haddad
- Department of Surgery, Carmel Medical Center, Haifa 3436212, Israel; (A.M.); (O.A.-Z.); (M.S.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525433, Israel;
- Correspondence:
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Cheng KC, Yip ASM. Prognostic factors of survival and a new scoring system for liver resection of colorectal liver metastasis. World J Hepatol 2022; 14:209-223. [PMID: 35126849 PMCID: PMC8790392 DOI: 10.4254/wjh.v14.i1.209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/03/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic resection has become the preferred treatment of choice for colorectal liver metastasis (CLM) patients.
AIM To identify the prognostic factors and to formulate a new scoring system for management of CLM.
METHODS Clinicopathologic and long-term survival data were analyzed to identify the significant predictors of survival by univariate and multivariate analyses with the Cox model. A clinical score was constructed based on the analysis results.
RESULTS Three factors of worse overall survival were identified in the multivariate analysis. They were number of liver metastases ≥ 5, size of the largest liver lesion ≥ 4 cm, and the presence of nodal metastasis from the primary tumor. These three factors were chosen as criteria for a clinical risk score for overall survival. The clinical score highly correlated with median overall survival and 5-year survival (P = 0.002).
CONCLUSION Priority over surgical resection should be given to the lowest score groups, and alternative oncological treatment should be considered in patients with the highest score.
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Affiliation(s)
- Kai-Chi Cheng
- Department of Surgery, Kwong Wah Hospital, Hong Kong, China
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7
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Kelly ME, Fahy M, Bolger JC, Boland PA, Neary C, McEntee GP, Conneely JB. Open versus laparoscopic liver resection of colorectal metastases: a meta-analysis of matched patient populations. Ir J Med Sci 2021; 191:1531-1538. [PMID: 34535883 DOI: 10.1007/s11845-021-02780-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
In recent years, the management of colorectal liver metastases (CRLM) has evolved significantly. Laparoscopic liver resection is increasingly being performed, despite a lack of major randomized controlled trial evidence or widespread international consensus. The objective of this review was to compare the short- and long-term outcomes following open and laparoscopic CRLM resection. A systematic review of comparative matched population studies was performed. Evaluated endpoints included surgical outcomes and survival outcomes. Twelve studies were included in this review, reporting on 3095 patients. R0 (negative margins) rates were higher in the laparoscopic CRLM group (89.3% versus 86.9%). In addition, laparoscopic resection was associated with less blood loss (486 mls versus 648 mls, p ≤ 0.0001*) and reduced blood transfusion rates (6.7% vs. 12.2%, OR 2.13, 95% CI 1.08-4.19, p = 0.03*). Major complication rates were higher in the open CRLM group (12.5% vs. 8.1%, OR 1.74, 95% CI 1.30-2.33, p = 0.03*), as was overall hospital length of stay (median 7 versus 5.5 days, p = 0.001*). Perioperative mortality was similar between both groups, and there was no significance in 5-year overall survival for open or laparoscopic CRLM resection groups (58% and 61% respectively). Laparoscopic CRLM resection is associated with less blood loss, lower transfusion rates, major complications, and overall hospital length of stay with comparable oncological outcome.
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Affiliation(s)
- Michael E Kelly
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
- Dept. of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Matthew Fahy
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Jarlath C Bolger
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Patrick A Boland
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Colm Neary
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Gerry P McEntee
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - John B Conneely
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
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Long-term oncological outcomes after laparoscopic parenchyma-sparing redo liver resections for patients with metastatic colorectal cancer: a European multi-center study. Surg Endosc 2021; 36:3374-3381. [PMID: 34462867 PMCID: PMC9001231 DOI: 10.1007/s00464-021-08655-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/16/2021] [Indexed: 11/10/2022]
Abstract
Background Laparoscopic redo resections for colorectal metastases are poorly investigated. This study aims to explore long-term results after second, third, and fourth resections. Material and methods Prospectively updated databases of primary and redo laparoscopic liver resections in six European HPB centers were analyzed. Procedure-related overall survival after first, second, third, and fourth resections were evaluated. Furthermore, patients without liver recurrence after first liver resection were compared to those with one redo, two or three redo, and patients with palliative treatment for liver recurrence after first laparoscopic liver surgery. Survival was calculated both from the date of the first liver resection and from the date of the actual liver resection. In total, 837 laparoscopic primary and redo liver resections performed in 762 patients were included (630 primary, 172 first redo, 29 second redo, and 6 third redo). Patients were bunched into four groups: Group 1—without hepatic recurrence after primary liver resection (n = 441); Group 2—with liver recurrence who underwent only one laparoscopic redo resection (n = 154); Group 3—with liver recurrence who underwent two laparoscopic redo resections (n = 29); Group 4—with liver recurrence who have not been found suitable for redo resections (n = 138). Results No significant difference has been found between the groups in terms of baseline characteristics and surgical outcomes. Rate of positive resection margin was higher in the group with palliative recurrence (group 4). Five-year survival calculated from the first liver resection was 67%, 62%, 84%, and 7% for group 1, 2, 3, and 4, respectively. Procedure-specific 5-year overall survival was 50% after primary laparoscopic liver resection, 52% after the 1st reoperation, 52% after the 2nd, and 40% after the 3rd reoperation made laparoscopic. Conclusions Multiple redo recurrences can be performed laparoscopically with good long-term results. Liver recurrence does not aggravate prognosis as long as the patient is suitable for reoperation.
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Taillieu E, De Meyere C, Nuytens F, Verslype C, D'Hondt M. Laparoscopic liver resection for colorectal liver metastases - short- and long-term outcomes: A systematic review. World J Gastrointest Oncol 2021; 13:732-757. [PMID: 34322201 PMCID: PMC8299931 DOI: 10.4251/wjgo.v13.i7.732] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/16/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND For well-selected patients and procedures, laparoscopic liver resection (LLR) has become the gold standard for the treatment of colorectal liver metastases (CRLM) when performed in specialized centers. However, little is currently known concerning patient-related and peri-operative factors that could play a role in survival outcomes associated with LLR for CRLM. AIM To provide an extensive summary of reported outcomes and prognostic factors associated with LLR for CRLM. METHODS A systematic search was performed in PubMed, EMBASE, Web of Science and the Cochrane Library using the keywords "colorectal liver metastases", "laparoscopy", "liver resection", "prognostic factors", "outcomes" and "survival". Only publications written in English and published until December 2019 were included. Furthermore, abstracts of which no accompanying full text was published, reviews, case reports, letters, protocols, comments, surveys and animal studies were excluded. All search results were saved to Endnote Online and imported in Rayyan for systematic selection. Data of interest were extracted from the included publications and tabulated for qualitative analysis. RESULTS Out of 1064 articles retrieved by means of a systematic and grey literature search, 77 were included for qualitative analysis. Seventy-two research papers provided data concerning outcomes of LLR for CRLM. Fourteen papers were eligible for extraction of data concerning prognostic factors affecting survival outcomes. Qualitative analysis of the collected data showed that LLR for CRLM is safe, feasible and provides oncological efficiency. Multiple research groups have reported on the short-term advantages of LLR compared to open procedures. The obtained results accounted for minor LLR, as well as major LLR, simultaneous laparoscopic colorectal and liver resection, LLR of posterosuperior segments, two-stage hepatectomy and repeat LLR for CRLM. Few research groups so far have studied prognostic factors affecting long-term outcomes of LLR for CRLM. CONCLUSION In experienced hands, LLR for CRLM provides good short- and long-term outcomes, independent of the complexity of the procedure.
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Affiliation(s)
- Emily Taillieu
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge, Kortrijk 8500, Belgium
| | - Celine De Meyere
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge, Kortrijk 8500, Belgium
| | - Frederiek Nuytens
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge, Kortrijk 8500, Belgium
| | - Chris Verslype
- Department of Gastroenterology and Hepatology, KU Leuven, Leuven 3000, Belgium
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge, Kortrijk 8500, Belgium
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Taillieu E, De Meyere C, Nuytens F, Verslype C, D'Hondt M. Laparoscopic liver resection for colorectal liver metastases — short- and long-term outcomes: A systematic review. World J Gastrointest Oncol 2021. [DOI: 10.4251/wjgo.v13.i7.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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11
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Mahamid A, Sawaied M, Berger Y, Halim NA, Goldberg N, Abu-Zaydeh O, Bitterman A, Sadot E, Haddad R. Hand-assisted Laparoscopic Surgery for Colorectal Liver Metastasis: Analysis of Short-term and Long-term Results. Surg Laparosc Endosc Percutan Tech 2021; 31:543-549. [PMID: 33788821 DOI: 10.1097/sle.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/01/2021] [Indexed: 12/07/2022]
Abstract
BACKGROUND There is scant data regarding the outcomes of hand-assisted laparoscopic surgery (HALS) for colorectal liver metastasis (CRLM). The aim of this study is to report our experience and analyze the short-term and long-term results. MATERIALS AND METHODS Retrospective study of patients undergoing HALS for CRLM in 2 university affiliated medical centers. RESULTS Two hundred and thirty-eight liver procedures were performed on 145 patients including 205 parenchymal sparing resections and 33 anatomic resections. The median number of metastases was 1 (range: 1 to 8), 38 patients (26.2%) had 3 or more metastases, and 41 patients (28.3 had a bi-lobar disease. The tumor size was 20 (2 to 90) mm, and 52 patients (36.6%) had a tumor larger than 30 mm. Nighty-nine patients (67.8%) received neoadjuvant chemotherapy. In 8 patients (5.5%) the laparoscopic liver resection was combined with ablation, and 16 patients (11%) underwent a synchronous resection of colorectal cancer. The median operative time, blood loss during surgery, and postoperative hospital stay were 163 minutes, 300 mL, and 4 days, respectively. The median modified Iwate complexity score was 4 (0 to 10) and the conversion rate to open surgery was 5.5%. The overall and major complication rates were 23.8% and 3.6%, respectively. The mortality rate was 0.7%. R0 resections were achieved in 91% of patients. Median overall survival for all the cohort (intend to treat) was 59 months, and the 8- and 10-year overall survival rates were 47.3% and 24.9%, respectively. CONCLUSIONS This study shows that HALS is a safe and efficacious treatment for selected patients with CRLM.
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Affiliation(s)
- Ahmad Mahamid
- Departments of Surgery
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa
| | | | - Yael Berger
- Department of Surgery, Rabin Medical Center, Petach-Tikva
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nasser A Halim
- Department of Surgery, Rabin Medical Center, Petach-Tikva
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natalia Goldberg
- Radiology, Carmel Medical Center
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa
| | | | - Arie Bitterman
- Departments of Surgery
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa
| | - Eran Sadot
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Riad Haddad
- Departments of Surgery
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa
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Glorioso JM, Nguyen MC, Long J, Jackson K, Philosophe R, Wethington SL, Philosophe B. Robotic Full Lobe Hepatectomy With Natural Orifice Extraction: Case Series Describing the Novel Technique of Robotic Major Hepatectomy and Transvaginal Specimen Extraction. ANNALS OF SURGERY OPEN 2021; 2:e041. [PMID: 37638241 PMCID: PMC10455210 DOI: 10.1097/as9.0000000000000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/05/2020] [Indexed: 11/26/2022] Open
Abstract
MINI-ABSTRACT A minimally invasive approach to partial hepatectomy with transvaginal specimen extraction is safe and feasible with the potential to improve the cosmetic outcome, minimize postoperative narcotic utilization, and shorten hospital length of stay. This series describes the initial experience using this novel technique.
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Affiliation(s)
- Jaime M. Glorioso
- From the Department of Surgery, Thomas Jefferson University School of Medicine, Philadelphia, PA
| | - Michelle C. Nguyen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jane Long
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kyle Jackson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Stephanie L. Wethington
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Benjamin Philosophe
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Aghayan DL, Kazaryan AM, Dagenborg VJ, Røsok BI, Fagerland MW, Waaler Bjørnelv GM, Kristiansen R, Flatmark K, Fretland ÅA, Edwin B. Long-Term Oncologic Outcomes After Laparoscopic Versus Open Resection for Colorectal Liver Metastases : A Randomized Trial. Ann Intern Med 2021; 174:175-182. [PMID: 33197213 DOI: 10.7326/m20-4011] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Despite the recent worldwide dissemination of laparoscopic liver surgery, no high-level evidence supports the oncologic safety of this approach. OBJECTIVE To evaluate long-term oncologic outcomes after laparoscopic versus open liver resection in patients with colorectal metastases. DESIGN A single-center, assessor-blinded, randomized controlled trial (OSLO-COMET [Oslo Randomized Laparoscopic Versus Open Liver Resection for Colorectal Metastases Trial]). (ClinicalTrials.gov: NCT01516710). SETTING Oslo University Hospital, the only provider of liver surgery for the 3 million inhabitants of southeastern Norway. PARTICIPANTS Patients with resectable colorectal liver metastases were randomly assigned to have open or laparoscopic liver resection. INTERVENTION From February 2012 to January 2016, a total of 280 patients were included in the trial (laparoscopic surgery: n = 133; open surgery: n = 147). MEASUREMENTS The primary outcome was postoperative morbidity within 30 days. Five-year rates of overall and recurrence-free survival were predefined secondary end points. RESULTS At a median follow-up of 70 months, rates of 5-year overall survival were 54% in the laparoscopic group and 55% in the open group (between-group difference, 0.5 percentage point [95% CI, -11.3 to 12.3 percentage points]; hazard ratio, 0.93 [CI, 0.67 to 1.30]; P = 0.67). Rates of 5-year recurrence-free survival were 30% in the laparoscopic group and 36% in the open group (between-group difference, 6.0 percentage points [CI, -6.7 to 18.7 percentage points]; hazard ratio, 1.09 [CI, 0.80 to 1.49]; P = 0.57). LIMITATION The trial was not powered to detect differences in secondary end points and was not designed to address a noninferiority hypothesis for survival outcomes. CONCLUSION In this randomized trial of laparoscopic and open liver surgery, no difference in survival outcomes was found between the treatment groups. However, differences in 5-year overall survival up to about 10 percentage points in either direction cannot be excluded. This trial should be followed by pragmatic multicenter trials and international registries. PRIMARY FUNDING SOURCE The South-Eastern Norway Regional Health Authority.
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Affiliation(s)
- Davit L Aghayan
- The Intervention Centre at Oslo University Hospital and Institute of Clinical Medicine at University of Oslo, Oslo, Norway, and Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia (D.L.A.)
| | - Airazat M Kazaryan
- The Intervention Centre at Oslo University Hospital, Oslo, and Østfold Hospital Trust, Grålum, Norway, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia, and I.M. Sechenov First Moscow State Medical University, Moscow, Russia (A.M.K.)
| | - Vegar Johansen Dagenborg
- Institute of Clinical Medicine at University of Oslo and Oslo University Hospital, Oslo, Norway (V.J.D., K.F.)
| | - Bård I Røsok
- Oslo University Hospital Rikshospitalet, Oslo, Norway (B.I.R.)
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway (M.W.F.)
| | | | - Ronny Kristiansen
- The Intervention Centre at Oslo University Hospital, Oslo, Norway (R.K., Å.A.F.)
| | - Kjersti Flatmark
- Institute of Clinical Medicine at University of Oslo and Oslo University Hospital, Oslo, Norway (V.J.D., K.F.)
| | | | - Bjørn Edwin
- The Intervention Centre at Oslo University Hospital and Institute of Clinical Medicine at University of Oslo, Oslo, Norway (B.E.)
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14
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Long-Term and Oncologic Outcomes of Robotic Versus Laparoscopic Liver Resection for Metastatic Colorectal Cancer: A Multicenter, Propensity Score Matching Analysis. World J Surg 2020; 44:887-895. [PMID: 31748885 DOI: 10.1007/s00268-019-05270-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND To assess long-term oncologic outcomes of robotic-assisted liver resection (RLR) for colorectal cancer (CRC) metastases as compared to a propensity-matched cohort of laparoscopic liver resections (LLR). Although safety and short-term outcomes of RLR have been described and previously compared to LLR, long-term and oncologic data are lacking. METHODS A retrospective study was performed of all patients who underwent RLR and LLR for CRC metastases at six high-volume centers in the USA and Europe between 2002 and 2017. Propensity matching was used to match baseline characteristics between the two groups. Data were analyzed with a focus on postoperative and oncologic outcomes, as well as long-term recurrence and survival. RESULTS RLR was performed in 115 patients, and 514 patients underwent LLR. Following propensity matching 115 patients in each cohort were compared. Perioperative outcomes including mortality, morbidity, reoperation, readmission, intensive care requirement, length-of-stay and margin status were not statistically different. Both prematching and postmatching analyses demonstrated similar overall survival (OS) and disease-free survival (DFS) between RLR and LLR at 5 years (61 vs. 60% OS, p = 0.87, and 38 vs. 31% DFS, p = 0.25, prematching; 61 vs. 60% OS, p = 0.78, and 38 vs. 44% DFS, p = 0.62, postmatching). CONCLUSIONS Propensity score matching with a large, multicenter database demonstrates that RLR for colorectal metastases is feasible and safe, with perioperative and long-term oncologic outcomes and survival that are largely comparable to LLR.
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Han K, Kim JH, Yang SG, Park SH, Choi HK, Chun SY, Kim PN, Park J, Lee M. A Single-Center Retrospective Analysis of Periprocedural Variables Affecting Local Tumor Progression after Radiofrequency Ablation of Colorectal Cancer Liver Metastases. Radiology 2020; 298:212-218. [PMID: 33170105 DOI: 10.1148/radiol.2020200109] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Local tumor progression (LTP) is associated with poorer survival in patients undergoing radiofrequency ablation (RFA) for colorectal liver metastasis (CLM). An algorithmic strategy to predict LTP may help in selection of patients who would benefit most from RFA for CLM. Purpose To estimate local tumor progression-free survival (LTPFS) following RFA of CLM and develop an algorithmic strategy based on clinical variables. Materials and Methods In this retrospective study, between March 2000 and December 2014, patients who underwent percutaneous RFA for CLM were randomly split into development (60%) and internal validation (40%) data sets. Kaplan-Meier method was used to estimate LTPFS and overall survival (OS) rates. Independent factors affecting LTPFS in the development data set were investigated by using multivariable Cox proportional hazard regression analysis. Risk scores were assigned to the risk factors and applied to the validation data set. Results A total of 365 patients (mean age, 60 years ± 11 [standard deviation]; 259 men) with 512 CLMs were evaluated. LTPFS and OS rates were 85% and 92% at 1 year, 73% and 41% at 5 years, 72% and 30% at 10 years, and 72% and 28% at 15 years, respectively. Independent risk factors for LTP included tumor size of 2 cm or greater (hazard ratio [HR], 3.8; 95% CI: 2.3, 6.2; P < .001), subcapsular tumor location (HR, 1.9; 95% CI: 1.1, 3.1; P = .02), and minimal ablative margin of 5 mm or less (HR, 11.7; 95% CI: 4.7, 29.2; P < .001). A prediction model that used the risk factors had areas under the curve of 0.89, 0.92, and 0.90 at 1, 5, and 10 years, respectively, and it showed significantly better areas under the curve when compared with the model using the minimal ablative margin of 5 mm or less alone. Conclusion Radiofrequency ablation provided long-term control of colorectal liver metastases. Although minimal ablative margin of 5 mm or less was the most dominant factor, the multifactorial approach including tumor size and subcapsular location better predicted local tumor progression-free survival. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Soulen and Sofocleous in this issue.
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Affiliation(s)
- Kichang Han
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Jin Hyoung Kim
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Seul Gi Yang
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Seong Ho Park
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Hyun-Kyung Choi
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Seng-Yong Chun
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Pyo Nyun Kim
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Jihong Park
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Myeongjee Lee
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
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Hołówko W, Triantafyllidis I, Neuberg M, Tabchouri N, Beaussier M, Bennamoun M, Sarran A, Lefevre M, Louvet C, Gayet B, Fuks D. Does the difficulty grade of laparoscopic liver resection for colorectal liver metastases correlate with long-term outcomes? Eur J Surg Oncol 2020; 46:1620-1627. [PMID: 32561203 DOI: 10.1016/j.ejso.2020.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Prognosis of patients with colorectal liver metastases (CRLM) is strongly correlated with the oncological outcome after liver resection. The aim of this study was to analyze the impact of laparoscopic liver resection (LLR) difficulty score (IMM difficulty score) on the oncological results in patients treated for CRLM. METHODS All patients who underwent LLRs for CRLM from 2000 to 2016 in our department, were retrospectively reviewed. Data regarding difficulty classification, -according to the Institute Mutualiste Montsouris score (IMM)-, recurrence rate, recurrence-free survival (RFS), overall survival (OS) and data regarding margin status were analyzed. RESULTS A total of 520 patients were included. Patients were allocated into 3 groups based on IMM difficulty score of the LLR they underwent: there were 227 (43,6%), 84 (16,2%) and 209 (40,2%) patients in groups I, II and III, respectively. The R1 resection rate in group I, II and III were 8,8% (20/227), 11,9% (10/84) and 12,4% (26/209) respectively (p = 0.841). Three- and 5-year RFS rates were 77% and 73% in group I, 58% and 51% in group II, 61% and 53% in group III, respectively (p = 0.038). Three and 5-year OS rates were 87% and 80% for group I, 77% and 66% for group II, 80% and 69% for group III respectively (p = 0.022). CONCLUSION The higher LLR difficulty score correlates with significant morbidity and worse RFS and OS, although the more technically demanding and difficult cases are not associated with increased rates of positive resection margins and recurrence.
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Affiliation(s)
- Wacław Hołówko
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, Université Paris Descartes, France; Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Ioannis Triantafyllidis
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, Université Paris Descartes, France; Department of General Surgery, General Hospital of Veria, Greece
| | - Maud Neuberg
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, Université Paris Descartes, France
| | - Nicolas Tabchouri
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, Université Paris Descartes, France
| | - Marc Beaussier
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, Université Paris Descartes, France
| | - Mostefa Bennamoun
- Department of Oncology, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France
| | - Anthony Sarran
- Department of Radiology, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France
| | - Marine Lefevre
- Department of Pathology, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France
| | - Christophe Louvet
- Department of Oncology, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France
| | - Brice Gayet
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, Université Paris Descartes, France
| | - David Fuks
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, Université Paris Descartes, France.
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17
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Wabitsch S, Schulz P, Fröschle F, Kästner A, Fehrenbach U, Benzing C, Haber PK, Denecke T, Pratschke J, Fikatas P, Schmelzle M. Incidence of incisional hernia after laparoscopic liver resection. Surg Endosc 2020; 35:1108-1115. [PMID: 32124059 DOI: 10.1007/s00464-020-07475-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 02/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Minimally invasive techniques have been broadly introduced to liver surgery during the last couple of years. In this study, we aimed to report the incidence and potential risk factors for incisional hernia (IH) as well as health-related quality of life (HRQoL) after laparoscopic liver resections (LLR). METHODS All patients undergoing LLR between January 2014 and June 2017 were contacted for an outpatient hernia examination. In all eligible patients, photo documentation of the scar was performed and IH was evaluated by clinical examination and by ultrasound. Patients also completed a questionnaire to evaluate IH-specific symptoms and HRQoL. Obtained results were retrospectively analyzed with regard to patients' characteristics, perioperative outcomes and applied minimally invasive techniques, such as multi-incision laparoscopic liver surgery or hand-assisted/single-incision laparoscopic surgery (HALS/SILS). RESULTS Of 184 patients undergoing surgery, 161 (87.5%) met the inclusion criteria and 49 patients (26.6%) participated in this study. After a median time of 26 months (range 19-50 months) after surgery, we observed an overall incidence of IH of 12%. Five of 6 patients were overweight or obese (BMI ≥ 25) and 5 of 6 hernias were located at the umbilical site. Univariate analysis suggested the performance status at time of operation (ASA score ≥ 3; HR 5.616, 95% CI 1.012-31.157, p = 0.048) and the approach (HALS/SILS, HR 6.571, 95% CI 1.097-39.379, p = 0.039) as potential risk factors for IH. A higher frequency of hernia-related physical restrictions (HRR; p = 0.058) and a decreased physical functioning (p = 0.17) were noted in patients with IH; however, both being short of statistical significance. CONCLUSION Advantages of laparoscopic surgery with regard to low rates of IH can be translated to minimally invasive liver surgery. Even though there are low rates of IH, patients with poor performance status at the time of operation should be monitored closely. While patients' characteristics are hard to influence, it might be worth focusing on surgical factors such as the approach and the closure of the umbilical site to further minimize the rate of IH.
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Affiliation(s)
- S Wabitsch
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Schulz
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - F Fröschle
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Kästner
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - U Fehrenbach
- Department of Radiology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - C Benzing
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P K Haber
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - T Denecke
- Department of Radiology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - J Pratschke
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Fikatas
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Schmelzle
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Aghayan DL, Fretland ÅA, Kazaryan AM, Sahakyan MA, Dagenborg VJ, Bjørnbeth BA, Flatmark K, Kristiansen R, Edwin B. Laparoscopic versus open liver resection in the posterosuperior segments: a sub-group analysis from the OSLO-COMET randomized controlled trial. HPB (Oxford) 2019; 21:1485-1490. [PMID: 30962136 DOI: 10.1016/j.hpb.2019.03.358] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/26/2019] [Accepted: 03/10/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic liver resection in the posterosuperior segments is technically challenging. This study aimed to compare the perioperative outcomes for laparoscopic and open resection of colorectal liver metastases located in the posterosuperior segments. METHODS This was a subgroup analysis of the OSLO-COMET randomized controlled trial, where 280 patients were randomly assigned to open or laparoscopic parenchyma-sparing liver resections of colorectal metastases. Patients with tumors in the posterosuperior segments were identified, and perioperative outcomes and health related quality of life (HRQoL) were compared. RESULTS We identified a total of 136 patients, 62 in the laparoscopic and 74 in the open group. The postoperative complication rate was 26% in the laparoscopic and 31% in the open group. The blood loss was less in the open group (500 vs. 250 ml, P = 0.006), but the perioperative transfusion rate was similar. The operative time was similar, while postoperative hospital stay was shorter in the laparoscopic group (2 vs. 4 days, P < 0.001). HRQoL was significantly better after laparoscopy at 1 month. CONCLUSION In patients undergoing laparoscopic or open liver resection of colorectal liver metastases in the posterosuperior segments, laparoscopic surgery was associated with shorter hospital stay and comparable perioperative outcomes.
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Affiliation(s)
- Davit L Aghayan
- The Intervention Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Norway; Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia.
| | - Åsmund A Fretland
- The Intervention Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Norway; Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Airazat M Kazaryan
- The Intervention Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia; Department of Surgery, Fonna Hospital Trust, Stord, Norway; Department of Faculty Surgery №2I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Mushegh A Sahakyan
- The Intervention Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia; Department of General and Laparoscopic Surgery, Central Clinical Military Hospital, Yerevan, Armenia
| | - Vegar J Dagenborg
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Norway; Department of Tumor Biology, Oslo University Hospital, Oslo, Norway; Department of Gastroenterological Surgery, Oslo University Hospital, Oslo, Norway
| | - Bjørn Atle Bjørnbeth
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Kjersti Flatmark
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Norway; Department of Tumor Biology, Oslo University Hospital, Oslo, Norway; Department of Gastroenterological Surgery, Oslo University Hospital, Oslo, Norway
| | - Ronny Kristiansen
- The Intervention Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Department of Information Technology, Oslo University Hospital, Oslo, Norway
| | - Bjørn Edwin
- The Intervention Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Norway; Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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19
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Troisi RI, Pegoraro F, Giglio MC, Rompianesi G, Berardi G, Tomassini F, De Simone G, Aprea G, Montalti R, De Palma GD. Robotic approach to the liver: Open surgery in a closed abdomen or laparoscopic surgery with technical constraints? Surg Oncol 2019; 33:239-248. [PMID: 31759794 DOI: 10.1016/j.suronc.2019.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 10/24/2019] [Indexed: 02/07/2023]
Abstract
The application of the minimally invasive approach has shown to be safe and effective for liver surgery and is in constant growth. The indications for laparoscopic surgery are steadily increasing across the field. In the early 2000s, robotic surgery led to some additional improvements, such as tremor filtration, instrument stability, 3D view and more comfort for the surgeon. These techniques bring in some advantages compared to the traditional OLR: less blood loss, shorter admissions, fewer adhesions, and a faster postoperative recovery and better outcomes in case of further hepatectomy for tumor recurrence has been shown. Concerning which is the best minimally invasive approach between laparoscopic and robotic surgery, the evidence is still conflicting. The latter shows good potential, since the endo-wristed instruments work similarly to the surgeon's hands, even with an intact abdominal wall. However, the technique is still under development, burdened by important costs, and limited by the lack of some instruments available for the laparoscopic approach. The paucity of universally accepted and proven data, especially concerning long-term outcomes, hampers drawing univocal acceptance at present. Furthermore, the number of variables related both to the patient and the disease further complicates the decision leading to a treatment tailored to each patient with strict selection. This review aims to explore the main differences between laparoscopic and robotic surgery, focusing on indications, operative technique and current debated clinical issues in recent literature.
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Affiliation(s)
- Roberto Ivan Troisi
- Department of Clinical Medicine and Surgery, Interuniversity Center for Technological Innovation Interdepartmental Center for Robotic Surgery, Federico II University Naples, Italy; Department of Human Structure and Repair, Ghent University Faculty of Medicine, Belgium.
| | - Francesca Pegoraro
- Department of Clinical Medicine and Surgery, Interuniversity Center for Technological Innovation Interdepartmental Center for Robotic Surgery, Federico II University Naples, Italy
| | - Mariano Cesare Giglio
- Department of Clinical Medicine and Surgery, Interuniversity Center for Technological Innovation Interdepartmental Center for Robotic Surgery, Federico II University Naples, Italy
| | | | - Giammauro Berardi
- Department of Human Structure and Repair, Ghent University Faculty of Medicine, Belgium
| | - Federico Tomassini
- Department of Human Structure and Repair, Ghent University Faculty of Medicine, Belgium
| | - Giuseppe De Simone
- Department of Clinical Medicine and Surgery, Interuniversity Center for Technological Innovation Interdepartmental Center for Robotic Surgery, Federico II University Naples, Italy
| | - Giovanni Aprea
- Department of Clinical Medicine and Surgery, Interuniversity Center for Technological Innovation Interdepartmental Center for Robotic Surgery, Federico II University Naples, Italy
| | - Roberto Montalti
- Department of Public Health, Federico II University Naples, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, Interuniversity Center for Technological Innovation Interdepartmental Center for Robotic Surgery, Federico II University Naples, Italy
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Triantafyllidis I, Gayet B, Tsiakyroudi S, Tabchouri N, Beaussier M, Bennamoun M, Sarran A, Lefevre M, Louvet C, Fuks D. Perioperative and long-term outcomes of laparoscopic liver resections for non-colorectal liver metastases. Surg Endosc 2019; 34:3833-3844. [PMID: 31586246 DOI: 10.1007/s00464-019-07148-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/24/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Liver is a common metastatic site not only of colorectal but of non-colorectal neoplasms, as well. However, resection of non-colorectal liver metastases (NCRLMs) remains controversial. The aim of this retrospective study was to analyze the short- and long-term outcomes of patients undergoing laparoscopic liver resection (LLR) for NCRLMs. METHODS From a prospectively maintained database between 2000 and 2018, patients undergoing LLR for colorectal liver metastases (CRLMs) and NCRLMs were selected. Clinicopathologic, operative, short- and long-term outcome data were collected, analyzed, and compared among patients with CRLMs and NCRLMs. RESULTS The primary tumor was colorectal in 354 (82.1%), neuroendocrine in 21 (4.9%), and non-colorectal, non-neuroendocrine in the remaining 56 (13%) patients. Major postoperative morbidities were 12.7%, 19%, and 3.6%, respectively (p = 0.001), whereas the mortality was 0.6% for patients with CRLMs and zero for patients with NCRLMs. The rate of R1 surgical margin was comparable (p = 0.432) among groups. According to the survival analysis, 3- and 5-year recurrence-free survival (RFS) rates were 76.1% and 64.3% in the CRLM group, 57.1% and 42.3% in the neuroendocrine liver metastase (NELM) group, 33% and 20.8% in the non-colorectal, non-neuroendocrine liver metastase (NCRNNELM) group (p = 0.001), respectively. Three- and 5-year overall survival (OS) rates were 88.3% and 82.7% in the CRLM group, 85.7% and 70.6% in the NELM group, 71.4% and 52.9% in the NCRNNELM group (p = 0.001), respectively. In total, 113 out of 354 (31.9%) patients with CRLMs, 2 out of 21(9.5%) with NELMs, and 8 out of 56 (14.3%) patients with NCRNNELMs underwent repeat LLR for recurrent metastatic tumors. CONCLUSION LLR is safe and feasible in the context of a multimodal management where an aggressive surgical approach, necessitating even complex procedures for bilobar multifocal metastases and repeat hepatectomy for recurrences, is the mainstay and may be of benefit in the long-term survival, in selected patients with NCRNNELMs.
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Affiliation(s)
- Ioannis Triantafyllidis
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France.,Department of General Surgery, General Hospital of Veria, 59132, Veria, Greece
| | - Brice Gayet
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France
| | - Sofia Tsiakyroudi
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France
| | - Nicolas Tabchouri
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France
| | - Marc Beaussier
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France
| | - Mostefa Bennamoun
- Department of Oncology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Anthony Sarran
- Department of Radiology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Marine Lefevre
- Department of Pathology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Christophe Louvet
- Department of Oncology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
| | - David Fuks
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France.
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Robotic-assisted versus laparoscopic major liver resection: analysis of outcomes from a single center. HPB (Oxford) 2019; 21:906-911. [PMID: 30617001 DOI: 10.1016/j.hpb.2018.11.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/29/2018] [Accepted: 11/08/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Debate exists regarding outcomes of robot-assisted versus laparoscopic hepatectomy. We reviewed and analyzed major hepatectomies (resection of ≥3 Couinaud liver segments) performed in a minimally invasive fashion at a single institution. METHODS From 2011 to 2016, 473 major hepatectomy procedures were performed, of which 173 (37%) were performed in a minimally invasive fashion (57 robot-assisted and 116 laparoscopic). Patient demographics, operating statistics and outcomes were analyzed retrospectively. RESULTS Patients undergoing robot-assisted versus laparoscopic hepatectomy were older (58.1 vs 53.2 years, respectively; p = 0.030), admitted to ICU postoperatively less frequently (43.9% vs 61.2%, respectively; p = 0.043), and readmitted less often within 90 days (7.0% vs 28.5%, respectively; p = 0.001). No significant differences were identified in relation to complications, blood loss, operative times, and length of stay. CONCLUSION Robot-assisted is an effective alternative to laparoscopic major hepatectomy for resection of malignant and benign liver lesions. Robotic-assisted offers technical advantages compared to laparoscopic surgery including improved optic visualization, operative dexterity, and ease of dissection and suturing. This experience suggested that the robotic platform was associated with improved outcomes including reduced postoperative ICU admission and 90-day readmission.
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Laparoscopic Multiple Parenchyma-sparing Concomitant Liver Resections for Colorectal Liver Metastases. Surg Laparosc Endosc Percutan Tech 2019; 29:187-193. [DOI: 10.1097/sle.0000000000000606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Guilbaud T, Marchese U, Gayet B, Fuks D. Highlights, limitations and future challenges of laparoscopic resection for colorectal liver metastases. J Visc Surg 2019; 156:329-337. [PMID: 31101548 DOI: 10.1016/j.jviscsurg.2019.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The liver is the most common site for metastatic colorectal cancer (CRLM). Despite advances in oncologic treatment, resection of metastases is still the only curative option. Although laparoscopic surgery for primary colorectal cancer is well documented and widely used, laparoscopic surgery for liver metastases has developed more slowly. However, in spite of some difficulties, laparoscopic approach demonstrated strong advantages including minimal parietal damage, decreased morbidity (reduced blood loss and need for transfusion, fewer pulmonary complications), and simplification of subsequent iterative hepatectomy. Up to now, more than 9 000 laparoscopic procedures have been reported worldwide and long-term results in colorectal liver metastases seem comparable to the open approach. Only one recent randomized controlled trial has compared the laparoscopic and the open approach. The purpose of the present update was to identify the barriers limiting widespread acceptance of laparoscopic approach, the benefits and the limits of laparoscopic hepatectomies in CRLM.
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Affiliation(s)
- T Guilbaud
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 15, rue de l'école de médecine, 75005 Paris, France.
| | - U Marchese
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 15, rue de l'école de médecine, 75005 Paris, France
| | - B Gayet
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 15, rue de l'école de médecine, 75005 Paris, France
| | - D Fuks
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 15, rue de l'école de médecine, 75005 Paris, France
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Wang M, Zhou J, Zhang L, Zhao Y, Zhang N, Wang L, Zhu W, He X, Zhu H, Xu W, Pan Q, Mao A, Li Q, Wang L. Surgical treatment of ovarian cancer liver metastasis. Hepatobiliary Surg Nutr 2019; 8:129-137. [PMID: 31098360 DOI: 10.21037/hbsn.2018.12.06] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In addition to hepatocellular carcinoma, metastatic liver cancer (MLC) is another focus of hepatic surgeon. Good outcome of patients with liver metastasis (LM) from colorectal cancer or neuroendocrine tumor have been achieved. Ovarian cancer liver metastasis (OCLM) has its unique oncological characteristics and a variety of metastasis patterns, which brings a challenge to hepatic surgeon. Hepatic surgeons hold different views and techniques from gynecologists, which makes differences in the evaluation and treatment of the disease. We reviewed recent studies and, in combination with our own clinical experience, attempted to introduce the progress of surgical treatment of liver metastases from OC. In our experience, both preoperative imaging and surgical procedures are based on the assurance of R0 resection. R0 cytoreductive surgery (CRS) is the most favorable determinant for the prognosis of OC patients, and R0 liver resection (LR) is a component of R0 CRS. Gynecologists and hepatic surgeons should do their own preoperative and intraoperative evaluation for the extrahepatic and intrahepatic metastasis respectively. During the operation, regardless of the miliary nodules dissemination between the right hemidiaphragm and liver capsule, liver parenchymal infiltration (LPI) or liver parenchymal metastasis (LPM), 1-2 cm resection margin should be emphasized. For patients with liver portal lymph node metastasis (LPLNM), hepatic portal skeletonization should be performed, rather than portal lymph node dissection. The operation should be as radical as possible to ensure the patients to achieve good prognosis.
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Affiliation(s)
- Miao Wang
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jiamin Zhou
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Lyu Zhang
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Yiming Zhao
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Ning Zhang
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Longrong Wang
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Weiping Zhu
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xigan He
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Hongxu Zhu
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Weiqi Xu
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Qi Pan
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Anrong Mao
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Qinchuan Li
- Department of Cardiothoracic Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Lu Wang
- Department of Hepatic Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Open versus minimally invasive liver surgery for colorectal liver metastases (LapOpHuva): a prospective randomized controlled trial. Surg Endosc 2019; 33:3926-3936. [DOI: 10.1007/s00464-019-06679-0] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/17/2019] [Indexed: 12/11/2022]
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Laparoscopic Versus Open Resection for Colorectal Liver Metastases: The OSLO-COMET Randomized Controlled Trial. Ann Surg 2019; 267:199-207. [PMID: 28657937 DOI: 10.1097/sla.0000000000002353] [Citation(s) in RCA: 425] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To perform the first randomized controlled trial to compare laparoscopic and open liver resection. SUMMARY BACKGROUND DATA Laparoscopic liver resection is increasingly used for the surgical treatment of liver tumors. However, high-level evidence to conclude that laparoscopic liver resection is superior to open liver resection is lacking. METHODS Explanatory, assessor-blinded, single center, randomized superiority trial recruiting patients from Oslo University Hospital, Oslo, Norway from February 2012 to January 2016. A total of 280 patients with resectable liver metastases from colorectal cancer were randomly assigned to undergo laparoscopic (n = 133) or open (n = 147) parenchyma-sparing liver resection. The primary outcome was postoperative complications within 30 days (Accordion grade 2 or higher). Secondary outcomes included cost-effectiveness, postoperative hospital stay, blood loss, operation time, and resection margins. RESULTS The postoperative complication rate was 19% in the laparoscopic-surgery group and 31% in the open-surgery group (12 percentage points difference [95% confidence interval 1.67-21.8; P = 0.021]). The postoperative hospital stay was shorter for laparoscopic surgery (53 vs 96 hours, P < 0.001), whereas there were no differences in blood loss, operation time, and resection margins. Mortality at 90 days did not differ significantly from the laparoscopic group (0 patients) to the open group (1 patient). In a 4-month perspective, the costs were equal, whereas patients in the laparoscopic-surgery group gained 0.011 quality-adjusted life years compared to patients in the open-surgery group (P = 0.001). CONCLUSIONS In patients undergoing parenchyma-sparing liver resection for colorectal metastases, laparoscopic surgery was associated with significantly less postoperative complications compared to open surgery. Laparoscopic resection was cost-effective compared to open resection with a 67% probability. The rate of free resection margins was the same in both groups. Our results support the continued implementation of laparoscopic liver resection.
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Gaupset R, Nesgaard JM, Kazaryan AM, Stimec BV, Edwin B, Ignjatovic D. Introducing Anatomically Correct CT-Guided Laparoscopic Right Colectomy with D3 Anterior Posterior Extended Mesenterectomy: Initial Experience and Technical Pitfalls. J Laparoendosc Adv Surg Tech A 2018; 28:1174-1182. [DOI: 10.1089/lap.2018.0059] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Robin Gaupset
- Department of Digestive Surgery, Akershus University Hospital, Lørenskog, Norway
| | | | - Airazat M. Kazaryan
- Department of Digestive Surgery, Akershus University Hospital, Lørenskog, Norway
- Intervention Centre, Oslo University Hospital—Rikshospitalet, Oslo, Norway
- Department of Surgery, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
- Department of Faculty Surgery N 2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Bojan V. Stimec
- Anatomy Sector, Department of Cell Physiology and Metabolism, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Bjørn Edwin
- Intervention Centre, Oslo University Hospital—Rikshospitalet, Oslo, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Hepatopancreatobiliary Surgery, Oslo University Hospital—Rikshospitalet, Oslo, Norway
| | - Dejan Ignjatovic
- Department of Digestive Surgery, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
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Shim JR, Lee SD, Park HM, Lee EC, Park B, Han SS, Kim SH, Park SJ. Outcomes of liver resection in patients with colorectal liver metastases by laparoscopic or open surgery. Ann Hepatobiliary Pancreat Surg 2018; 22:223-230. [PMID: 30215044 PMCID: PMC6125264 DOI: 10.14701/ahbps.2018.22.3.223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/13/2018] [Accepted: 02/16/2018] [Indexed: 12/11/2022] Open
Abstract
Backgrounds/Aims Colorectal cancer is found with liver metastases about 20-25% due to characteristics of cancer itself. Approximately 20% of liver metastases are found to be resectable. The objective of this study was to evaluate short-term outcomes of patients who received liver resection with colorectal cancer operation in our center by laparoscopic surgery or open surgery. Methods Short-term outcomes of laparoscopic surgery of liver resection (LSLR) group who underwent liver resection for colorectal liver metastases (CRLM) at a single institute from 2013 to 2016 were compared to those of open surgery of liver resection (OSLR) group. Results A total of 123 patients underwent liver resection for CRLM, including 101 (82.1%) patients in the OSLR group and 22 (17.9%) patients in the LSLR group. There were significant differences in tumor characteristics between the two groups, including synchronous and metachronous (p=0.004), tumor number (p<0.001), and tumor margin (p=0.002). For postoperative outcomes, only the length of hospital stay (LOS) was significantly different between the two groups (8.5 days in LSLR vs. 11 days in OSLR, p<0.001). There was no significant difference in overall rate of postoperative complications between the two groups (9.1% in LSLR vs. 23.8% in OSLR, p=0.158). Conclusions There are no significant differences in postoperative outcomes between LSLR and OSLR except LOS, liver metastasis number, and resection margin. LSLR may be favorable for highly selected patients with CRLM.
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Affiliation(s)
- Jae-Ryong Shim
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Seung Duk Lee
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Hyung-Min Park
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Eung-Chang Lee
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Boram Park
- Biometrics Research Branch and Biostatistics Collaboration Unit, Research Institute, National Cancer Center, Goyang, Korea
| | - Sung-Sik Han
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Seong Hoon Kim
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Sang Jae Park
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
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Yue M, Li S, Yan G, Li C, Kang Z. Short- and long-term outcomes of laparoscopic hepatectomy for colorectal liver metastases in elderly patients. Cancer Manag Res 2018; 10:2581-2587. [PMID: 30127644 PMCID: PMC6089117 DOI: 10.2147/cmar.s156379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose This study aimed to evaluate the short- and long-term outcomes of laparoscopic hepatectomy (LH) for colorectal liver metastases (CRLM) in elderly patients. Patients and methods Between January 2009 and January 2016, LH was performed for 241 consecutive patients who were ≥60 years old and had CRLM. Based on their age at the LH, the patients were divided into an elderly group (≥70 years old, 78 patients) and a middle-aged group (60–69 years old, 163 patients). The short- and long-term outcomes were compared between the two groups. Results Compared to the middle-aged group, the elderly group had higher values for Charlson comorbidity index, proportion of preoperative chemotherapy, and American Society of Anesthesiologists score. No other significant differences were observed in the preoperative characteristics. The elderly group had a higher conversion rate, compared to the middle-aged group, although no significant differences were observed in the surgical procedures, surgical times, intraoperative blood losses, numbers and severities of postoperative 90-day complications, postoperative 90-day mortality rates, pathology results, and other short-term outcomes. Long-term follow-up revealed similar rates of recurrence, disease-free survival, and overall survival in the two groups. Multivariable analysis revealed that age did not independently predict overall survival or disease-free survival. Conclusion Similar short- and long-term outcomes were observed after LH for CRLM in elderly and middle-aged patients. Thus, advanced age is not a contraindication for LH treatment in this setting.
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Affiliation(s)
- Meng Yue
- Department of Surgery, First Hospital, JiLin University, Changchun, Jilin, People's Republic of China,
| | - Shiquan Li
- Department of Surgery, First Hospital, JiLin University, Changchun, Jilin, People's Republic of China,
| | - Guoqiang Yan
- Department of Surgery, First Hospital, JiLin University, Changchun, Jilin, People's Republic of China,
| | - Chenyao Li
- Department of Surgery, First Hospital, JiLin University, Changchun, Jilin, People's Republic of China,
| | - Zhenhua Kang
- Department of Surgery, First Hospital, JiLin University, Changchun, Jilin, People's Republic of China,
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Abstract
Since the development of systemic combination chemotherapy, postchemotherapy extirpation has been performed in selected patients mainly with locally advanced and/or initially unresectable bladder cancer, and, in very selected patients, surgical consolidation for visceral metastases has also been performed. The purpose of this article was to review and summarize the current evidence for the role of surgical consolidation in metastatic urothelial carcinoma.
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Liu X, Min X, Ma Z, He X, Du Z. Laparoscopic hepatectomy produces better outcomes for hepatolithiasis than open hepatectomy: An updated systematic review and meta-analysis. Int J Surg 2018; 51:151-163. [PMID: 29367038 DOI: 10.1016/j.ijsu.2018.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/13/2018] [Accepted: 01/16/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The present meta-analysis focused on comparing the efficacy and safety of laparoscopic hepatectomy (LH) versus open hepatectomy (OH) for hepatolithiasis. In detail, short-term outcomes including operative time, intraoperative blood loss, intraoperative blood transfusion, postoperative time to oral intake, length of hospital stay, overall postoperative complication rate, initial residual stone, and stone recurrence were analyzed systematically. METHODS PubMed, Embase, Web of Science and Cochrane Library were comprehensively searched for eligible studies up to Jun. 30. 2017. Bibliographic citation management software (EndNoteX7) was applied to literature management. Quality assessment was carried out according to the modification of the Newcastle-Ottawa Scale (NOS). The data were analyzed by Stata SE12.0 (StataCorp, College Station, TX). Sensitivity analysis was conducted by deleting single study step by step. Odds ratio (OR) were calculated for dichotomous data, and standard mean difference (SMD) with 95% confidence intervals (CI) was calculated continuous data. RESULTS = 0%; P = 0.22). In addition, our stratified analysis according to types of LH indicated that the laparoscopic approach still produced more favorable outcomes whatever patients underwent left lateral sectionectomy (LLS) or left hemihepatectomy (LHH). CONCLUSION The laparoscopic hepatectomy is a better alternative to open approach in patients with hepatolithiasis, providing less overall complication rate, shorter postoperative stay of hospital stay, less blood loss, and shorter time to oral intake. However, high-quality randomized controlled trials (RCTs) are badly needed to provide higher-level evidence due to unavoidable bias from non-randomized trials.
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Affiliation(s)
- Xiaohong Liu
- Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou 730030, China
| | - Xiaocui Min
- Department of Hepatology, The Second Hospital of Lanzhou University, 82 Cuiyingmen, Lanzhou 730030, China
| | - Zhen Ma
- Department of Hepatology, The Second Hospital of Lanzhou University, 82 Cuiyingmen, Lanzhou 730030, China
| | - Xiaodong He
- Lanzhou University, 199 West Donggang Road, Lanzhou, Gansu 730000, China
| | - Zhixing Du
- Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou 730030, China.
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Kumar RP, Barkhatov L, Edwin B, Albregtsen F, Elle OJ. Portal and Hepatic Vein Segmentation with Leak Restriction: A Pilot Study. IFMBE PROCEEDINGS 2018. [DOI: 10.1007/978-981-10-5122-7_206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Ziogas IA, Tsoulfas G. Advances and challenges in laparoscopic surgery in the management of hepatocellular carcinoma. World J Gastrointest Surg 2017; 9:233-245. [PMID: 29359029 PMCID: PMC5752958 DOI: 10.4240/wjgs.v9.i12.233] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/04/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma is the fifth most common malignancy and the third most common cause of cancer-related mortality worldwide. From the wide variety of treatment options, surgical resection and liver transplantation are the only therapeutic ones. However, due to shortage of liver grafts, surgical resection is the most common therapeutic modality implemented. Owing to rapid technological development, minimally invasive approaches have been incorporated in liver surgery. Liver laparoscopic resection has been evaluated in comparison to the open technique and has been shown to be superior because of the reported decrease in surgical incision length and trauma, blood loss, operating theatre time, postsurgical pain and complications, R0 resection, length of stay, time to recovery and oral intake. It has been reported that laparoscopic excision is a safe and feasible approach with near zero mortality and oncologic outcomes similar to open resection. Nevertheless, current indications include solid tumors in the periphery < 5 cm, especially in segments II through VI, while according to the consensus laparoscopic major hepatectomy should only be performed by surgeons with high expertise in laparoscopic and hepatobiliary surgery in tertiary centers. It is necessary for a surgeon to surpass the 60-cases learning curve observed in order to accomplish the desirable outcomes and preserve patient safety. In this review, our aim is to thoroughly describe the general principles and current status of laparoscopic liver resection for hepatocellular carcinoma, as well as future prospects.
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Affiliation(s)
- Ioannis A Ziogas
- Medical School, Aristotle University of Thessaloniki, Thessaloniki 54453, Greece
| | - Georgios Tsoulfas
- Associate Professor of Surgery, 1st Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54453, Greece
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Cheng Y, Zhang L, Li H, Wang L, Huang Y, Wu L, Zhang Y. Laparoscopic versus open liver resection for colorectal liver metastases: a systematic review. J Surg Res 2017; 220:234-246. [PMID: 29180186 DOI: 10.1016/j.jss.2017.05.110] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/18/2017] [Accepted: 05/25/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) has been proposed as a safe and feasible treatment option for colorectal liver metastasis (CRLM). However, the short-term and oncologic outcomes of LLR versus open liver resection (OLR) for CRLM have not been adequately assessed. Thus, we herein provide an updated systematic review comparing short-term and oncologic outcomes of CRLM patients undergoing LLR versus OLR. METHODS A systematic literature search was performed in the Pubmed, Embase, and Cochrane Library databases (until November 2, 2016) with a limitation to the publications in English. Quality assessment was performed based on the modification of the Newcastle-Ottawa Scale. Dichotomous data were calculated by odds ratio (OR), and continuous data were calculated by weighted mean difference (WMD) with 95% confidence intervals (CIs). RESULTS A total of 28 studies enrolling 4591 patients with CRLM were included. With respect to short-term outcomes, patients in LLR group showed significantly reduced blood loss (WMD: -143.64; 95% CI: -180.56 to -106.73; I2 = 86%; P < 0.001), lower operative transfusion requirement (OR: 0.40; 95% CI: 0.30-0.53; I2 = 0%; P < 0.001), shorter hospital stay (WMD: -2.47; 95% CI: -2.99 to -1.94; I2 = 82%; P < 0.001), reduced overall postoperative morbidity (OR: 0.53; 95% CI: 0.42-0.66; I2 = 38%; P < 0.001) and reduced severe morbidity (OR: 0.44; 95% CI: 0.32-0.60; I2 = 35%; P < 0.001). Regarding oncologic outcomes, there were no significant differences between the two surgical procedures in recurrence and 1-, 3-, and 5-overall survival and disease-free survival except for slightly higher R0 resection rate in LLR group was slightly higher than that of OLR group (OR: 1.43; 95% CI: 1.03-1.97; I2 = 37%; P = 0.03). CONCLUSIONS LLR should be the standard approach for selected patients with CRLM, and further research should focus on determining which patients would benefit most from LLR.
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Affiliation(s)
- Yusheng Cheng
- Department of Liver Transplantation, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lei Zhang
- Department of Biliary-Pancreatic Surgery, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huizi Li
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Guangdong, China
| | - Li Wang
- Department of Liver Transplantation, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yiming Huang
- Department of Liver Transplantation, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lihao Wu
- School of Computer Engineering, Gungzhou College of South China University of Technology, Guangzhou, China
| | - Yingcai Zhang
- Department of Liver Transplantation, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Aghayan DL, Pelanis E, Avdem Fretland Å, Kazaryan AM, Sahakyan MA, Røsok BI, Barkhatov L, Bjørnbeth BA, Jakob Elle O, Edwin B. Laparoscopic Parenchyma-sparing Liver Resection for Colorectal Metastases. Radiol Oncol 2017. [PMID: 29520204 PMCID: PMC5839080 DOI: 10.1515/raon-2017-0046] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Laparoscopic liver resection (LLR) of colorectal liver metastases (CLM) is increasingly performed in specialized centers. While there is a trend towards a parenchyma-sparing strategy in multimodal treatment for CLM, its role is yet unclear. In this study we present short- and long-term outcomes of laparoscopic parenchyma-sparing liver resection (LPSLR) at a single center. Patients and methods LLR were performed in 951 procedures between August 1998 and March 2017 at Oslo University Hospital, Oslo, Norway. Patients who primarily underwent LPSLR for CLM were included in the study. LPSLR was defined as non-anatomic hence the patients who underwent hemihepatectomy and sectionectomy were excluded. Perioperative and oncologic outcomes were analyzed. The Accordion classification was used to grade postoperative complications. The median follow-up was 40 months. Results 296 patients underwent primary LPSLR for CLM. A single specimen was resected in 204 cases, multiple resections were performed in 92 cases. 5 laparoscopic operations were converted to open. The median operative time was 134 minutes, blood loss was 200 ml and hospital stay was 3 days. There was no 90-day mortality in this study. The postoperative complication rate was 14.5%. 189 patients developed disease recurrence. Recurrence in the liver occurred in 146 patients (49%), of whom 85 patients underwent repeated surgical treatment (liver resection [n = 69], ablation [n = 14] and liver transplantation [n = 2]). Five-year overall survival was 48%, median overall survival was 56 months. Conclusions LPSLR of CLM can be performed safely with the good surgical and oncological results. The technique facilitates repeated surgical treatment, which may improve survival for patients with CLM.
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Affiliation(s)
- Davit L Aghayan
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Egidijus Pelanis
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Åsmund Avdem Fretland
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway.,Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Rikshospitalet, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Airazat M Kazaryan
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway.,Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Mushegh A Sahakyan
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bård I Røsok
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Rikshospitalet, Norway
| | - Leonid Barkhatov
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Atle Bjørnbeth
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Rikshospitalet, Norway
| | - Ole Jakob Elle
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Edwin
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway.,Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Rikshospitalet, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Aghayan DL, Kazaryan AM, Fretland ÅA, Sahakyan MA, Røsok BI, Bjørnbeth BA, Edwin B. Laparoscopic liver resection for metastatic melanoma. Surg Endosc 2017; 32:1470-1477. [PMID: 28916919 DOI: 10.1007/s00464-017-5834-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 08/20/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Stage IV metastatic melanoma carries a poor prognosis. In the case of melanoma liver metastasis (MLM), surgical resection may improve survival and represents a therapeutic option, with varying levels of success. Laparoscopic liver resection (LLR) for metastatic melanoma is poorly studied. The aim of this study was to analyze the outcomes of LLR in patients with MLM. MATERIALS AND METHODS Between April 2000 and August 2013, 11 (1 cutaneous, 9 ocular and 1 unknown primary) patients underwent LLR for MLM at Oslo University Hospital-Rikshospitalet and 13 procedures in total were carried out. Perioperative and oncologic outcomes were analyzed. Postoperative morbidity was classified using the Accordion classification. Kaplan-Meier method was used for survival analysis. RESULTS A total of 23 liver specimens were resected. The median operative time was 137 (65-470) min, while the median blood loss was less than 50 (<50-900) ml. No intraoperative unfavorable incidents and 30-day mortality occurred. Median follow-up was 33 (9-92) months. Ten patients (91%) developed recurrence within a median of 5 months (2-18 months) and two patients underwent repeat LLR for recurrent liver metastases. One-, three-, and five-year overall survival rates were 82, 45 and 9%, respectively. The median overall survival was 30 (9-92) months. CONCLUSION Perioperative morbidity and long-term survival after LLR for MLM seems to be comparable to open liver resection. Thus, LLR may be preferred over open liver resection due to the well-known advantages of laparoscopy, such as reduced pain and improved possibility for repeated resections.
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Affiliation(s)
- Davit L Aghayan
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway.
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Airazat M Kazaryan
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway
- Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Åsmund Avdem Fretland
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mushegh A Sahakyan
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bård I Røsok
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Bjørn Atle Bjørnbeth
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Bjørn Edwin
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Zhang XL, Liu RF, Zhang D, Zhang YS, Wang T. Laparoscopic versus open liver resection for colorectal liver metastases: A systematic review and meta-analysis of studies with propensity score-based analysis. Int J Surg 2017; 44:191-203. [DOI: 10.1016/j.ijsu.2017.05.073] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/29/2017] [Accepted: 05/31/2017] [Indexed: 02/08/2023]
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Abstract
Laparoscopic liver surgery has become an established procedure in the treatment of liver tumors. Due to its short-term and long-term advantages, the number of centers with experience in laparoscopic liver surgery has greatly increased in the last few years. The complexity of the interventions performed has nearly reached the level of open surgery. This article describes the importance of laparoscopic hepatic surgery and discusses the evidence for the procedure. In addition, the indications for the most frequently resected tumors, metastases of colorectal cancer and hepatocellular carcinoma are explained together with important aspects of certain tumor localizations. In addition, the authors explain the technical aspects of the surgical technique and give an overview on new developments. To illustrate the possibilities of laparoscopic liver surgery, a video of a complete laparoscopically performed associating liver partition and portal vein ligation (ALPPS) procedure is available as supplementary material.
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Affiliation(s)
- M R Schön
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, 76133, Karlsruhe, Deutschland.
| | - C Justinger
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, 76133, Karlsruhe, Deutschland
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Nomi T, Fuks D, Louvet C, Nakajima Y, Gayet B. Outcomes of Laparoscopic Liver Resection for Patients with Large Colorectal Liver Metastases: A Case-Matched Analysis. World J Surg 2017; 40:1702-8. [PMID: 27000874 DOI: 10.1007/s00268-016-3467-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite the expansion of laparoscopic approach in the treatment of liver tumors, limited data have been reported regarding large colorectal liver metastases (CRLMs). This study aimed at assessing the short- and long-term outcomes after laparoscopic liver resection (LLR) for large (≥5 cm) CRLMs. METHODS This was a case-matched study (1:2) comparing patients with large (group L; ≥5 cm) and small (group S; <5 cm) CRLMs using demographic, tumor, and surgical characteristics as matching variables. Postoperative outcomes and survival data were compared in the 2 groups. RESULTS Forty patients who underwent LLR for large CRLMs were matched with 80 patients with tumors <5 cm. Major hepatectomy was performed with 75.0 % of patients in Group L and 66.3 % in group S (p = 0.403). Operative time was 300 min in group L and 240 min in group S (p = 0.059). The postoperative mortality and overall morbidity rates were comparable in the 2 groups (p = 1.000 and 0.170, respectively). Postoperative major complication (Dindo-Clavien ≥3) was similar between the two groups (p = 0.072). R0 resection was achieved in 92.5 % in the group L and in 95.0 % in the group S (p = 1.000). The 5-year overall survival and recurrence-free survival were better for group S than for group L (47.3 vs. 35.4 %, p = 0.044 and 27.3 vs. 14.9 %, p = 0.042, respectively). Multivariate analysis identified positive surgical margins and synchronous presentation as prognostic factors. CONCLUSION Since LLR was performed safely with favorable oncological adequacy in selected patients with large CRLMs, tumor size should not modify the surgical approach.
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Affiliation(s)
- Takeo Nomi
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France.,Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8522, Japan
| | - David Fuks
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France
| | - Christophe Louvet
- Department of Oncology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Yoshiyuki Nakajima
- Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8522, Japan
| | - Brice Gayet
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France.
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40
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Yamashita S, Loyer E, Kang HC, Aloia TA, Chun YS, Mehran RJ, Eng C, Lee JE, Vauthey JN, Conrad C. Total Transthoracic Approach Facilitates Laparoscopic Hepatic Resection in Patients with Significant Prior Abdominal Surgery. Ann Surg Oncol 2016; 24:1376-1377. [PMID: 27878479 DOI: 10.1245/s10434-016-5685-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND While the oncologic safety of minimally invasive hepatectomy for colorectal liver metastases (CLM) has been demonstrated, lesions in the postero-superior segments may be challenging.1 - 3 For these lesions, a transthoracic approach may be particularly helpful, especially in patients with a hostile/reoperative abdomen or morbid obesity.4 , 5 PATIENT: A 43-year-old man with a body mass index of 36.0 who had undergone rectosigmoid resection for primary cancer 5 years ago recurred with a solitary liver metastasis in SVIII. He had previously undergone the following resections for metachronous CLM: (i) partial resections of SV/VIII and SII/III; (ii) ablation for SVII; and (iii) left hepatectomy, common bile duct resection, and choledochojejunostomy. Following four cycles of FOLFIRI/panitumumab with good response, the patient was considered for his fourth abdominal cancer intervention via a thoracoscopic approach. TECHNIQUE In a modified French position with left-lung ventilation, access to the right thoracic cavity was gained. Following thoracic adhesiolysis, transdiaphragmatic intraoperative ultrasonography (IOUS) was performed. To ensure optimal margins, IOUS-guided transthoracic hepatic resection with partial resection of the diaphragm was conducted. The diaphragm was reconstructed and a chest tube placed. Operative time was 247 min, with an estimated blood loss of 100 mL. Postoperative recovery was uneventful; pathology demonstrated no viable tumor, with the closest margin 5 mm from the necrotic area. CONCLUSION Transthoracic hepatic resection of SVIII can optimize the port-target axis while minimizing morbidity. A systematic approach that includes precise port positioning, non-traumatic intrathoracic adhesiolysis, and meticulous transdiaphragmatic IOUS-guided parenchymal transection can optimize outcomes.
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Affiliation(s)
- Suguru Yamashita
- Department of Surgical Oncology, Hepato-Pancreato-Biliary Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Evelyne Loyer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hyunseon C Kang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas A Aloia
- Department of Surgical Oncology, Hepato-Pancreato-Biliary Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yun Shin Chun
- Department of Surgical Oncology, Hepato-Pancreato-Biliary Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cathy Eng
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey E Lee
- Department of Surgical Oncology, Hepato-Pancreato-Biliary Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, Hepato-Pancreato-Biliary Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Claudius Conrad
- Department of Surgical Oncology, Hepato-Pancreato-Biliary Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Cherqui D, Wakabayashi G, Geller DA, Buell JF, Han HS, Soubrane O, O'Rourke N. The need for organization of laparoscopic liver resection. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:665-667. [PMID: 27770492 DOI: 10.1002/jhbp.401] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 12/23/2022]
Abstract
In this article, we present the rationale for creating a new society aiming at organizing laparoscopic liver surgery. It has been named International Laparoscopic Liver Society (ILLS). Its main mission is to facilitate the diffusion and education of laparoscopic liver resection for meaningful improvements in patient care. This will include organization of a biannual congress dedicated to laparoscopic liver resection, coordination of international registries, helping in the education of surgeons wishing to learn these techniques including travel grants, provide a website serving as a forum supporting collaboration between surgeons interested in the advancement of laparoscopic liver resection techniques (http://www.ills.global/). ILLS aims at working in collaboration with existing HPB societies.
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Affiliation(s)
- Daniel Cherqui
- Hepatobiliary Center, Paul Brousse Hospital - University Paris Sud, 14 Avenue Paul Vaillant Couturier, 94800, Villejuif, France
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Ageo, Saitama, Japan
| | - David A Geller
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joseph F Buell
- Department of Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Ho-Seong Han
- Department of Surgery, Seoul National University, College of Medicine, Seoul National Universtiy Bundang Hospital, Seongnam, South Korea
| | - Olivier Soubrane
- Department of HPB Surgery and Liver Transplant, Beaujon Hospital - University Denis Diderot, Paris, France
| | - Nicholas O'Rourke
- Department of Surgery, Royal Brisbane Hospital, Brisbane, Queensland, Australia
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Abe T, Ishizaki J, Kikuchi H, Minami K, Matsumoto R, Harabayashi T, Sazawa A, Mochizuki T, Chiba S, Akino T, Murakumo M, Miyajima N, Tsuchiya K, Maruyama S, Murai S, Shinohara N. Outcome of metastatic urothelial carcinoma treated by systemic chemotherapy: Prognostic factors based on real-world clinical practice in Japan. Urol Oncol 2016; 35:38.e1-38.e8. [PMID: 27693091 DOI: 10.1016/j.urolonc.2016.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/19/2016] [Accepted: 08/27/2016] [Indexed: 11/17/2022]
Abstract
AIM To clarify prognostic factors of metatstatic urothelial carcinoma treated by systemic chemotherapy in real-world clinical practice in the Japanese population. MATERIALS AND METHODS A total of 228 patients with metastatic urothelial carcinoma undergoing systemic chemotherapy between 2000 and 2013 were included in the present multi-institutional study. The gemcitabine plus cisplatin regimen was administered as first-line chemotherapy to 131 patients, whereas methotrexate, vinblastine, doxorubicin, and cisplatin or its modified regimen was given to 71 patients. Of the 228 patients, 119 received at least 2 different regimens and 22 underwent resection of metastases (metastasectomy). Multivariate survival analysis was performed using the Cox proportional hazards model. The characteristics included were age, sex, Eastern Cooperative Oncology Group performance status (PS), primary site, pathology of primary site, hemoglobin levels, lactate dehydrogenase levels, C-reactive protein levels, corrected calcium levels, estimated glomerular filtration rate levels, history of prior chemotherapy, metastatic sites, resection of primary site, number of metastatic organs, and metastasectomy. RESULTS The median overall survival (OS) time was 17 months. On multivariate analysis, female sex, good Eastern Cooperative Oncology Group PS at presentation, hemoglobin level≥10g/dl, and single organ metastasis were significant independent predictors of prolonged OS. For the survival effect of metastasectomy, the median OS time of the 22 patients with metastasectomy was 53 months, which was significantly longer when compared with patients not undergoing metastasectomy (15mo). After adjustment for the 4 aforementioned prognostic factors, metastasectomy still remained significant (hazard ratio: 0.364, P = 0.0008). CONCLUSIONS Female sex, more favorable PS at presentation, hemoglobin level>10g/dl, and single organ metastasis were favorable prognostic factors. In addition, metastasectomy was associated with long-term disease control.
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Affiliation(s)
- Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Junji Ishizaki
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Keita Minami
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Ataru Sazawa
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | | | - Satoshi Chiba
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | | | | | - Naoto Miyajima
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kunihiko Tsuchiya
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoru Maruyama
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Cipriani F, Rawashdeh M, Stanton L, Armstrong T, Takhar A, Pearce NW, Primrose J, Abu Hilal M. Propensity score-based analysis of outcomes of laparoscopic versus open liver resection for colorectal metastases. Br J Surg 2016; 103:1504-12. [PMID: 27484847 DOI: 10.1002/bjs.10211] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 03/25/2016] [Accepted: 04/13/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is a need for high-level evidence regarding the added value of laparoscopic (LLR) compared with open (OLR) liver resection. The aim of this study was to compare the surgical and oncological outcomes of patients with colorectal liver metastases (CRLM) undergoing LLR and OLR using propensity score matching to minimize bias. METHODS This was a single-centre retrospective study using a prospective database of patients undergoing liver resection for CRLM between August 2004 and April 2015. Co-variates selected for matching included: number and size of lesions, tumour location, extent and number of resections, phase of surgical experience, location and lymph node status of primary tumour, perioperative chemotherapy, unilobar or bilobar disease, synchronous or metachronous disease. Prematching and postmatching analyses were compared. Surgical and oncological outcomes were analysed. RESULTS Some 176 patients undergoing LLR and 191 having OLR were enrolled. After matching, 133 patients from each group were compared. At prematching analysis, patients in the LLR group showed a longer overall survival (OS) and higher R0 rate than those in the OLR group (P = 0·047 and P = 0·030 respectively). Postmatching analyses failed to confirm these results, showing similar OS and R0 rate between the LLR and OLR group (median OS: 55·2 versus 65·3 months respectively, hazard ratio 0·70 (95 per cent c.i. 0·42 to 1·05; P = 0·082); R0 rate: 92·5 versus 86·5 per cent, P = 0·186). The 5-year OS rate was 62·5 (95 per cent c.i. 45·5 to 71·5) per cent) for OLR and 64·3 (48·2 to 69·5) per cent for LLR. Longer duration of surgery, lower blood loss and morbidity, and shorter postoperative stay were found for LLR on postmatching analysis. CONCLUSION Propensity score matching showed that LLR for CRLM may provide R0 resection rates and long-term OS comparable to those for OLR, with lower blood loss and morbidity, and shorter postoperative hospital stay.
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Affiliation(s)
- F Cipriani
- Hepatobiliary and Pancreatic Surgical Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Rawashdeh
- Hepatobiliary and Pancreatic Surgical Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - L Stanton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - T Armstrong
- Hepatobiliary and Pancreatic Surgical Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Takhar
- Hepatobiliary and Pancreatic Surgical Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - N W Pearce
- Hepatobiliary and Pancreatic Surgical Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Primrose
- Hepatobiliary and Pancreatic Surgical Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Abu Hilal
- Hepatobiliary and Pancreatic Surgical Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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Liu F, Zhang J, Lei C, Wei Y, Li B. Feasibility of laparoscopic major hepatectomy for hepatic paragonimiasis: two case reports. Medicine (Baltimore) 2016; 95:e4939. [PMID: 27661049 PMCID: PMC5044919 DOI: 10.1097/md.0000000000004939] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Though accumulated evidence proved that laparoscopic major hepatectomy was technically feasible, it remains a challenging procedure and is limited to highly specialized centers. Paragonimiasis is one of the most important food-borne parasitic zoonoses caused by the trematode of the genus Paragonimus. Although hepatic paragonimiasis is rare, the previous studies had investigated hepatic paragonimiasis from different perspectives. However, the safety and feasibility of laparoscopic major hepatectomy for hepatic paragonimiasis have not yet been reported in the literature. METHODS We here present 2 cases of hepatic paragonimiasis at the deep parts of the liver with treatment by laparoscopic major hepatectomy. One case is a 32-year-old male patient who was admitted to the hospital due to upper abdominal discomfort without fever for 1 month. The clinical imaging revealed that there was a lesion about 5.9 × 3.7 cm in the boundary of right anterior lobe and right posterior lobe of the liver with rim enhancement and tract-like nonenhanced areas. The other one is a 62-year-old female patient who was referred to the hospital for 1 month of right upper abdominal pain and fever. The ultrasonography showed that there was a huge hypoechoic mass (about 10.8 × 6.3 cm) in middle lobe of the liver with tract-like nonenhanced areas. Both patients were from an endemic area of paragonimiasis and the proportion of eosinophil in the second case was increased. RESULTS The preoperative diagnosis of the first case was ambiguous and the hepatic paragonimiasis was considered for the second case. The first case underwent laparoscopic extended right posterior lobe hepatectomy and the other case underwent laparoscopic extended left hemihepatectomy. Both operations went very well and the operation times for the 2 cases were 275 minutes and 310 minutes, respectively. The 2 patients' postoperative recovery was smooth without major postoperative complications (such as, bleeding, bile leakage, and liver failure). Moreover, the 2 patients were discharged on the 6th day and 7th day after surgery, respectively. The postoperative histopathological examination manifested hepatic paragonimiasis in both patients. CONCLUSION This study suggests that the laparoscopic approach may be safe and technically feasible for hepatic paragonimiasis.
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Affiliation(s)
- Fei Liu
- Department of Liver Surgery & Liver Transplantation Center
| | | | - Chuanfen Lei
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Yonggang Wei
- Department of Liver Surgery & Liver Transplantation Center
- Correspondence: Yonggang Wei, Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu 610041, Sichuan Province, China (e-mail: ); Bo Li, Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu 610041, Sichuan Province, China (e-mail: )
| | - Bo Li
- Department of Liver Surgery & Liver Transplantation Center
- Correspondence: Yonggang Wei, Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu 610041, Sichuan Province, China (e-mail: ); Bo Li, Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu 610041, Sichuan Province, China (e-mail: )
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Barkhatov L, Fretland ÅA, Kazaryan AM, Røsok BI, Brudvik KW, Waage A, Bjørnbeth BA, Sahakyan MA, Edwin B. Validation of clinical risk scores for laparoscopic liver resections of colorectal liver metastases: A 10-year observed follow-up study. J Surg Oncol 2016; 114:757-763. [PMID: 27471127 DOI: 10.1002/jso.24391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 07/19/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of this study was to validate clinical risk scores in patients underwent laparoscopic resection of colorectal liver metastases (CLM) with 5 years follow-up or more, and assess 5- and 10-year actual survival in this group. METHODS A total of 516 laparoscopic liver resections were performed in 406 patients with CLM between February 1998 and September 2015. A follow-up of 5 and 10 years could be assessed in 144 and 29 patients, respectively. The Fong score, pre- and postoperative Basingstoke Predictive Index (BPI), Nordlinger score, and Iwatsuki score were validated. RESULTS Five- and ten-year cancer-related actual survival was 54% and 32%, respectively. The Fong score, pre- and postoperative BPI and the Nordlinger score divided patients into risk groups with significant difference in survival between the groups. However, predicted 5-year survival rates were lower than the actual 5-year survival (mean difference in 17%,13%, 20%, and 30%, respectively). CONCLUSION The Fong score, pre- and postoperative BPI and the Nordlinger score systems can be used to predict survival for laparoscopically operated patients in the era of multimodal-treatment after adjusting of survival rates. The actual five- and 10-year survival after laparoscopic resection of CLM is similar to results previously published for open liver resection. J. Surg. Oncol. 2016;114:757-763. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Leonid Barkhatov
- Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway. .,Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
| | - Åsmund A Fretland
- Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.,Department of Gastrointestinal and Hepatobiliary Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Airazat M Kazaryan
- Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway.,Surgical Department, Finnmark Hospital, Kirkenes, Norway
| | - Bård I Røsok
- Department of Gastrointestinal and Hepatobiliary Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Kristoffer W Brudvik
- Department of Gastrointestinal and Hepatobiliary Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Anne Waage
- Department of Gastrointestinal and Hepatobiliary Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Bjørn A Bjørnbeth
- Department of Gastrointestinal and Hepatobiliary Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Mushegh A Sahakyan
- Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Bjørn Edwin
- Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.,Department of Gastrointestinal and Hepatobiliary Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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Cherqui D. Evolution of laparoscopic liver resection. Br J Surg 2016; 103:1405-7. [DOI: 10.1002/bjs.10252] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/18/2016] [Indexed: 01/06/2023]
Abstract
Important development in hepatic surgery
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Affiliation(s)
- D Cherqui
- Hepatobiliary Centre, Paul Brousse Hospital – Université Paris Sud, Institut National de la Santé et de la Recherche Médicale U1193, 14 Avenue Paul Vaillant Couturier, 94800, Villejuif, France
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Villani V, Bohnen JD, Torabi R, Sabbatino F, Chang DC, Ferrone CR. "Idealized" vs. "True" learning curves: the case of laparoscopic liver resection. HPB (Oxford) 2016; 18:504-9. [PMID: 27317954 PMCID: PMC4913127 DOI: 10.1016/j.hpb.2016.03.610] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/24/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Learning curves are believed to resemble an "idealized" model, in which continuous improvement occurs until a plateau is reached. We hypothesized that this "idealized" model would not adequately describe the learning process for a complex surgical technique, specifically laparoscopic liver resection (LLR). METHODS We analyzed the first 150 LLRs performed by a surgeon with expertise in hepatobiliary/laparoscopic surgery but with no previous LLR experience. We divided the procedures performed in 5 consecutive groups of 30 procedures, then compared groups in terms of complications, operative time, length of stay, and estimated blood loss. RESULTS We observed an increase in operative complexity (3.3% major operations in Group 1 vs. 23.3% in Group 5, p = 0.05). Complications decreased from Group 1 to Group 2 (20%-3%), but increased again as more complex procedures were performed (3% in Group 2-13% in Group 5). Similar improvement/regression patterns were observed for operative time and EBL. DISCUSSION The "true" learning curve for LLR is more appropriately described as alternating periods of improvement and regression until mastery is achieved. Surgeons should understand the true learning curves of procedures they perform, recognizing and mitigating the increased risk they assume by taking on more complex procedures.
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Affiliation(s)
- Vincenzo Villani
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Jordan D Bohnen
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Radbeh Torabi
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Francesco Sabbatino
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Cristina R Ferrone
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States.
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Brown KM, Geller DA. What is the Learning Curve for Laparoscopic Major Hepatectomy? J Gastrointest Surg 2016; 20:1065-71. [PMID: 26956007 DOI: 10.1007/s11605-016-3100-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/01/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic liver resection is rapidly expanding with more than 9500 cases performed worldwide. While initial series reported non-anatomic resection of benign peripheral hepatic lesions, approximately 50-65 % of laparoscopic liver resections are now being done for malignant tumors, primarily hepatocellular carcinoma (HCC) or colorectal cancer liver metastases (mCRC). METHODS We performed a literature review of published studies evaluating outcomes of major laparoscopic liver resection, defined as three or more Couinaud segments. RESULTS Initial fears of adverse oncologic outcomes or tumor seeding have not been demonstrated, and dozens of studies have reported comparable 5-year disease-free and overall survival between laparoscopic and open resection of HCC or mCRC in case-cohort and propensity score-matched analyses. Increased experience has led to laparoscopic anatomic liver resections including laparoscopic major hepatectomy. A steep learning curve of 45-60 cases is evident for laparoscopic hepatic resection. CONCLUSION Laparoscopic major hepatectomy is safe and effective in the treatment of benign and malignant liver tumors when performed in specialized centers with dedicated teams. Comparable to other complex laparoscopic surgeries, laparoscopic major hepatectomy has a learning curve of 45-60 cases.
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Affiliation(s)
- Kimberly M Brown
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - David A Geller
- Liver Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA. .,UPMC Liver Cancer Center, UPMC Montefiore, 3459 Fifth Ave, 7 South, Pittsburgh, PA, 15213-2582, USA.
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Cheek SM, Sucandy I, Tsung A, Marsh JW, Geller DA. Evidence supporting laparoscopic major hepatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:257-9. [PMID: 27040039 DOI: 10.1002/jhbp.338] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Laparoscopic liver resection (LLR) has been increasing in frequency with over 9,000 cases done worldwide. Benefits of laparoscopic resection include less blood loss, smaller incisions, decreased postoperative morbidity, and shorter length of stay compared to open liver resection. With increased experience, several centers have reported series of laparoscopic major hepatectomy, although this represents only about 25% of total LLR performed. Evidence is accumulating to support laparoscopic major hepatectomy with the understanding that there is a steep learning curve, and surgeons should begin with minor LLR before moving on to laparoscopic major hepatectomy. Controversy still remains concerning indications, techniques, learning curve, risks, and long-term cancer outcomes with laparoscopic major hepatectomy.
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Affiliation(s)
- Susannah M Cheek
- Division of Hepatobiliary and Pancreatic Surgery, UPMC Liver Cancer Center, University of Pittsburgh, 3459 Fifth Avenue, UPMC Montefiore, 7 South, Pittsburgh, PA 15213-2582, USA.
| | - Iswanto Sucandy
- Division of Hepatobiliary and Pancreatic Surgery, UPMC Liver Cancer Center, University of Pittsburgh, 3459 Fifth Avenue, UPMC Montefiore, 7 South, Pittsburgh, PA 15213-2582, USA
| | - Allan Tsung
- Division of Hepatobiliary and Pancreatic Surgery, UPMC Liver Cancer Center, University of Pittsburgh, 3459 Fifth Avenue, UPMC Montefiore, 7 South, Pittsburgh, PA 15213-2582, USA
| | - J Wallis Marsh
- Division of Hepatobiliary and Pancreatic Surgery, UPMC Liver Cancer Center, University of Pittsburgh, 3459 Fifth Avenue, UPMC Montefiore, 7 South, Pittsburgh, PA 15213-2582, USA
| | - David A Geller
- Division of Hepatobiliary and Pancreatic Surgery, UPMC Liver Cancer Center, University of Pittsburgh, 3459 Fifth Avenue, UPMC Montefiore, 7 South, Pittsburgh, PA 15213-2582, USA
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Abstract
One of the most relevant technologic advancements in laparoscopic liver resection (LLR) is owing to the improved ability to safely secure and divide vascular and biliary structures and the liver parenchyma by the use of endostaplers. We compared, retrospectively, 35 LLRs with the Tri-Staple technology versus 57 LLRs without, during a 14-month period. Colorectal liver metastases were overall the main indication for LLR. Neither major hepatectomy nor left lateral sectionectomy was done in the nonstapled group. Mean surgical time and blood loss were similar, whereas the tumor number and size were significantly larger in the stapled group (P ≤ 0.01). The conversion rate was 0% and 3.5% (n = 2); and the morbidity rate was 9% (n = 3) and 12% (n = 7), respectively, in the stapled and nonstapled group (P = 0.8). No overall 3-month mortality was recorded. Endo GIA Reloads with Tri-Staple technology allow a proper division of the intrahepatic vessels and biliary structure. These devices in LLRs are safe and feasible, allowing major hepatectomy and complex cases as 2-staged procedures and laparoscopic living donor liver resections.
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