Comparison Between Minimally Invasive Right Anterior and Right Posterior Sectionectomy vs Right Hepatectomy: An International Multicenter Propensity Score-Matched and Coarsened-Exact-Matched Analysis of 1,100 Patients

Laparoscopic liver resection or enucleation for giant hepatic hemangioma: how to choose?

BACKGROUND

Laparoscopic treatment has been increasingly adopted for giant hepatic hemangioma (HH), but the role of liver resection or enucleation remains uncertain. The aim of this study is to compare the laparoscopic resection (LR) with laparoscopic enucleation (LE) for HH, and to provide evidence on how to choose the most suitable approach for HH.

METHODS

A retrospective analysis of HH patients underwent laparoscopic treatment between March 2015 and August 2022 was performed. Perioperative outcomes were compared based on the surgical approaches, and risk factors for increased blood loss was calculated by logistic regression analysis.

RESULTS

A total of 127 patients in LR group and 287 patients in LE group were enrolled in this study. The median blood loss (300 vs. 200 mL, P < 0.001) was higher in LE group than that in LR group. Independent risk factors for blood loss higher than 400 mL were tumor size ≥ 10 cm, tumor adjacent to major vessels, tumor occupying right liver or caudate lobe, and the portal phase enhancement ratio (PER) ≥ 38.9%, respectively. Subgroup analysis showed that LR was associated with less blood loss (155 vs. 400 mL, P < 0.001) than LE procedure in patients with high PER value. Both LR and LE approaches exhibited similar perioperative outcomes in patients with low PER value.

CONCLUSIONS

Laparoscopic treatment for HH could be feasibly and safely performed by both LE and LR. For patients with PER higher than 38.9%, the LR approach is recommended.

Robotic sectionectomy versus robotic hemihepatectomy for anatomic liver resection: a comparative analysis of perioperative outcomes

Sectionectomy is a parenchma-sparing alternative to (extended) right or left hemihepatectomy. However, the effectiveness and safety of robotic sectionectomy (RS) versus robotic (extended) hemihepatectomy (RH) for the treatment of liver tumors remains unclear. We reviewed our prospective database for consecutive patients who had undergone robotic hepatectomies between March 2021 and July 2023 and included all patients with RS and RH. Demographic data, perioperative outcomes and long-term outcomes were analyzed and compared between both groups. Thirty patients met our inclusion criteria, of whom 16 patients underwent RS as opposed to 14 patients who underwent RH. Baseline characteristics were comparable between the study groups. The duration of Pringle maneuver was significantly longer in the RS group, while the remaining operative details were comparable. There were no significant differences in posthepatectomy outcomes between the study groups. All patients had negative resection margins. RS is a safe and effective parenchyma-sparing treatment modality.

Laparoscopic Anatomic Bi-segmentectomy (S5 and S6) Using Takasaki's Approach and Indocyanine Green Fluorescence Navigation

BACKGROUND

To date, most laparoscopic anatomic bi-segmentectomy practices have been performed vertically, such as the resection of segments 6 and 7, segments 5 and 8, and segments 2 and 3;1-3 however, transversal hepatectomy may be more appropriate for certain lesions that are located in a specific area.4,5 Herein, we present a video of a pure laparoscopic anatomic bi-segmentectomy (S5 and S6) using Takasaki's approach and indocyanine green fluorescence navigation.

METHOD

A 58-year-old male with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) was admitted to our institution. The preoperative abdominal computed tomography (CT) scan showed a 5 × 4 cm tumor located between segments 5 and 6. Right hepatectomy was not adopted because of severe cirrhosis and portal hypertension. Therefore, laparoscopic anatomic bi-segmentectomy (5 and 6) was planned. After cholecystectomy, G5 and G6 were dissected and ligated using Takasaki's Glissonean pedicle approach.6 The ischemic line then appeared on the liver surface. An intraoperative ultrasound was used to confirm that the tumor was within the ischemic line. Afterwards, intraoperative fluorescence navigation (negative stained) was performed to detect the demarcation line and guide the transection of liver parenchymal.

RESULTS

The operative time was 225 min and the estimated blood loss was 150 mL. The total Pringle time was 75 min. The postoperative course was uneventful and the patient was discharged on postoperative day 8. Pathology confirmed the diagnosis of HCC and the surgical margin was negative.

CONCLUSIONS

Laparoscopic anatomic bi-segmentectomy (S5 and S6) is technically feasible and safe, which may be a beneficial alternative to formal right hepatectomy in some cases.

Clinical Outcomes of Robotic Resection for Perihilar Cholangiocarcinoma: A First, Multicenter, Trans-Atlantic, Expert-Center, Collaborative Study

INTRODUCTION

Perihilar cholangiocarcinoma is a difficult cancer to treat with frequent vascular invasion, local recurrence, and poor survival. Due to the need for biliary anastomosis and potential vascular resection, the standard approach is an open operation. Suboptimal outcomes after laparoscopic resection had been sporadically reported by high-volume centers. In this first, Trans-Atlantic, multicenter study, we report our outcomes of robotic resection for perihilar cholangiocarcinoma. This is the largest study of its kind in the Western hemisphere.

METHODS

Between 2016 and 2023, we prospectively followed patients undergoing robotic resection for perihilar cholangiocarcinoma at three, high-volume, robotic, liver-surgery centers.

RESULTS

Thirty-eight patients underwent perihilar cholangiocarcinoma utilizing the robotic technique; Klatskin type-3 was the most common. The median age was 72 years, and 82% of the patients underwent preoperative biliary drainage. Median operative time was 481 minutes with a median estimated blood loss of 200 mL. The number of harvested lymph nodes was seven, and 11 (28%) patients yielded positive lymph nodes. Three patients required vascular reconstruction; 18% of patients had >1 biliary anastomosis. R0 resection margins were achieved in 82% of patients. Clavien-Dindo Grade ≥3 complications were seen in 16% of patients. The length of stay was 6 days. Five patients had an unplanned readmission within 30 days. One patient died within 30 days. With a median follow-up of 15 months, 68% of patients are alive without disease, 13% recurred, and 19% died.

CONCLUSIONS

Application of the robotic platform for perihilar cholangiocarcinoma is safe and feasible with acceptable short-term clinical and oncological outcomes.