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Kirimker EO, Ozgu K, Ersoz S, Tuzuner A. Outcomes of Laparoscopic Versus Open Liver Resection: A Case-control Study With Propensity Score Matching. Surg Laparosc Endosc Percutan Tech 2023; 33:375-381. [PMID: 37311047 DOI: 10.1097/sle.0000000000001190] [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: 11/03/2022] [Accepted: 04/26/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND This study aimed to evaluate the perioperative outcomes of patients with benign and malignant liver lesions scheduled for laparoscopic and open surgery using a propensity score-matched approach to analyze additional cofactors influencing outcomes. PATIENTS AND METHODS In this study, we retrospectively reviewed 270 patients who underwent laparoscopic or open liver resection at our institute between October 2016 and November 2021. Patients were divided into open and laparoscopic liver resection groups and compared according to the intention to treat principle. In the purification process for the nonrandom nature of the study, a matching analysis was performed at a 1:1 case-control ratio. The PS model included selected data on body mass index, additional data on the American Society of Anesthesiology score, cirrhosis, lesion <2 cm from the hilum, lesion <2 cm from the hepatic vein or inferior vena cava, and type of neoadjuvant chemotherapy. RESULTS The operation time and 30- and 90-day mortality rates were similar between the groups. The average length of hospital stay was 11 days in the open surgery group and 9 days in the laparoscopic surgery group after matching ( P =0.011). The 30-day morbidity rate was statistically different between the groups before and after matching, favoring the laparoscopic group ( P =0.001 and 0.006, respectively). After the propensity score-matched approch, the open group's Pringle time was shorter than that of the laparoscopic group. The total operative time was longer in the laparoscopic than in the open surgery group. This did not change after matching (300 vs. 240 min). CONCLUSIONS Laparoscopic surgery is a feasible and safe treatment option for patients with liver tumors, with promising results in terms of morbidity and hospital stay.
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Salehi O, Kazakova V, Vega EA, Kutlu OC, Alarcon SV, Freeman R, Kozyreva O, Conrad C. Selection criteria for minimally invasive resection of intrahepatic cholangiocarcinoma-a word of caution: a propensity score matched analysis using the national cancer database. Surg Endosc 2021; 36:5382-5391. [PMID: 34750709 DOI: 10.1007/s00464-021-08842-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND While minimally invasive liver resection (MILR) vs. open approach (OLR) has been shown to be safe, the perioperative and oncologic safety for intrahepatic cholangiocarcinoma (ICC) specifically, necessitating often complex hepatectomy and extended lymphadenectomy, remains ill-defined. METHODS The National Cancer Database was queried for patients with ICC undergoing liver resection from 2010 to 2016. After 1:1 Propensity Score Matching (PSM), Kruskal-Wallis and χ2 tests were applied to compare short-term outcomes. Kaplan-Meier survival analyses and Cox multivariable regression were performed. RESULTS 988 patients met inclusion criteria: 140 (14.2%) MILR and 848 (85.8%) OLR resulting in 115 patients MILR and OLR after 1:1 PSM with c-index of 0.733. MILR had lower unplanned 30-day readmission [OR 0.075, P = 0.014] and positive margin rates [OR 0.361, P = 0.011] and shorter hospital length of stay (LOS) [OR 0.941, P = 0.026], but worse lymph node yield [1.52 vs 2.07, P = 0.001]. No difference was found for 30/90-day mortality. Moreover, multivariate analysis revealed that MILR was associated with poorer overall survival compared to OLR [HR 2.454, P = 0.001]. Subgroup analysis revealed that survival differences from approach were dependent on major hepatectomy, tumor size > 4 cm, or negative margins. CONCLUSION MILR vs. OLR is associated with worse lymphadenectomy and survival in patients with ICC greater than 4 cm requiring major hepatectomy. Hence, MILR major hepatectomy for ICC should only be approached selectively and if surgeons are able to perform an appropriate lymphadenectomy.
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Affiliation(s)
- Omid Salehi
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA.,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA
| | - Vera Kazakova
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA
| | - Eduardo A Vega
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA.,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA
| | - Onur C Kutlu
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA
| | - Sylvia V Alarcon
- Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA.,Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, MA, USA
| | - Richard Freeman
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA.,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA
| | - Olga Kozyreva
- Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA.,Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, MA, USA
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA. .,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA.
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Torterolli F, Watanabe RK, Tabushi FI, Peixoto IL, Nassif PAN, Tefilli NL, Rocha SL, Malafaia O. BAR, SOFT AND DRI POST-HEPATIC TRANSPLANTATION: WHAT IS THE BEST FOR SURVIVAL ANALYSIS? ACTA ACUST UNITED AC 2021; 34:e1576. [PMID: 34133523 PMCID: PMC8195467 DOI: 10.1590/0102-672020210001e1576] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/29/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Liver transplantation is the treatment of choice for patients with terminal liver disease. The Balance of Risk Score (BAR), Survival Outcomes Following Liver Transplantation (SOFT) and Donor Risk Index (DRI) scores are predictive systems for post-transplant survival. AIM To evaluate the most accurate score and the best cutoff point for each predictor in the brazilian population. METHOD Retrospective cross-sectional study of 177 patients. Data on the recipient, donor and transplant were analyzed and the prognostic scores BAR, SOFT and DRI were calculated for each transplant. To determine the BAR and SOFT cutoff points associated with death in three months, ROC curves were adjusted. Results : The best cutoff point for BAR was 9 points with an area under the ROC curve=0.69 and for SOFT it was 12 points with an area under the ROC curve=0.73. The DRI score did not discriminate survival (p = 0.139). CONCLUSION The SOFT score proved to be better than BAR for survival analysis post-hepatic transplantation and the DRI was not effective.
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Affiliation(s)
| | | | - Fernando Issamu Tabushi
- Postgraduete Course in Principles of Surgery, Mackenzie Evangelical College of Paraná.,Mackenzie Evangelical College of Paraná, Curitiba, PR, Brazil
| | | | - Paulo Afonso Nunes Nassif
- Postgraduete Course in Principles of Surgery, Mackenzie Evangelical College of Paraná.,Mackenzie Evangelical College of Paraná, Curitiba, PR, Brazil
| | | | | | - Osvaldo Malafaia
- Postgraduete Course in Principles of Surgery, Mackenzie Evangelical College of Paraná.,Mackenzie Evangelical College of Paraná, Curitiba, PR, Brazil
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SteinbrÜck K, Fernandes R, D'Oliveira M, Capelli R, Cano R, Vasconcelos H, Basilio L, Enne M. EXTERNAL PRINGLE MANEUVER IN LAPAROSCOPIC LIVER RESECTION: A SAFE, CHEAP AND REPRODUCIBLE WAY TO PERFORM IT. ACTA ACUST UNITED AC 2021; 33:e1555. [PMID: 33503115 PMCID: PMC7836078 DOI: 10.1590/0102-672020200004e1555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Tourniquet for right hepatectomy tightened and secured with forceps (arrow). Laparoscopic liver resection is performed worldwide. Hemorrhage is a major complication and bleeding control during hepatotomy is an important concern. Pringle maneuver remains the standard inflow occlusion technique. AIM Describe an extracorporeal, efficient, fast, cheap and reproducible way to execute the Pringle maneuver in laparoscopic surgery, using a chest tube. METHODS From January 2014 to March 2020, our team performed 398 hepatectomies, 63 by laparoscopy. We systematically encircle the hepatoduodenal ligament and prepare a tourniquet to perform Pringle maneuver. In laparoscopy, we use a 24 Fr chest tube, which is inserted in the abdominal cavity through a small incision. We thread the cotton tape through the tube, pulling it out through the external end, outside the abdomen. To perform the tourniquet, we just need to push the tube as we hold the tape, clamping both with one forceps. RESULTS The 24 Fr chest tube is firm and works perfectly to occlude blood inflow as the cotton band is tightened. It has an internal diameter of 5,5 mm, sufficient for a laparoscopic grasper pass through it to catch the cotton band, and an external diameter of 8 mm, which allows to be inserted in the abdomen through a tiny incision. The cost of this tube and the cotton band is less than US$ 1. No complications related to the method were identified in our patients. CONCLUSIONS The extracorporeal Pringle maneuver presented here is a safe, cheap and reproducible method, that can be used for bleeding control in laparoscopic liver surgery.
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Affiliation(s)
- Klaus SteinbrÜck
- Hepatobiliary Multidisciplinary Group, Rio de Janeiro, RJ, Brazil.,Bonsucesso Federal Hospital - Health Ministry, Hepatobiliary Surgery, Rio de Janeiro, RJ, Brazil
| | - Reinaldo Fernandes
- Hepatobiliary Multidisciplinary Group, Rio de Janeiro, RJ, Brazil.,Bonsucesso Federal Hospital - Health Ministry, Hepatobiliary Surgery, Rio de Janeiro, RJ, Brazil
| | | | - Rafaela Capelli
- Hepatobiliary Multidisciplinary Group, Rio de Janeiro, RJ, Brazil
| | - Renato Cano
- Hepatobiliary Multidisciplinary Group, Rio de Janeiro, RJ, Brazil.,Ipanema Federal Hospital - Health Ministry, Hepatobiliary Surgery, Rio de Janeiro, RJ, Brazil
| | - Hanna Vasconcelos
- Hepatobiliary Multidisciplinary Group, Rio de Janeiro, RJ, Brazil.,Ipanema Federal Hospital - Health Ministry, Hepatobiliary Surgery, Rio de Janeiro, RJ, Brazil
| | - Luiza Basilio
- Hepatobiliary Multidisciplinary Group, Rio de Janeiro, RJ, Brazil.,Ipanema Federal Hospital - Health Ministry, Hepatobiliary Surgery, Rio de Janeiro, RJ, Brazil
| | - Marcelo Enne
- Hepatobiliary Multidisciplinary Group, Rio de Janeiro, RJ, Brazil.,Ipanema Federal Hospital - Health Ministry, Hepatobiliary Surgery, Rio de Janeiro, RJ, Brazil
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HERMAN P, FONSECA GM, KRUGER JAP, JEISMANN VB, COELHO FF. RESSECÇÃO LAPAROSCÓPICA DE TUMORES BENIGNOS DO FÍGADO: POSIÇÃO ATUAL. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2021; 34:e1641. [PMID: 35107503 PMCID: PMC8846456 DOI: 10.1590/0102-672020210002e1641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/25/2021] [Indexed: 11/22/2022]
Abstract
The main indications of the use of laparoscopic liver surgery (LLS), in the early
days, were benign liver lesions. As LLS became more popular, indications for
malignant diseases outnumbered those for benign ones. This study aims to rule
out the indications and results of LLS for the treatment of benign liver
tumors.
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