1
|
Ma D, Wang W, Wang J, Zhang T, Jiang Z, Du G, Yang J, Zhang X, Qin G, Jin B. Laparoscopic versus open surgery for hilar cholangiocarcinoma: a retrospective cohort study on short-term and long-term outcomes. Surg Endosc 2022; 36:3721-3731. [PMID: 34398281 DOI: 10.1007/s00464-021-08686-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/07/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Laparoscopic surgery (LS) for hilar cholangiocarcinoma (HCCa) remains under development, and its feasibility and safety remain controversial. This study therefore evaluated the outcomes of this technique and compared them to those of open surgery (OS). METHODS In total, 149 patients underwent surgical resection for HCCa at our center between February 2017 and September 2020. After screening and propensity score matching, 47 OS group patients and 20 LS group patients remained, and their baseline characteristics, pathologic findings, surgical outcomes, and long-term outcomes were compared. RESULT The baseline characteristics and pathologic findings were comparable between the two groups. The mean incision length was longer in the OS group than in the LS group (21.0 cm vs. 13.2 cm, P < 0.001). No significant differences were observed in the other surgical outcomes between the two groups. Regarding long-term outcomes, the overall survival rate and disease-free survival rate of the OS group were significantly higher than those of the LS group (P = 0.0057, P = 0.043). However, the two groups had significantly different follow-up times (19.2 months vs. 14.7 months, P = 0.041). CONCLUSION LS for HCCa is technically achievable, and our study revealed that it is equivalent to OS in terms of short-term outcomes but was poorer in terms of long-term outcomes.
Collapse
Affiliation(s)
- Delin Ma
- Department of Surgery, School of Medicine, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China.,Department of Organ Transplantation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Wei Wang
- Department of Surgery, School of Medicine, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Jianlei Wang
- Department of Organ Transplantation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Tingxiao Zhang
- Department of Organ Transplantation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Zhaochen Jiang
- Department of Organ Transplantation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Gang Du
- Department of Organ Transplantation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Jinhuan Yang
- Department of Organ Transplantation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Xiqing Zhang
- School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Guanjun Qin
- Department of Hepatobiliary Surgery, Xuchang Central Hospital Affiliated to Henan University of Science and Technology, Xuchang, 461000, Henan, China
| | - Bin Jin
- Department of Organ Transplantation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China.
| |
Collapse
|
2
|
Laparoscopic Minor Liver Resections for Hepatocellular Carcinoma in the Posterosuperior Segments Using the Rubber Band Technique. World J Surg 2022; 46:1151-1160. [PMID: 35147738 DOI: 10.1007/s00268-022-06468-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Although laparoscopic minor liver resections (LLR) of posterosuperior (PS) segments are technically challenging, several expert centers are increasingly performing this procedure. In the present study, we introduced novel techniques, including the rubber band traction method and positional changes, and compared surgical outcomes of LLR for hepatocellular carcinoma (HCC) located in PS segments with open minor liver resection (OLR). METHODS From January 2008 to August 2019, 113 patients underwent laparoscopic (n = 55) or open (n = 58) minor liver resections for single small HCCs (<5 cm) located in PS segments. Propensity score matching in a 1:1 ratio was conducted to minimize preoperative selection bias, and surgical outcomes were compared between the two groups. RESULTS There was no intraoperative mortality or reoperation in either group. One conversion to open surgery was necessary due to severe post-operative adhesions. The matched LLR group compared to OLR had significantly shorter operative time (215.16 vs. 251.41 min, P = 0.025), lesser blood loss (218.11 vs. 358.92 mL, P = 0.046), lower complication rate (8.1% vs. 29.7%, P = 0.018), and shorter hospital stay (7.03 vs. 11.78 days, P = 0.001). Intraoperative transfusion, R0 resection, resection margin, 5-year disease-free survival and 5-year overall survival were comparable. CONCLUSION Our standardized LLR provided improved short-term outcomes and similar long-term outcomes, when compared with OLR. With advanced techniques and accumulated surgical experience, LLR can be the first option for HCC in PS segments at expert centers.
Collapse
|
3
|
Ziogas IA, Evangeliou AP, Mylonas KS, Athanasiadis DI, Cherouveim P, Geller DA, Schulick RD, Alexopoulos SP, Tsoulfas G. Economic analysis of open versus laparoscopic versus robotic hepatectomy: a systematic review and meta-analysis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:585-604. [PMID: 33740153 DOI: 10.1007/s10198-021-01277-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 02/25/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Following the publication of reports from landmark international consensuses (Louisville 2008 and Morioka 2014), minimally invasive hepatectomy became widely accepted as a legitimate alternative to open surgery. We aimed to compare the operative, hospitalization, and total economic costs of open (OLR) vs. laparoscopic (LLR) vs. robotic liver resection (RLR). METHODS We performed a systematic literature review (end-of-search date: July 3, 2020) according to the PRISMA statement. Random-effects meta-analyses were conducted. Quality assessment was performed with the Cochrane Risk of Bias tool for randomized controlled trials, and the Newcastle-Ottawa Scale for non-randomized studies. RESULTS Thirty-eight studies reporting on 3847 patients (1783 OLR; 1674 LLR; 390 RLR) were included. The operative costs of LLR were significantly higher than those of OLR, while subgroup analysis also showed higher operative costs in the LLR group for major hepatectomy, but no statistically significant difference for minor hepatectomy. Hospitalization costs were significantly lower in the LLR group, with subgroup analyses indicating lower costs for LLR in both major and minor hepatectomy series. No statistically significant difference was observed regarding total costs between LLR and OLR both overall and on subgroup analyses in either major or minor hepatectomy series. Meta-analyses showed higher operative, hospitalization, and total costs for RLR vs. LLR, but no statistically significant difference regarding total costs for RLR vs. OLR. CONCLUSION LLR's higher operative costs are offset by lower hospitalization costs compared to OLR leading to no statistically significant difference in total costs, while RLR appears to be a more expensive alternative approach.
Collapse
Affiliation(s)
- Ioannis A Ziogas
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, 1313 21st Avenue South, Nashville, TN, 37232-4753, USA. .,Surgery Working Group, Society of Junior Doctors, Athens, Greece.
| | - Alexandros P Evangeliou
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,Aristotle University of Thessaloníki School of Medicine, Thessaloníki, Greece
| | - Konstantinos S Mylonas
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Dimitrios I Athanasiadis
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - David A Geller
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Richard D Schulick
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sophoclis P Alexopoulos
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, 1313 21st Avenue South, Nashville, TN, 37232-4753, USA
| | - Georgios Tsoulfas
- Department of Transplant Surgery, Aristotle University of Thessaloniki School of Medicine, Thessaloníki, Greece
| |
Collapse
|
4
|
Zhao Z, Yin Z, Pan L, Li C, Hu M, Lau WY, Liu R. Robotic hepatic resection in postero-superior region of liver. Updates Surg 2020; 73:1007-1014. [PMID: 33030697 DOI: 10.1007/s13304-020-00895-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Laparoscopic hepatectomy in the posterosuperior hepatic region is technically challenging and demanding. However, minimally invasive procedures carried out using the Da Vinci robot provide potential advantages in complex hepatectomy. This study reported the experience of a single center on robotic hepatectomy in the posterosuperior hepatic region. METHODS This retrospective study evaluated the general characteristics and perioperative outcomes of consecutive patients who underwent robotic hepatectomy in the posterosuperior hepatic region at our center from March 2015 to January 2020. RESULTS For 100 patients who were included into this study, 53 underwent anatomical segmentectomy or subsegmentectomy and 47 non-anatomical partial hepatectomy. There was no conversion to laparotomy. The R0 resection rate was 100%. The following perioperative outcomes were compared between patients who underwent anatomical segmentectomy/subsegmentectomy versus those who underwent non-anatomical partial hepatectomy: operation times of 160 versus 126 min, intraoperative blood losses of 100 versus 50 ml, intraoperative blood transfusion rates of 7.54% versus 4.26%, postoperative lengths of hospital stay of 5 versus 4 days, Clavien-Dindo Grade I-II complications rates of 15.09% versus 19.15%, Grade III-V complications rates of 3.77% versus 0%, bile leakage rates of 4% versus 7% and pleural effusion rates of also 4% versus 7%, respectively. CONCLUSION The results indicated the safety and feasibility of robotic anatomical and non-anatomical liver resections in the posterosuperior hepatic region. The robotic transabdominal approach is an option for hepatectomy in the posterosuperior hepatic region.
Collapse
Affiliation(s)
- Zhiming Zhao
- The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhuzeng Yin
- The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lichao Pan
- The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chenggang Li
- The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Minggen Hu
- The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
| | - Rong Liu
- The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
| |
Collapse
|
5
|
Rubinkiewicz M, Mizera M, Małczak P, Gajewska N, Torbicz G, Su M, Karcz K, Pędziwiatr M. Laparoscopic versus open liver resections of posterolateral liver segments - a systematic review and meta-analysis. Wideochir Inne Tech Maloinwazyjne 2020; 15:395-402. [PMID: 32904535 PMCID: PMC7457196 DOI: 10.5114/wiitm.2020.94268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 02/23/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Laparoscopic resection has become an accepted approach to liver tumour surgery. However, it is considered difficult, especially in unfavourably located lesions. AIM To compare the outcomes of laparoscopic (LLR) and open liver resection (OLR) of posterolateral segments. MATERIAL AND METHODS We searched the PubMed, EMBASE, and Scopus databases from inception to 30 September 2019. Full text articles and conference abstracts were included for further analysis. This review follows the PRISMA guidelines. RESULTS From 643 articles, 15 studies (N = 1196 patients) were included in the meta-analysis. All of them were non-randomised. Our findings showed that LLR had significantly lowered overall morbidity compared to OLR (MD = 0.66; 95% CI: 0.51-0.86; p = 0.002). Length of hospital stay (MD = 2.48; 95% CI: -3.87, -1.08; p < 0.001) was also shorter in the LLR group. Operative time (MD = 55.65; 95% CI: 24.14-87.16; p < 0.001) was significantly shorter in the OLR group. In terms of blood loss, major complications, R0 resection rates, and resection margin, there were no significant differences. CONCLUSIONS Our meta-analysis showed that the laparoscopic approach to resections of posterolateral liver segments is beneficial. However, the results are based on non-randomised trials, and further research is needed to fully establish their clinical application.
Collapse
Affiliation(s)
- Mateusz Rubinkiewicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Mizera
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Natalia Gajewska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Grzegorz Torbicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michael Su
- Faculty of Medicine, Jagiellonian University, Krakow, Poland
| | - Konrad Karcz
- Clinic of General, Visceral and Transplantation Surgery, Ludwig Maximilian University, Munich, Germany
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
6
|
Cao J, Li WD, Zhou R, Shang CZ, Zhang L, Zhang HW, Lau WY, Chen YJ. Totally laparoscopic anatomic S7 segmentectomy using in situ split along the right intersectoral and intersegmental planes. Surg Endosc 2020; 35:174-181. [PMID: 31993823 DOI: 10.1007/s00464-020-07376-z] [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: 09/13/2019] [Accepted: 01/06/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND The traditional open or laparoscopic segmentectomy of liver segment 7 (S7) requires exposing and controlling the root of the right hepatic vein(RHV)after full mobilization and lifting up of the right liver before liver transection. This approach violates the "no-touch" principle for malignant tumors, and makes laparoscopic resection technically challenging. So reports on isolated totally laparoscopic anatomic S7 segmentectomy have rarely been reported. This study describes our experience in laparoscopic anatomic S7 segmentectomy using in situ split along the right intersectoral and intersegmental planes of the liver. To our knowledge, this is the first description of this novel approach. METHODS From September 2017 to May 2019, patients who underwent laparoscopic anatomic S7 segmentectomy for hepatocellular carcinoma at the HPB Surgery Department, Sun Yat-Sen Memorial Hospital entered into this retrospective study. This in situ split approach was designed using main vessels as the plane markers of right intersectoral and intersegmental planes, along which liver transection was carried out. There was no need to mobilize the right liver and control the root of RHV. RESULTS There were 9 women and 15 men. The average diameter of the tumors on preoperative CT/MR was 3.4 cm (range 2-6 cm). All the procedures were successfully carried out laparoscopically. There was no perioperative death. The average operative time was 216.5 min (range 180-310 min). The average blood loss was 320 ml (range 120-620 ml). Pathological study showed all the operations to be R0 resections. CONCLUSION Laparoscopic anatomic S7 segmentectomy using the in situ split approach resulted in R0 liver resection in all our patients with primary liver cancer. The operation was technically feasible and it provided a better view and increased maneuverability in the cramped operative space compared with the traditional open/laparoscopic approach. The approach also better complies with the "no-touch" principle for malignant tumors. Its long-term oncological outcomes require further studies.
Collapse
Affiliation(s)
- Jun Cao
- Department of Hepatobiliopancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Yanjiangxi road 107#, Guangzhou, China
| | - Wen-da Li
- Department of Hepatobiliopancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Yanjiangxi road 107#, Guangzhou, China
| | - Rui Zhou
- Department of Hepatobiliopancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Yanjiangxi road 107#, Guangzhou, China
| | - Chang-Zhen Shang
- Department of Hepatobiliopancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Yanjiangxi road 107#, Guangzhou, China
| | - Lei Zhang
- Department of Hepatobiliopancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Yanjiangxi road 107#, Guangzhou, China
| | - Hong-Wei Zhang
- Department of Hepatobiliopancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Yanjiangxi road 107#, Guangzhou, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
| | - Ya-Jin Chen
- Department of Hepatobiliopancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Yanjiangxi road 107#, Guangzhou, China.
| |
Collapse
|
7
|
Comparison of laparoscopic versus open liver resection for lesions located in posterosuperior segments: a meta-analysis of short-term and oncological outcomes. Surg Endosc 2019; 33:3910-3918. [PMID: 31451921 DOI: 10.1007/s00464-019-07071-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/15/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of laparoscopic liver resection (LLR) for lesions located in posterosuperior (PS) segments remains a matter of development to be further assessed. This systematic review aims to compare the short-term and oncological outcomes between laparoscopic and open liver resection (OLR) in PS lesions. METHODS EMBASE, MEDLINE and Cochrane Library were searched from date of inception to June 2019. This meta-analysis was performed using the STATA 12.0 statistical software. Standardized mean differences (SMDs), odds ratios (ORs) and hazard ratios (HRs) were calculated for continuous variables, dichotomous variables and long-term variables, respectively, with 95% confidence intervals (CIs). RESULTS A total of 788 patients from eight studies were identified for the final analysis, with 371 patients in the LLR group and 417 in the OLR group. Although the operation time (SMD 0.22; 95% CI 0.08-0.36; P = 0.003) was longer whereas overall complication rate (OR 0.50; 95% CI 0.36-0.70; P < 0.001) and postoperative hospital stay (SMD - 0.45; 95% CI - 0.59 to - 0.30; P = 0.003) were lower in the LLR group than in the OLR group, no significant differences in blood loss (SMD - 0.14; 95% CI - 0.28 to 0.00; P = 0.054), transfusion rate (OR 0.92; 95% CI 0.56-1.54; P = 0.764), major complication rate (OR 0.63; 95% CI 0.38-1.05; P = 0.079), R0 resection rate (OR 1.04; 95% CI 0.55-1.96; P = 0.902), and disease-free survival (DFS) for hepatocellular carcinoma (HCC) (HR 1.43; 95% CI 0.95-2.17), DFS for colorectal liver metastases (HR 1.05; 95% CI 0.61-1.81), overall survival for HCC (HR 1.00; 95% CI 0.43-2.30) were noted between the groups. CONCLUSION LLR is technically feasible and safe without compromising long-term oncological outcomes for selected patients with lesions in the PS segments of the liver.
Collapse
|