Case‐matched analysis of totally laparoscopic versus open liver resection for HCC: Short and middle term results

Aldrighetti, Luca; Guzzetti, Eleonora; Pulitanò, Carlo; Cipriani, Federica; Catena, Marco; Paganelli, Michele; Ferla, Gianfranco

doi:10.1002/jso.21541

Cited by 135 publications

(96 citation statements)

References 15 publications

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“…This extensive review of the literature in combination with our clinical experiences indicate that pure laparo- [34] NA NA NA NA NA NA 0/25 1/33 Aldrighetti et al [35] 0/16 1/16 NA NA 6.3 ± 1.7 9.0 ± 3.8 0/16 0/16 Tranchart et al [36] 3/42 11/42 0/36 4/53 6.7 ± 5.9 9.6 ± 3.4 1/42 1/42 Kim et al [37] of their operating time and blood loss was 288 min and 50 mL. From these experiences, we propose the following advantages of laparoscopic hepatectomy for HCC patients: (1) advantageous for repeat procedures: Repeat pure laparoscopic hepatectomy (and combined treatments) for patients with liver cirrhosis and multicentric/ metachronous HCCs was feasible and safe.…”

Section: Introductionmentioning

confidence: 69%

“…The safety and feasibility of the laparoscopic approach and its short-term benefits for HCC patients with chronic liver dysfunction have been demonstrated by several series [21][22][23][24][25][26][27][28][29][30][31] . To date, several studies have investigated the major differences between laparoscopic hepatectomy and open hepatectomy (Tables 1 and 2) [32][33][34][35][36][37][38][39] . Favorable short-term results, including fewer incidences of ascites and liver failure, and shorter postoperative hospital stays, correlate with the laparoscopic procedure.…”

Section: Laparoscopic Hepatectomy For Hcc Patients: An Overviewmentioning

confidence: 99%

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Pure laparoscopic hepatectomy for hepatocellular carcinoma with chronic liver disease

Morise¹,

Kawabe

Kawase

et al. 2013

WJH

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Pure laparoscopic hepatectomy is a less invasive procedure than conventional open hepatectomy for the resection of hepatic lesions. Increases in experiences with the technique, in combination with advances in technology, have promoted the popularity of pure laparoscopic hepatectomy. However, indications for usage and potential contraindications of the procedure remain unresolved. The characteristics and specific advantages of the procedure, especially for hepatocellular carcinoma (HCC) patients with chronic liver diseases, are reviewed and discussed in this paper. For cirrhotic patients with liver tumors, pure laparoscopic hepatectomy minimizes destruction of the collateral blood and lymphatic flow from laparotomy and mobilization, and mesenchymal injury from compression. Therefore, pure laparoscopic hepatectomy has the specific advantage of minimal postoperative ascites production that leads to lowering the risk of disturbance in water or electrolyte balance and hypoproteinemia. It minimizes complications that routinely trigger postoperative serious liver failure. Under adequate patient positioning and port arrangement, the partial resection of the liver in the area of subphrenic space, peri-inferior vena cava area or next to the attachment of retro-peritoneum is facilitated in pure laparoscopic surgery by providing good vision and manipulation in the small operative field. Furthermore, the features of reduced post-operative adhesion, good vision, and manipulation within the small area between the adhesions make this procedure safer in the context of repeat hepatectomy procedures. These improved features are especially advantageous for patients with liver cirrhosis and multicentric and/or metachronous HCCs. Key words: Laparoscopic hepatectomy; Hepatocellular carcinoma; Liver cirrhosis; Chronic liver disease; Liver Tumor; Liver resection; Repeat hepatectomy; Bridging therapy to transplantation; Ascites; Postoperative liver failure Core tip: For cirrhotic patients with liver tumor, pure laparoscopic hepatectomy minimizes destruction of the collateral blood/lymphatic flow from laparotomy and mobilization, and has advantage of minimal postoperative ascites. It restrains the complications, which trigger the postoperative liver failure. The partial resection in the area of subphrenic space, peri-inferior vena cava area or next to the attachment of retro-peritoneum is facilitated with good vision and manipulation in the small operative field. Furthermore, repeat pure laparoscopic hepatectomy for patients with multicentric/ metachronous hepatocellular carcinomas was feasible and safe with the advantages of less post-operative adhesion and good vision and manipulation between the adhesions.

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Section: Introductionmentioning

confidence: 69%

Section: Laparoscopic Hepatectomy For Hcc Patients: An Overviewmentioning

confidence: 99%

Pure laparoscopic hepatectomy for hepatocellular carcinoma with chronic liver disease

Morise¹,

Kawabe

Kawase

et al. 2013

WJH

View full text Add to dashboard Cite

show abstract

“…However, in selected patients who undergo surgery by experienced hands, one of the most important advantage of the laparoscopic approach is the potential improvement in terms of blood loss and transfusion rates [4][5][6][7][8][9][10][11]. This specific improvement of the laparoscopic approach in comparison to open surgery was particularly underlined by the experts at the Morioka consensus.…”

Section: Discussionmentioning

confidence: 99%

“…), bleeding control during laparoscopic liver resection (LLR) is a liverspecific improvement, which has been underlined by many experts [4][5][6][7][8][9][10][11]. Several studies aimed to elucidate the factors responsible for reduced blood loss during laparoscopic liver surgery.…”

Section: Introductionmentioning

confidence: 99%

Bleeding control during laparoscopic liver resection: a review of literature

Tranchart

O’Rourke

Dam

et al. 2015

J Hepatobiliary Pancreat Sci

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Despite the established advantages of laparoscopy, bleeding control during laparoscopic liver resection (LLR) is a liver-specific improvement. The 2nd International Consensus Conference on Laparoscopic Liver Resection was held in October 2014 at Morioka, Japan. One of the most capital questions was: What is essential in bleeding control during LLR? In order to correctly address this question, we conducted a comprehensive review of the literature. Essential points based on personal experience of the expert panel are also discussed. A total of 54 publications were identified. Based on this analysis, the working group built these recommendations: (1) a pneumoperitoneum of 10-14 mmHg should be used as it allows a good control of the bleeding without significant modifications of hemodynamics; (2) a low central venous pressure (<5 mmHg) should be used; (3) laparoscopy facilitates inflow and outflow control; and (4) surgeons should be experienced with the use of all surgical devices for liver transection and should master laparoscopic suture before starting LLR. Precoagulation with radiofrequency can be useful, particularly in cases of atypical resection. These recommendations are mostly based on experts' opinions and on B or C quality of evidence grade studies. More prospective data are required to confirm these results.

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“…[2][3][4][5][6] While early experience was focused on benign diagnoses, this approach is now used for many hepatic malignancies. [7][8][9][10][11] It is accepted that minimally invasive liver resections have similar perioperative morbidity, mortality and long-term survival as open resections, 5,9 and some studies have shown that laparoscopic liver resection is associated with less blood loss, shorter hospital stay and comparable longterm survival. 12 However, the procedures are technically demand ing, and advanced skills in laparoscopy are required.…”

mentioning

confidence: 99%

Starting a new laparoscopic liver surgery program: initial experience and improved efficiency

Liang

Jayaraman

2015

Can J Surg

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Background: Owing to the anatomic complexity of the liver and the risk of hemorrhage, most liver resections are still performed using an open procedure. We evaluated the outcomes of introducing a laparoscopic liver program to a community teaching hospital. Methods:We retrospectively reviewed laparoscopic liver resections performed between August 2010 and July 2013 at St. Joseph's Health Centre in Toronto. The primary outcomes were mortality, major morbidity and negative margins. Secondary outcomes included other perioperative outcomes. We used nonparametric tests to compare the outcomes during the first (group A) and second (group B) halves of the study period.Results: Group A included 19 patients and group B had 25 patients; 9 and 4 patients, respectively, had major resections. Group A had the only death due to liver failure. There was no difference in major complications (10.6% v. 16%) or length of stay (4.5 v. 4.6 d) between the groups. One patient in group B had a positive margin. There was a significant decrease in duration of surgery (from 237 to 170 min, p = 0.007), with a trend toward shorter duration for major resections (from 318 to 238 min, p = 0.07). Furthermore, more procedures were performed for malignancy in group B than group A (36.8% v. 84.0%, p = 0.001). Conclusion:Laparoscopic liver resection can be safely introduced into a Canadian community teaching hospital. Average duration of surgery decreased by 67 minutes despite a 2-fold increase in the number of cases performed for malignancy. Résultats : Le groupe A incluait 19 patients et le groupe B, 25 patients; 9 et 4 patients, respectivement, ont subi des résections majeures. Le groupe A a enregistré le seul décès attribuable à une insuffisance hépatique. On n'a noté aucune différence quant aux complications majeures (10,6 % c. 16 %) ou quant à la durée de l'hospitalisation (4,5 c. 4,6 jours) entre les groupes. Un patient du groupe B a présenté une marge positive. On a noté en général une diminution significative de la durée de l'intervention (de 237 à 170 minutes, p = 0,007); dans le cas des résections majeures, on a noté une tendance à la diminution de la durée de l'intervention (de 318 à 238 mi nutes, p = 0,07). En outre, un plus grand nombre d'interventions ont été effectuées pour des cas de cancer dans le groupe B que dans le groupe A (36,8 % c. 84,0 %, p = 0,001). Conclusion :La résection hépatique laparoscopique peut être pratiquée de manière sécuritaire dans un hôpital d'enseignement communautaire canadien. La durée moyenne des interventions a diminué de 67 minutes, malgré une augmentation du double du nombre d'interventions effectuées pour des cas de cancer.

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Case‐matched analysis of totally laparoscopic versus open liver resection for HCC: Short and middle term results

Cited by 135 publications

References 15 publications

Pure laparoscopic hepatectomy for hepatocellular carcinoma with chronic liver disease

Pure laparoscopic hepatectomy for hepatocellular carcinoma with chronic liver disease

Bleeding control during laparoscopic liver resection: a review of literature

Starting a new laparoscopic liver surgery program: initial experience and improved efficiency

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