Efficacy and safety of laparoscopic hepatectomy for hepatocellular carcinoma comorbid with cirrhosis

Inoué, Yoshihiro; Yokohama, Keisuke; Ohama, Hideko; Tsuchimoto, Yusuke; Terazawa, Tetsuji; Asai, Akira; Fukunishi, Shinya; Okuda, Jun; Higuchi, Kazuhide; Uchiyama, Kazuhisa

doi:10.5114/pg.2020.99039

Cited by 5 publications

(6 citation statements)

References 30 publications

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“…We also demonstrated that SII ≤ 431.7 on POD 3 was associated with shorter hospital stay, which indicates this index may be practical in predicting the faster postoperative recovery. Interestingly, similar with published study, most of matched patients in our retrospective cohort were diagnosed with rHCC accompanied with liver cirrhosis, indicating that LRH can be a safe and efficient procedure for cirrhotic patients ( 27 , 28 ). However, the operation time, blood transfusion rate, and incidence of postoperative complications in the LRH group were similar to those in the ORH group.…”

Section: Discussionsupporting

confidence: 89%

Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score–Matched Study and Meta-Analysis

Chen

Gao

et al. 2021

Front. Oncol.

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Background: It remains unclear whether the short-term benefits of laparoscopic repeat hepatectomy (LRH) accrue to patients with recurrent liver tumors. The present study aimed to report our own center's experience and perform a meta-analysis to evaluate the safety and feasibility of LRH in comparison with open repeat hepatectomy (ORH) for treating recurrent liver tumors.Patients and Methods: A propensity score–matched study was performed including 426 patients receiving LRH or ORH for recurrent hepatocellular carcinoma between January 2017 and December 2018. Surgical outcomes and perioperative inflammation-based markers, including monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune–inflammation index were collected from medical records and analyzed. Additionally, a systematic literature review was performed to identify relevant studies in PubMed, EMBASE, Web of Science, and Cochrane library databases up to October 1, 2020. Information including patient demographics, pathologic characteristics, and short-term outcomes was extracted and analyzed using random- or fixed-effects models.Results: Of 68 LRHs, 57 were matched with an ORH finally. Our study demonstrated that LRH was significantly associated with less intraoperative blood loss (50 vs. 100 mL; P < 0.001), lower rate of hepatic inflow occlusion (10.52 vs. 33.3%; P = 0.003), and shorter postoperative hospital stay (5 vs. 6 days; P = 0.001) after 1:1 propensity score matching. The operation time, rate of blood transfusion, and postoperative complications were similar between the two groups. Moreover, all four inflammation-based markers were significantly lower in LRH group on postoperative day 1. In the meta-analysis, a total of 12 studies comprising 1,315 patients receiving repeat hepatectomy met the selection criteria. Similar to our own study, the meta-analysis showed shorter hospital stay [standard mean difference (SMD) = −0.51, 95% confidence interval (CI) = −0.79 to −0.22, P < 0.001], less intraoperative blood loss (SMD = −0.79, 95% CI = −1.11 to −0.47, P < 0.001), and lower rate of major postoperative complications [odds ratio (OR) = 0.35, 95% CI = 0.19–0.66, P = 0.001] in the LRH group. There was no difference in the field of overall postoperative complication and operation time between LRH and ORH groups.Conclusion: Compared with ORH, LRH results in relatively better surgical outcomes and faster postoperative recovery. It could be considered a feasible and effective option for the treatment of recurrent liver tumors.

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Section: Discussionsupporting

confidence: 89%

Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score–Matched Study and Meta-Analysis

Chen

Gao

et al. 2021

Front. Oncol.

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“…The detailed laparoscopic technique routinely used in our department has been described in previous reports [1,2,4,5]. With abdominal ultrasonography, we assessed the tumour for the presence of abdominal wall adhesions, after which the first trocar was placed at a site that was deemed to be free of adhesions.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…Multimodality treatment for liver tumours is currently available owing to developments in hepatectomy and other therapies [1,2]. However, the clinical course often requires multiple surgeries.…”

Section: Introductionmentioning

confidence: 99%

Does repeat laparoscopic hepatectomy without extracorporeal Pringle manoeuvre worsen treatment outcomes?

Inoué¹,

Suzuki²,

Ota³

et al. 2022

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Introduction:The Pringle manoeuvre is used in most hospitals to counteract intraoperative haemorrhage in laparoscopic hepatectomy by occluding the flow of blood to the liver. However, in laparoscopic repeat hepatectomy (LRH), outcomes of previous surgery and the influence of other factors frequently make it difficult to occlude the inflow of blood.Aim: To discuss the value of inflow occlusion during LRH and provide tips for its performance.Material and methods: Sixty-three patients who underwent LRH with or without the Pringle manoeuvre were analysed retrospectively. We investigated the efficacy and safety of the Pringle manoeuvre in LRH. Student's t and χ 2 tests, Mann-Whitney's U test, Wilcoxon's signed-rank test, and Fisher's exact test were used in the statistical analysis.Results: Nineteen patients underwent LRH with the Pringle manoeuvre, and 44 patients underwent LHR without the Pringle manoeuvre. After propensity score matching, there were no significant differences in terms of operative time, estimated blood loss, and postoperative complication rate (p = 0.973, 0.120, and not applicable, respectively). However, the rate of conversion to open repeat hepatectomy (ORH) was significantly lower in the Pringle manoeuvre group (p = 0.034). In many cases, the cause of conversion to ORH was the non-use of inflow occlusion and the resulting inability to control intraoperative haemorrhage. Laboratory data collected after surgery showed no significant difference between the 2 groups regardless of whether blood flow was occluded or not.Conclusions: LRH with the Pringle manoeuvre can be performed safely using various surgical devices. However, it is often challenging to perform the Pringle manoeuvre in patients with a history of cholecystectomy or segment 5 resection of the liver, and caution is required.

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“…Тем не менее основным методом лечения при ГЦК остается резекция печени. Показания к резекции в настоящее время расширяют за счет внедрения современных эндовидеохирургических технологий, прецизионного планирования объемов и тщательной бескровной техники оперирования, а также методов интраоперационной диагностики и навигации при выполнении экономных вмешательств у больных циррозом печени (ЦП) [3][4][5][6][7].…”

Section: вве де ниеunclassified

Minimally invasive surgery for hepatocellular carcinoma

et al. 2022

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Aim. To evaluate outcomes of laparoscopic liver resections in patients with hepatocellular carcinoma (HCC).Materials and methods. 40 endovideosurgical liver resections were performed in patients with HCC in the period of 2011–2021. Concomitant cirrhosis was detected in 36 cases (90%).Results. The average duration of surgery was 158.1 ± 78.6 min. The duration of anatomical lobar resections appeared to be the longest – 230 min. The average volume of intraoperative blood loss was 259.5 ± 260.5 ml, which almost excluded blood transfusions. The duration of hospitalization comprised 11.2 ± 2.3 days. One-year survival was achieved in 95% of cases, two-year – in 81%, three-year – in 64%.Conclusion. Laparoscopic liver resections in hepatocellular carcinoma prove to be safe and provide satisfactory surgical and oncological outcomes.

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Efficacy and safety of laparoscopic hepatectomy for hepatocellular carcinoma comorbid with cirrhosis

Cited by 5 publications

References 30 publications

Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score–Matched Study and Meta-Analysis

Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score–Matched Study and Meta-Analysis

Does repeat laparoscopic hepatectomy without extracorporeal Pringle manoeuvre worsen treatment outcomes?

Minimally invasive surgery for hepatocellular carcinoma

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