Evolution of Laparoscopic Liver Surgery from Innovation to Implementation to Mastery: Perioperative and Oncologic Outcomes of 2,238 Patients from 4 European Specialized Centers

Berardi, Giammauro; Cleven, Stijn Van; Fretland, Åsmund Avdem; Barkhatov, Leonid; Halls, Mark; Cipriani, Federica; Aldrighetti, Luca; Hilal, Mohammed Abu; Edwin, Bjørn; Troisi, Roberto

doi:10.1016/j.jamcollsurg.2017.08.006

Cited by 88 publications

(49 citation statements)

References 47 publications

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“…Since the early days of LLR, HCC has been the most common indication [51]. Nowadays, the total rate of LLR has increased to over 40% [52], especially in experienced centers. Similarly, the rate of major LLR has increased to 30% [11].…”

Section: Resultsmentioning

confidence: 99%

Open Liver Resection, Laparoscopic Liver Resection, and Percutaneous Thermal Ablation for Patients with Solitary Small Hepatocellular Carcinoma (≤30 mm): Review of the Literature and Proposal for a Therapeutic Strategy

Viganò¹,

Laurenzi²,

Solbiati³

et al. 2018

Dig Surg

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Background: Patients with a single hepatocellular carcinoma (HCC) ≤3 cm and preserved liver function have the highest likelihood to be cured if treated. The most adequate treatment methods are yet a matter that is debated. Methods: We reviewed the literature about open anatomic resection (AR), laparoscopic liver resection (LLR), and percutaneous thermal ablation (PTA). Results: PTA is effective as resection for HCC < 2 cm, when they are neither subcapsular nor perivascular. PTA in HCC of 2–3 cm is under evaluation. AR with the removal of the tumor-bearing portal territory is recommended for HCC > 2 cm, except for subcapsular ones. In comparison with open surgery, LRR has better short-term outcomes and non-inferior long-term outcomes. LLR is standardized for superficial limited resections and for left-sided AR. Conclusions: According to the available evidences, the following therapeutic proposal can be advanced. Laparoscopic limited resection is the standard for any subcapsular HCC. PTA is the first-line treatment for deep-located HCC < 2 cm, except for those in contact with Glissonean pedicles. Laparoscopic AR is the standard for deep-located HCC of 2–3 cm of the left liver, while open AR is the standard for deep-located HCC of 2–3 cm in the right liver. HCC in contact with Glissonean pedicles should be scheduled for resection (open or laparoscopic) independent of their size. Liver transplantation is reserved to otherwise untreatable patients or as a salvage procedure at recurrence.

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Section: Resultsmentioning

confidence: 99%

Open Liver Resection, Laparoscopic Liver Resection, and Percutaneous Thermal Ablation for Patients with Solitary Small Hepatocellular Carcinoma (≤30 mm): Review of the Literature and Proposal for a Therapeutic Strategy

Viganò¹,

Laurenzi²,

Solbiati³

et al. 2018

Dig Surg

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“…Laparoscopic liver surgery is mostly performed in specialized centres that have implemented a minimally invasive liver programme. This is mainly because these procedures require specific expertise.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with open surgery, LLR is associated with decreased morbidity, a shorter length of hospital stay, less pain, more rapid recovery and improved cosmetic results. More than 10 000 laparoscopic procedures have been performed to date with good outcomes, especially in referral centres. The risk of haemorrhage, the technical difficulty of laparoscopic ultrasonography, and the need to maintain adequate surgical margins result in a long and demanding learning curve.…”

Section: Introductionmentioning

confidence: 99%

Multicentre analysis of the learning curve for laparoscopic liver resection of the posterosuperior segments

Berardi

Fretland

Elberm

et al. 2019

British Journal of Surgery

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Background: Laparoscopic liver resection demands expertise and a long learning curve. Resection of the posterosuperior segments is challenging, and there are no data on the learning curve. The aim of this study was to evaluate the learning curve for laparoscopic resection of the posterosuperior segments.Methods: A cumulative sum (CUSUM) analysis of the difficulty score for resection was undertaken using patient data from four specialized centres. Risk-adjusted CUSUM analysis of duration of operation, blood loss and conversions was performed, adjusting for the difficulty score of the procedures. A receiver operating characteristic (ROC) curve was used to identify the completion of the learning curve.Results: According to the CUSUM analysis of 464 patients, the learning curve showed an initial decrease in the difficulty score followed by an increase and, finally, stabilization. More patients with cirrhosis or previous surgery were operated in the latest phase of the learning curve. A smaller number of wedge resections and a larger number of anatomical resections were performed progressively. Dissection using a Cavitron ultrasonic surgical aspirator and the Pringle manoeuvre were used more frequently with time. Risk-adjusted CUSUM analysis showed a progressive decrease in operating time. Blood loss initially increased slightly, then stabilized and finally decreased over time. A similar trend was found for conversions. The learning curve was estimated to be 40 procedures for wedge and 65 for anatomical resections.Conclusion: The learning curve for laparoscopic liver resection of the posterosuperior segments consists of a stepwise process, during which accurate patient selection is key.

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“…However, continuous assessment of outcomes is encouraged, especially if high‐level studies are lacking. Major LLR is considered to be safe and feasible, but it was judged that there remain risks associated with the newness of the procedure and the lack of experience of surgeons carrying out major LLR . Recommendation of the consensus meeting was that surgeons undertaking these procedures should be experienced both in liver surgery and advanced laparoscopy and that outcomes should be evaluated in registries and by RCT, where appropriate .…”

Section: Current Topics In Liver Surgerymentioning

confidence: 99%

Current topics in the surgical treatments for hepatocellular carcinoma

Ban

Ogura

Akahoshi

et al. 2018

Annals of Gastroent Surgery

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Treatment strategy for hepatocellular carcinoma (HCC) requires optimal selection of therapies based on various factors related to tumor condition and liver functional reserve. Although several evidence‐based guidelines have been proposed for the treatment of HCC, the criteria and range of indications differ among these guidelines according to the circumstances of each country. In European nations and the USA, patients with the Barcelona Clinic Liver Cancer stage 0‐A are subjects for surgical resection, whereas in Asian countries, even those with the intermediate stage are regarded as surgical candidates. Furthermore, since the recent introduction and rapidly widely spreading use of laparoscopic liver resection, this technique has become an important treatment option for surgical resection. In this review article, we overview the current topics of treatment of HCC with a special focus on surgical therapy.

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Evolution of Laparoscopic Liver Surgery from Innovation to Implementation to Mastery: Perioperative and Oncologic Outcomes of 2,238 Patients from 4 European Specialized Centers

Abstract: Since laparoscopy was introduced, a long implementation process has been necessary to allow for standardization and improvement in surgical care, mastery of the technique, and the ability to obtain good perioperative results with safe oncologic outcomes.

Cited by 88 publications

References 47 publications

Open Liver Resection, Laparoscopic Liver Resection, and Percutaneous Thermal Ablation for Patients with Solitary Small Hepatocellular Carcinoma (≤30 mm): Review of the Literature and Proposal for a Therapeutic Strategy

Open Liver Resection, Laparoscopic Liver Resection, and Percutaneous Thermal Ablation for Patients with Solitary Small Hepatocellular Carcinoma (≤30 mm): Review of the Literature and Proposal for a Therapeutic Strategy

Multicentre analysis of the learning curve for laparoscopic liver resection of the posterosuperior segments

Current topics in the surgical treatments for hepatocellular carcinoma

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