Hand-Assisted Laparoscopic Surgery Is Superior to Open Liver Resection for Colorectal Liver Metastases in the Posterosuperior Segments

Abstract

Introduction: Laparoscopic liver resections (LLR) of colorectal metastasis located in posterosuperior segments (1, 4A, 7 and 8) are challenging and highly demanding. The aim of our study is to determine the safety and feasibility of hand-assisted laparoscopic surgery (HALS) in the resections of the posterosuperior lesions and to compare the peri-operative, short-term and long-term outcomes with the open liver resection (OLR) approach.Methods and Results: A retrospective study of patients who underwent either HALS or OLR for metastatic colorectal cancer (mCRC) located in the posterosuperior segments of the liver between 2008 and 2018 in two university affiliated medical centers.Results: A total of 187 patients were identified, of whom 78 underwent HALS and 109 underwent OLR. There was no difference between the HALS and OLR with regard to preoperative factors (age, primary CRC tumor location, number and anatomical distribution of liver metastasis, pre-operative neo-adjuvant treatment, operative time, blood transfusion rate, and resection margins positivity). On the other hand, HALS compared to OLR had a significantly shorter mean hospital stay (4 vs. 6 days; P = 0.003), and a lower total complications rate (25 vs. 47% P = 0.006). Both groups had no 30-day mortality. Also, patients who underwent HALS vs. OLR had similar liver metastases recurrence (55 vs. 51%. P = 0.65) and 5-year survival (47 vs. 45%. P = 0.72).Conclusions: HALS for mCRC located in posterosuperior liver segments is safe and feasible and it is a preferable approach due to its lower complication rate and shorter hospital stay while not compromising survival and disease recurrence.

Laparoscopic Versus Open Simultaneous Resection of Primary Colorectal Cancer and Associated Liver Metastases: A Comparative Retrospective Study

“…Regarding short-term outcomes, the main finding of our study was the longer global operative time (286 vs. 225 min, ie, 61 min more) in the laparoscopic group. This duration is acceptable according to the data that was included in a recent systemic review conducted by Abu-Zaydeh et al21 which reported a median operative time of 320 minutes in laparoscopic procedures. Our study also found that the patients in the laparoscopic group had a median hospital stay that was a statistically significant 2 days shorter than for patients in the open surgery group.…”

Safety and Feasibility of Laparoscopic Parenchymal-Sparing Hepatectomy for Lesions with Proximity to Major Vessels in Posterosuperior Liver Segments 7 and 8

“…Recent international consensus meetings held in Southampton recommended that PSH for PSS be performed by experienced surgeons in select patients in high-volume centers [ 6 ]. Some comparative studies have reported that, for tumors in PSS, LLR is superior to OLR in terms of intraoperative blood loss, postoperative hospital stay, and major complication rates [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. In the present study, we showed that LLR for lesions in PSS resulted in lower intraoperative blood loss than OLR and that there was no difference in short-term and long-term outcomes between the two groups.…”

“…A previous study that compared the HALS technique to OLR for CRLM in PSS demonstrated that the HALS technique is a safe, feasible, and preferable approach because it leads to a lower complication rate and shorter hospital stays without compromising survival and disease recurrence [ 7 ]. We adopted the HALS technique for patients with tumors located in close proximity to major hepatic veins in PSS that would likely have required sacrificing the major hepatic veins in preoperative estimations.…”

“…In recent years, appropriate anesthetic respiratory and circulatory management and the development of surgical techniques have enabled LLR to be performed safely at many hospitals, and recent studies have indicated that LLR is technically feasible and safe for selected patients with lesions in PSS [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. Nevertheless, laparoscopic parenchymal-sparing hepatectomy (PSH) for liver lesions with proximity to major vessels (PMV) in PSS has not yet been examined.…”