Is minimally invasive surgery of lesions in the right superior segments of the liver justified? A multi‐institutional study of 245 patients

Abstract

Background: Controversy exists regarding the safety and feasibility of minimally invasive resection for lesions in segments 7 or 8. We compare outcomes of minimally invasive surgery (MIS) and Open parenchymal sparing liver resections at two high-volume centers. Methods: From 2003 to 2016 we identified patients who underwent MIS or Open resections for lesions in segments 7 or 8 at two institutions (MSKCC and SGH). Outcomes were compared using univariate and multivariate analyses. Results: Two-hundred and forty-five patients underwent resection of lesions in segments 7 or 8 (MIS 30% and Open 70%). Compared to the Open group, the MIS group had longer operative time (223 ± 88 vs 188 ± 72 minutes, P = .003), lower blood loss (297 ± 287 vs 448 ± 670 mL, P = .03), and shorter mean length of stay (5.2 ± 7.4 vs 8.3 ± 11.7 days, P < .001), which remained significant on multivariate analysis. No differences in Pringle time, rate of postoperative complications, or R0 resections were detected. Conclusions: With appropriately selected patients treated by experienced MIS hepatopancreatobiliary surgeons, MIS resection of segments 7 or 8 is safe with similar rates of complications and R0 resections, with significantly less blood loss and shorter length of stay.

Reply: Comparison between short and long‐term outcomes after minimally‐invasive versus open primary liver resections for hepatocellular carcinoma

“…In this study, 41% of the MIS cases were located in the difficult posterosuperior segments 2 . Nonetheless, we, like many other authors, have previously demonstrated that patients benefit from the same advantages of MIS over the open approach even for tumors in in these difficult locations 6 …”

Minimally invasive versus open right anterior sectionectomy and central hepatectomy for central liver malignancies: a propensity‐score‐matched analysis

“…In addition, most well‐validated difficulty scoring systems for MILR grade CH and RAS as ‘highly difficult’ procedures that should only be attempted by experienced hepatobiliary surgeons in a tertiary referral centre 13,45 . With regards to the discussion of technically difficult MILR, our institution recently reported on the oncological safety and benefits of a minimally invasive approach to segments VII and VIII lesions, including decreased blood loss and shorter duration of hospital stay 46 …”

Comparison between the difficulty of laparoscopic limited liver resections of tumors located in segment 7 versus segment 8: An international multicenter propensity‐score matched study

“…[6][7][8]14 These challenges may be partially overcome by using the lateral position, additional intercostal trocars, and the flexible tip laparoscope. [6][7][8][15][16][17] Nonetheless, despite the greater complexity, LLR of segments 7 and 8 have shown the known advantages of minimally invasive surgery over the open approach such as significantly lower blood loss and length of hospital stay. 15,18 To date, there are no head-to-head comparative studies between LLR of Segments 7 and 8.…”