Laparoscopic left-sided hepatectomy for the treatment of hepatolithiasis: A comparative study with open approach

Peng, Long; Liu, Zhanying; Zhu, Jisheng; Wan, Renhua; Xiao, Weidong; Li, Yong

doi:10.1016/j.ijsu.2017.02.068

Cited by 35 publications

(32 citation statements)

References 26 publications

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“…All 16 studies were retrospective except for 1 RCT (level of evidence: 2b)[ 17 ]. Among the remaining 15 studies, 3 compared contemporary series of patients (level of evidence: 3a)[ 20 , 25 , 30 ], 11 were retrospective case-control studies (level of evidence: 3b)[ 16 , 19 , 21 - 24 , 26 - 29 , 31 ], and 1 was a retrospective study using historical series as controls (level of evidence: 4)[ 18 ] (Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic VS open hepatectomy for hepatolithiasis: An updated systematic review and meta-analysis

Li¹,

Zheng²,

Cai³

et al. 2017

WJG

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AIMTo perform a meta-analysis on laparoscopic hepatectomy VS conventional liver resection for treating hepatolithiasis.METHODSWe conducted a systematic literature search on PubMed, Embase, Web of Science and Cochrane Library, and undertook a meta-analysis to compare the efficacy and safety of laparoscopic hepatectomy VS conventional open liver resection for local hepatolithiasis in the left or right lobe. Intraoperative and postoperative outcomes (time, estimated blood loss, blood transfusion rate, postoperative intestinal function recovery time, length of hospital stay, postoperative complication rate, initial residual stone, final residual stone and stone recurrence) were analyzed systematically.RESULTSA comprehensive literature search retrieved 16 publications with a total of 1329 cases. Meta-analysis of these studies showed that the laparoscopic approach for hepatolithiasis was associated with significantly less intraoperative estimated blood loss [weighted mean difference (WMD): 61.56, 95% confidence interval (CI): 14.91-108.20, P = 0.01], lower blood transfusion rate [odds ratio (OR): 0.41, 95%CI: 0.22-0.79, P = 0.008], shorter intestinal function recovery time (WMD: 0.98, 95%CI: 0.47-1.48, P = 0.01), lower total postoperative complication rate (OR: 0.52, 95%CI: 0.39-0.70, P < 0.0001) and shorter stay in hospital (WMD: 3.32, 95%CI: 2.32-4.32, P < 0.00001). In addition, our results showed no significant differences between the two groups in operative time (WMD: 21.49, 95%CI: 0.27-43.24, P = 0.05), residual stones (OR: 0.79, 95%CI: 0.50-1.25, P = 0.31) and stone recurrence (OR: 0.34, 95%CI: 0.11-1.08, P = 0.07). Furthermore, with subgroups analysis, our results proved that the laparoscopic approach for hepatolithiasis in the left lateral lobe and left side could achieve satisfactory therapeutic effects.CONCLUSIONThe laparoscopic approach is safe and effective, with less intraoperative estimated blood loss, fewer postoperative complications, reduced length of hospital stay and shorter intestinal function recovery time than with conventional approaches.

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Section: Resultsmentioning

confidence: 99%

Laparoscopic VS open hepatectomy for hepatolithiasis: An updated systematic review and meta-analysis

Li¹,

Zheng²,

Cai³

et al. 2017

WJG

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“…Compared with open hepatectomy, laparoscopic hepatectomy enables more accurate visualization and vascular anatomy. However, only a few retrospective studies comparing OLH and LLH without the ERAS program have been published summarizing their complications and long-term follow-up dates, such as residual stones and risk of recurrence, which are the main concerns of surgeons [11,12].…”

Section: Discussionmentioning

confidence: 99%

Total laparoscopic partial hepatectomy versus open partial hepatectomy for primary left-sided hepatolithiasis: study protocol for a randomized controlled trial

pan¹,

Wu²,

Zhou³

et al. 2020

Preprint

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Background : The advantages of laparoscopic left-sided hepatectomy (LLH) for treating hepatolithiasis in terms of the time to functional recovery , postoperative length of hospital stay (LOS), morbidity, long-term abdominal wall hernias, hospital costs, residual stone rate and recurrence of calculus have not been confirmed by a randomized controlled trial. The aim of this trial is to compare the safety and effectiveness of LLH to those of open left-sided hepatectomy (OLH) for the treatment of hepatolithiasis. Methods: Patients with hepatolithiasis eligible for left-sided hepatectomy will be recruited. The experimental design will produce two randomized arms (laparoscopic and open hepatectomy) at a 1:1 ratio and a prospective registry. All patients will undergo surgery in the setting of an enhanced recovery after surgery (ERAS) program. The prospective registry will be based on patients who cannot be randomized because of the explicit treatment preference of the patient or surgeon or because of ineligibility (not meeting the inclusion and exclusion criteria) for randomization in this trial. The primary outcome is the time to functional recovery. The secondary outcomes are LOS, percentage readmission, morbidity, mortality, hospital costs, long-term incidence of incisional hernias, residual stone rate and recurrence of calculus. It will be assumed that, in patients undergoing LLH, the length of hospital stay will be reduced by 1.3 days. A sample size of 44 patients in each randomization arm has been calculated as sufficient to detect a 1.3-day reduction in LOS (90% power and α = 0.05 (two-tailed)). The trial is a randomized controlled trial that will provide evidence for the merits of laparoscopic surgery in patients undergoing liver resection within an ERAS program. Discussion: Although the outcomes of LLH have been proven to be comparable to those of OLH in retrospective studies, the use of LLH remains restricted, partly due to the lack of short-and long-term informative RCTs pertaining to patients with hepatolithiasis in ERAS programs. To evaluate the surgical and long-term outcomes of LLH, we will perform a prospective RCT to compare LLH with OLH for hepatolithiasis within an ERAS program. Trial registration: ClinicalTrials.gov NCT03958825 . Keywords: Laparoscopic, open liver resection, ERAS, Hepatectomy

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“…The hepatic reserve was evaluated in terms of the computed tomographic volumetry and indocyanine green retention rate at 15 min (ICG-R15). The indication of LMH was similar to that of OMH including the terms of the hepatic reserve, type of hepatectomy, and postoperative care [13,14]. For these patients with central lesions in the suprahepatic junction adjacent to the major hepatic vein and tumors adjacent or invading to the main portal pedicle or inferior vena cava, however, laparoscopic hepatectomy was not usually considered.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…It has been described in more detail elsewhere for the techniques of LMH and OMH performed at our institution [13,14]. For both anatomical right or left hepatectomy, intraoperative ultrasonography was used routinely in order to decide the type of hepatectomy and get the free resection margin ( Fig.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Laparoscopic versus open major liver resection for hepatocellular carcinoma: a case-matched analysis of short- and long-term outcomes

Wang

et al. 2020

Preprint

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Background: The feasibility and safety of laparoscopic major hepatectomy (LMH) is still uncertain. The purpose of the present study is to compare the short- and long-term outcomes of LMH with those of open major hepatectomy (OMH) for hepatocellular carcinoma (HCC).Method: Between January 2012 and December 2018, a total of 26 patients received laparoscopic major hepatectomy in our center. To minimize any confounding factors, a 1:3 case-matched analysis was conducted based on the demographics and extent of liver resection. Data of demographics, perioperative outcomes and long-term oncologic outcomes were reviewed.Results: Intraoperative blood loss (P=0.007) were significantly lower in LMH group. In addition, LMH group exhibited a lower overall complication rate (P=0.039) and shorter postoperative hospital stay (P=0.024). However, no statistically significant difference was found between LMH and OMH regarding operation time (P=0.215) and overall cost (P=0.024). Two laparoscopic cases were converted to open liver resection. In regard with long-term outcomes, there was no significant difference between LMH and OMH regarding disease-free survival (DFS) (P=0.079) and overall survival (OS) (P=0.172).Conclusion: LMH can be an effective and safe alternative to OMH for selected patients with liver cancer in short- and long-term outcomes.

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Laparoscopic left-sided hepatectomy for the treatment of hepatolithiasis: A comparative study with open approach

Abstract: LLH is a safe and effective treatment for selected patients with hepatolithiasis, with an advantage over OLH in the field of intraoperative blood loss, intraoperative transfusion, overall complication and postoperative recovery.

Cited by 35 publications

References 26 publications

Laparoscopic VS open hepatectomy for hepatolithiasis: An updated systematic review and meta-analysis

Laparoscopic VS open hepatectomy for hepatolithiasis: An updated systematic review and meta-analysis

Total laparoscopic partial hepatectomy versus open partial hepatectomy for primary left-sided hepatolithiasis: study protocol for a randomized controlled trial

Laparoscopic versus open major liver resection for hepatocellular carcinoma: a case-matched analysis of short- and long-term outcomes

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