Laparoscopic liver resection in patients with liver cirrhosis—the path towards standard of care

Cheung, Tan To

doi:10.21037/hbsn.2017.09.02

Cited by 2 publications

(2 citation statements)

References 14 publications

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“…Recent studies from high volume centers have demonstrated that major liver resections via the minimally invasive approach demonstrated superior short-term outcome in terms of blood loss, transfusion requirement, complication rate and hospital stay even in patients with liver cirrhosis (8,14,17,(32)(33)(34)(35)(36). Overall survival appears to be comparable with open approach in patients with liver tumors (32)(33)(34)(35). Hence, with these encouraging results, many high-volume centers have been trying to expand the indications of MILR to patient with larger tumours and even huge tumours (14).…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive liver resection for huge (≥10 cm) tumors: an international multicenter matched cohort study with regression discontinuity analyses

Cheung

Wang

Ефанов

et al. 2021

Hepatobiliary Surg Nutr

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Background: The application and feasibility of minimally invasive liver resection (MILR) for huge liver tumours (≥10 cm) has not been well documented.Methods: Retrospective analysis of data on 6,617 patients who had MILR for liver tumours were gathered from 21 international centers between 2009-2019. Huge tumors and large tumors were defined as tumors with a size ≥10.0 cm and 3.0-9.9 cm based on histology, respectively. 1:1 coarsened exact-matching (CEM) and 1:2 Mahalanobis distance-matching (MDM) was performed according to clinically-selected variables.Regression discontinuity analyses were performed as an additional line of sensitivity analysis to estimate local treatment effects at the 10-cm tumor size cutoff.Results: Of 2,890 patients with tumours ≥3 cm, there were 205 huge tumors. After 1:1 CEM, 174 huge tumors were matched to 174 large tumors; and after 1:2 MDM, 190 huge tumours were matched to 380 large tumours. There was significantly and consistently increased intraoperative blood loss, frequency in the application of Pringle maneuver, major morbidity and postoperative stay in the huge tumour group compared to the large tumour group after both 1:1 CEM and 1:2 MDM. These findings were reinforced in RD analyses. Intraoperative blood transfusion rate and open conversion rate were significantly higher in the huge tumor group after only 1:2 MDM but not 1:1 CEM.Conclusions: MILR for huge tumours can be safely performed in expert centers It is an operation with substantial complexity and high technical requirement, with worse perioperative outcomes compared to MILR for large tumors, therefore judicious patient selection is pivotal.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive liver resection for huge (≥10 cm) tumors: an international multicenter matched cohort study with regression discontinuity analyses

Cheung

Wang

Ефанов

et al. 2021

Hepatobiliary Surg Nutr

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“…Hepatectomy is a successful radical treatment for HCC, and it is occasionally required in patients with severe liver fibrosis. In liver fibrosis, it is difficult to crush or dissociate the liver parenchyma while preserving fine blood vessels [ 8 , 9 ]. Additionally, a fibrotic liver usually has portal hypertension, which makes even small vessel injuries result in spurt hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Liver Resection Utilizing a Water Jet Scalpel for Patients With Liver Fibrosis

Uemoto,

Fujikawa,

Matsuoka

2023

Cureus

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Introduction A variety of devices are utilized in order to resect liver parenchyma in laparoscopic liver resection. However, liver fibrosis makes hepatectomy problematic because the liver is rigid and prone to bleeding. The water jet scalpel, which dissociates the liver parenchyma with a jet stream has no thermal damage and is clinically utilized in liver resection, but its safety and efficacy during laparoscopic liver resection for patients with liver fibrosis remain unknown. Methods We analyzed patients who underwent laparoscopic liver resection utilizing the water jet scalpel with liver fibrosis at our hospital. A water jet scalpel was used for liver parenchymal transection, and a saline-linked ball-tipped electrocautery was simultaneously used for hemostasis. Results Subsectionectomy was one case, left lateral sectionectomy was two cases, and non-anatomical liver resection was three cases. The median blood loss was 70 mL (24-104 mL). There was no need for the intraoperative Pringle's maneuver. No perioperative blood transfusion was performed, and there were no postoperative complications, including posthepatectomy liver failure. Conclusion It was suggested that laparoscopic liver resection in patients with liver fibrosis can be safely performed with the water jet scalpel.

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Laparoscopic liver resection in patients with liver cirrhosis—the path towards standard of care

Cited by 2 publications

References 14 publications

Minimally invasive liver resection for huge (≥10 cm) tumors: an international multicenter matched cohort study with regression discontinuity analyses

Minimally invasive liver resection for huge (≥10 cm) tumors: an international multicenter matched cohort study with regression discontinuity analyses

Laparoscopic Liver Resection Utilizing a Water Jet Scalpel for Patients With Liver Fibrosis

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