Laparoscopic repeat liver resection

Morise, Zenichi

doi:10.1002/ags3.12363

Cited by 13 publications

(7 citation statements)

References 37 publications

(61 reference statements)

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“…Besides, the proper trocar placement should be adjusted according to operation custom of the surgeon, as well as the changed liver anatomy and formed adhesions caused by previous hepatectomy. Moreover, for the consideration of future abdominal operations, it is better to avoid unnecessary extensive adhesiolysis when the adhesion does not affect the operative procedure ( 34 , 35 ).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score–Matched Study and Meta-Analysis

Chen

Gao

et al. 2021

Front. Oncol.

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Background: It remains unclear whether the short-term benefits of laparoscopic repeat hepatectomy (LRH) accrue to patients with recurrent liver tumors. The present study aimed to report our own center's experience and perform a meta-analysis to evaluate the safety and feasibility of LRH in comparison with open repeat hepatectomy (ORH) for treating recurrent liver tumors.Patients and Methods: A propensity score–matched study was performed including 426 patients receiving LRH or ORH for recurrent hepatocellular carcinoma between January 2017 and December 2018. Surgical outcomes and perioperative inflammation-based markers, including monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune–inflammation index were collected from medical records and analyzed. Additionally, a systematic literature review was performed to identify relevant studies in PubMed, EMBASE, Web of Science, and Cochrane library databases up to October 1, 2020. Information including patient demographics, pathologic characteristics, and short-term outcomes was extracted and analyzed using random- or fixed-effects models.Results: Of 68 LRHs, 57 were matched with an ORH finally. Our study demonstrated that LRH was significantly associated with less intraoperative blood loss (50 vs. 100 mL; P < 0.001), lower rate of hepatic inflow occlusion (10.52 vs. 33.3%; P = 0.003), and shorter postoperative hospital stay (5 vs. 6 days; P = 0.001) after 1:1 propensity score matching. The operation time, rate of blood transfusion, and postoperative complications were similar between the two groups. Moreover, all four inflammation-based markers were significantly lower in LRH group on postoperative day 1. In the meta-analysis, a total of 12 studies comprising 1,315 patients receiving repeat hepatectomy met the selection criteria. Similar to our own study, the meta-analysis showed shorter hospital stay [standard mean difference (SMD) = −0.51, 95% confidence interval (CI) = −0.79 to −0.22, P < 0.001], less intraoperative blood loss (SMD = −0.79, 95% CI = −1.11 to −0.47, P < 0.001), and lower rate of major postoperative complications [odds ratio (OR) = 0.35, 95% CI = 0.19–0.66, P = 0.001] in the LRH group. There was no difference in the field of overall postoperative complication and operation time between LRH and ORH groups.Conclusion: Compared with ORH, LRH results in relatively better surgical outcomes and faster postoperative recovery. It could be considered a feasible and effective option for the treatment of recurrent liver tumors.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score–Matched Study and Meta-Analysis

Chen

Gao

et al. 2021

Front. Oncol.

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“…The location of trocar hole should be adjusted according to the newest liver anatomy and the adhesions formed after the previous surgery. Unnecessary adhesiolysis should also be avoided for favoring the future abdominal surgeries (35,36). As for postoperative survival, our results revealed that patients receiving LRH had a significantly better OS than patients receiving ORH (P < 0.05).…”

Section: Discussionmentioning

confidence: 71%

The role of laparoscopic surgery in the surgical management of recurrent liver malignancies: A systematic review and meta-analysis

Hu²,

Ma³

et al. 2023

Front. Surg.

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ObjectiveTo evaluate the efficiency of laparoscopic surgery in treating recurrent liver tumors vs. conventional open surgery.MethodsDatabase searching was conducted in PubMed, the Cochrane Library and EMBASE. Rev Man 5.3 software and Stata 13.0 software were applied in statistical analyses.ResultsA total of fourteen studies were finally included with 1,284 patients receiving LRH and 2,254 with ORH. LRH was associated with less intraoperative hemorrhage, a higher R0 resection rate, a lower incidence of Pringle Maneuver, a lower incidence of postoperative morbidities, a better overall survival and an enhanced postoperative recovery vs. ORH. Patients receiving LRH shared similar operative time, tumor number and disease-free survival as those with ORH. However, tumor size was relatively larger in patients receiving ORH and major hepatectomy, anatomic hepatectomy were rarely performed in patients with LRH. Additional analyses between LRH and laparoscopic primary hepatectomy revealed less intraoperative blood loss in patients with LRH.ConclusionLRH is safe and feasible with more favorable peri-operative outcomes and faster postoperative recovery. However, it is only applicable for some highly-selected cases not requiring complex surgical procedures. Future larger well-designed studies are expected for further validation.

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“…Laparoscopy can be used to distinguish adhesions from organs with a clear surgical field of view, and the tension created by a pneumoperitoneum may facilitate closer adhesiotomy, allowing for meticulous maneuvering to reduce serious complications, including massive bleeding and intestinal damage 1,6,16–19 . Additionally, laparoscopy eliminates the need for extensive adhesiolysis, 20,21 which is possibly the reason for the shorter operative time and lesser intraoperative bleeding volume in LRLR than in ORLR in this study. LRLR reduces the occurrence of ascites, 17,19 which might be explained by the fact that the abdominal wall’s collateral circulation and the diaphragm’s lymphatic flow in patients with portal hypertension are minimally disrupted in laparoscopic surgery than in open surgery; in LRLR, only four or five trocars are required in the upper quadrant of the abdomen instead of a large subcostal incision 18 .…”

Section: Discussionmentioning

confidence: 83%

Surgical outcomes of laparoscopic versus open repeat liver resection for liver cancers: A report from a nationwide surgical database in Japan

Kaibori¹,

Ichihara

Matsubara

et al. 2022

J Hepato Biliary Pancreat

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Background/Purpose Laparoscopic (repeat) liver resection (LRLR) is a well‐established liver tumor treatment. However, since its outcomes and comparison with open repeat liver resection (ORLR) in recurrent liver cancer remain inadequately studied, this study then aimed to compare their short‐term outcomes for liver cancers (hepatocellular carcinoma, intrahepatic cholangiocellular carcinoma, and metastatic liver cancer). Methods Repeat liver resection cases between 2013 and 2017 from Japan’s National Clinical Database were extracted. We used propensity score matching (PSM) to compare the proportion of patients with postoperative complications of Clavien‐Dindo classification grade II or higher (CD2+) (primary endpoint), as well as the operative time, intraoperative bleeding volume, and intraoperative transfusion implementation rate (secondary endpoints). Results Of 2902 patients (ORLR, 2476; LRLR, 426), 712 (356 per type) with comparable backgrounds remained via PSM. Before and after PSM, the postoperative CD2+ complication rate was significantly lower in the LRLR group, who had shorter operative time, smaller intraoperative bleeding volume, and lower intraoperative transfusion rate, than in the ORLR group (after matching, 7.6% vs 18.3%, P < 0.0001). Conclusions LRLR showed better short‐term outcomes than ORLR, making it a safer and more effective liver cancer treatment.

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Laparoscopic repeat liver resection

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 13 publications

References 37 publications

Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score–Matched Study and Meta-Analysis

Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score–Matched Study and Meta-Analysis

The role of laparoscopic surgery in the surgical management of recurrent liver malignancies: A systematic review and meta-analysis

Surgical outcomes of laparoscopic versus open repeat liver resection for liver cancers: A report from a nationwide surgical database in Japan

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