Laparoscopic versus open unisegmentectomy in two specialized centers. Feasibility and short-term results

Garbarino, Giovanni; Marchese, Ugo; Tobome, Romaric; Ward, Marc; Vibert, Éric; Gayet, Brice; Cherqui, Daniel; Fuks, David

doi:10.1016/j.hpb.2019.09.017

Cited by 3 publications

(4 citation statements)

References 32 publications

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“…Although it was initially considered that LH would compromise the resection margin due to the lack of palpation ( 29 ), the magnification of laparoscopy, the anatomical resection, and the routine application of laparoscopic ultrasound may compensate the deficiency of palpation. In this study, consistent with other researches ( 7 , 24 , 25 , 28 , 29 ), no significant difference in surgical margin was observed between the two groups.…”

Section: Discussionsupporting

confidence: 92%

“…After the course of technique innovation and procedure exploration in the first 10 years of 21st century, recent attentions have been focused on evaluation of the performance of laparoscopic liver resection over conventional laparotomy (11). Several advantages of laparoscopic minor hepatic resection, sectionectomy, and segmentectomy over open approach, like less intraoperative blood loss (1,5,(22)(23)(24)(25)(26), shorter postoperative hospital stay (1,5,(22)(23)(24)(25)(26)(27)(28), have been widely reported by surgeons. Nevertheless, there is no strong evidence like RCT supporting these conclusions and replacement of open liver resection by LH is still challenging.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic versus open left hemihepatectomy for hepatocellular carcinoma: a propensity score matching analysis

Ye¹,

Weng²,

Zhou³

et al. 2020

Transl Cancer Res TCR

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Background: Despite the increasing application of laparoscopic hepatectomy (LH) for hepatocellular carcinoma (HCC), laparoscopic left hemihepatectomy (LLH) remains a relatively rare surgery and comparison of perioperative and oncological outcomes between LLH and open left hemihepatectomy (OLH) is lacking. Methods: A total of 276 HCC patients who underwent either LLH or OLH between January 2008 and November 2019 were enrolled in this retrospective observational study and a 1:2 propensity score matching (PSM) was performed between LLH and OLH groups. Results: Patients in LLH group had smaller tumor size (P=0.001) and earlier TNM staging (P=0.022) before matching. Despite the similar transfusion rate after matching, patients undergoing LLH (n=27)experienced less intraoperative blood loss (100.0 versus 200.0 mL; P=0.034) and application of hepatic portal occlusion (11.1% versus 63.5%; P<0.001) compared to those in OLH group (n=52). There were no statistical differences of resection margin and incidence of complications between the groups. The overall survival (OS) and disease-free survival (DFS) of patients in LLH group were comparable to OLH group (3-year OS rate: 75.0% versus 84.9%; 1-year DFS rate: 92.3% versus 92.2%).Conclusions: LLH may be a feasible and safe alternative to OLH for selected HCC cases, providing potential short-term benefits without compromising oncologic adequacy and prognosis.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Laparoscopic versus open left hemihepatectomy for hepatocellular carcinoma: a propensity score matching analysis

Ye¹,

Weng²,

Zhou³

et al. 2020

Transl Cancer Res TCR

View full text Add to dashboard Cite

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“…The surgical approach used in IMM has been described previously [7, 10, 12, 13]. LLR was performed using 5 or 6 trocars placed approximately one hand breadth below the right subcostal margin, including a 12‐mm trocar for intraoperative ultrasonography, as previously described.…”

Section: Methodsmentioning

confidence: 99%

“…LLR is currently associated with at least the same or better results than those observed with open resections in terms of postoperative outcomes regardless of tumor localization, type of resection, or quality of parenchyma [7]. In addition to consensus meetings that have helped organize LLR activity worldwide [8], algorithms and scores that can help in the selection of patients have emerged, such as the Morioka classification [9].…”

Section: Introductionmentioning

confidence: 99%

Postoperative Outcomes After Laparoscopic Liver Resections in Low and High‐Volume Centers: A Multicentric Case‐Matched Comparative Study

et al. 2021

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Background Laparoscopic liver resection (LLR) is the gold standard for liver resections. Despite its feasibility and safety in high-volume centers (HVC), its performance is controversial in low-volume centers (LVCs). We aimed to evaluate the results of LLR performed in LVC. Methods Patients who underwent LLR between 2013 and 2019 in three LVCs were compared after case-matching with those in an HVC using the Institut Mutualiste Montsouris LLR Difficulty Score (IMMLDS). Results Seventy-six patients treated in three LVCs were matched to 152 in HVCs for age, body mass index, and resection type. The incidence of LLR significantly increased in LVCs over time (2013-2016 vs. 2017-2019) (21.2% vs. 39.3%; p = 0.002 and) while abdominal drainage rate decreased (77.4% vs. 51.1%; p = 0.003). In IMMLDS group I (60 vs. 120 patients), higher Pringle maneuver (43.3% vs. 2.5%; p \ 0.0001), median blood loss (175 ml vs. 50 ml; p \ 0.0001), abdominal drainage (58.3% vs. 6.6%; p \ 0.0001), and conversion rate (8.3% vs. 1.6%, p = 0.04) were observed in LVCs. The overall postoperative morbidity was comparable (Clavien I-II: p = 0.54; Clavien [ II: p = 0.71). In IMMLDS groups II-III, Pringle maneuver (56.5% vs. 3.1%; p \ 0.0001), blood loss (350 ml vs. 175 ml; p = 0.02), and abdominal drainage (75% vs. 28.3%; p = 0.004) were different; however, postoperative morbidity was not. The surgical difficulty notwithstanding, length of stay (group I: p = 0.13; group II-III: p = 0.93) and R0 surgical margin (group I: p = 0.3; group II-III p = 0.39) were not different between LVCs and HVCs.Conclusions LLR performed at an LVC can be feasible and safe with acceptable morbidity.

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Systematic review of perioperative and oncologic outcomes of minimally-invasive surgery for hilar cholangiocarcinoma

et al. 2021

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Laparoscopic versus open unisegmentectomy in two specialized centers. Feasibility and short-term results

Abstract: Background: Anatomical segmentectomy is defined as the complete removal of the Couinaud's segment. The aim of this study was to compare the perioperative outcomes of laparoscopic (LS) versus open (OS) unisegmentectomy in two high volume centers.

Cited by 3 publications

References 32 publications

Laparoscopic versus open left hemihepatectomy for hepatocellular carcinoma: a propensity score matching analysis

Laparoscopic versus open left hemihepatectomy for hepatocellular carcinoma: a propensity score matching analysis

Postoperative Outcomes After Laparoscopic Liver Resections in Low and High‐Volume Centers: A Multicentric Case‐Matched Comparative Study

Systematic review of perioperative and oncologic outcomes of minimally-invasive surgery for hilar cholangiocarcinoma

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