Laparoscopic vs. open left lateral sectionectomy: An update meta-analysis of randomized and non-randomized controlled trials

Macacari, Rodrigo; Coelho, Fabrício Ferreira; Bernardo, Wanderley Marques; Krüger, Jaime Arthur Pirola; Jeismann, Vagner Birk; Fonseca, Gilton Marques; Cesconetto, Danielle Menezes; Cecconello, Ivan; Herman, Paulo

doi:10.1016/j.ijsu.2018.11.021

Cited by 45 publications

(57 citation statements)

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“…Analysis of four Canadian centres between 2008 and 2012 reported a high perioperative transfusion rate of 26·5 per cent in patients undergoing liver resections, compared with 15 per cent here. Other recent major institutional series have reported transfusion rates of 5–33 per cent. This discrepancy probably reflects temporal trends towards more restrictive transfusion practices, resulting from emerging evidence correlating perioperative transfusion with worse postoperative and oncological outcomes.…”

Section: Discussionmentioning

confidence: 93%

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Phlebotomy resulting in controlled hypovolaemia to prevent blood loss in major hepatic resections (PRICE-1): a pilot randomized clinical trial for feasibility

Martel

Baker

Wherrett

et al. 2020

British Journal of Surgery

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Background: Major liver resection is associated with blood loss and transfusion. Observational data suggest that hypovolaemic phlebotomy can reduce these risks. This feasibility RCT compared hypovolaemic phlebotomy with the standard of care, to inform a future multicentre trial.Methods: Patients undergoing major liver resections were enrolled between June 2016 and January 2018. Randomization was done during surgery and the surgeons were blinded to the group allocation. For hypovolaemic phlebotomy, 7-10 ml per kg whole blood was removed, without intravenous fluid replacement. Co-primary outcomes were feasibility and estimated blood loss (EBL).Results: A total of 62 patients were randomized to hypovolaemic phlebotomy (31) or standard care (31), at a rate of 3⋅1 patients per month, thus meeting the co-primary feasibility endpoint. The median EBL difference was −111 ml (P = 0⋅456). Among patients at high risk of transfusion, the median EBL difference was −448 ml (P = 0⋅069). Secondary feasibility endpoints were met: enrolment, blinding and target phlebotomy (mean(s.d.) 7⋅6(1⋅9) ml per kg). Blinded surgeons perceived that parenchymal resection was easier with hypovolaemic phlebotomy than standard care (16 of 31 versus 10 of 31 respectively), and guessed that hypovolaemic phlebotomy was being used with an accuracy of 65 per cent (20 of 31). There was no significant difference in overall complications (10 of 31 versus 15 of 31 patients), major complications or transfusion. Among those at high risk, transfusion was required in two of 15 versus three of nine patients (P = 0⋅326).Conclusion: Endpoints were met successfully, but no difference in EBL was found in this feasibility study. A multicentre trial (PRICE-2) powered to identify a difference in perioperative blood transfusion is justified. Registration number: NCT02548910 (http://www.clinicaltrials.gov).

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Section: Discussionmentioning

confidence: 93%

“…In part as a consequence of blood loss, red blood cell (RBC) transfusion remains common in liver surgery, occurring in 5–50 per cent of procedures. Population‐based analysis from the American College of Surgeons National Surgical Quality Improvement Program revealed a transfusion rate of 22 per cent in liver surgery in 2013.…”

Section: Introductionmentioning

confidence: 99%

Phlebotomy resulting in controlled hypovolaemia to prevent blood loss in major hepatic resections (PRICE-1): a pilot randomized clinical trial for feasibility

Martel

Baker

Wherrett

et al. 2020

British Journal of Surgery

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“…Currently, minor laparoscopic resections in anterolateral segments and left lateral sectionectomy are considered the gold standard approach in many specialized centers (3,8,21). However, resections of bilateral lesions, nodules in posterosuperior segments or in central locations of the liver (segments 1, 4a, 7, and 8), and major hepatectomies are still challenging (22,23).…”

Section: Discussionmentioning

confidence: 99%

“…The available results have shown its safety, feasibility, and potential bene ts over open liver resections (OLRs) (1,2). Observational studies and meta-analysis showed that laparoscopy decreased intraoperative bleeding, postoperative complications, and length of hospital stay when compared with OLRs (2,3).…”

Section: Introductionmentioning

confidence: 99%

“…Although an impressive outspreading has been observed, most MILRs are actually minor or limited resections of peripheral lesions, mainly located in the anterolateral segments of the liver (3,7,8). Due to the complexity of the operation and concerns about safe and oncologically appropriate resections, major hepatectomies (resection of ≥ 3 contiguous segments) and notably anatomical right hepatectomies remain challenging for minimally invasive surgery (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

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Minimally invasive versus open right hepatectomy: Comparative study with propensity score matching analysis

Duarte

Coelho

Valverde

et al. 2020

Preprint

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Abstract Background Minimally invasive liver resections (MILRs) have been increasingly performed in recent years. However, the majority of MILRs are actually minor or limited resections of peripheral lesions. Due to the technical complexity major hepatectomies remain challenging for minimally invasive surgery. The aim of this study was to compare the short and long-term outcomes of patients undergoing minimally invasive right hepatectomies (MIRHs) with contemporary patients undergoing open right hepatectomies (ORHs). Methods Consecutive patients submitted to anatomic right hepatectomies between January 2013 and December 2018 in two tertiary referral centers were studied. Study groups were compared on an intention-to-treat basis after propensity score matching (PSM). Overall survival (OS) analyses were performed for the entire cohort and specific etiologies subgroups. Results During study period 178 right hepatectomies were performed. After matching, 37 patients were included in MIRH group and 60 in ORH group. The groups were homogenous for all baseline characteristics. MIRHs had significant lower blood loss (400 ml vs. 500 ml, P = 0.01), lower rate of minor complications (13.5% vs. 35%, P = 0.03) and larger resection margins (10 mm vs. 5 mm, P = 0.03) when compared to ORHs. Additionally, a non-significant decrease in hospital stay (ORH 9 days vs. MIRH 7 days, P = 0.09) was observed. No differences regarding the use of Pringle’s maneuver, operative time, major complications or perioperative mortality were observed. OS was similar between the groups (P = 0.13). Similarly, no difference in OS was found in subgroups of patients with primary liver tumors (P = 0.09) and liver metastasis (P = 0.80). Conclusions MIRHs are feasible and safe. Minimally invasive approach is associated with less blood loss, a significant reduction in minor perioperative complications, and did not negatively affect long-term outcomes.

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Long‐Term Safety and Efficacy of Pure Laparoscopic Donor Hepatectomy in Pediatric Living Donor Liver Transplantation

Kim

Cho

et al. 2020

Liver Transpl.

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Background: Laparoscopic living-donor hepatectomy for transplantation has been established well over the last decade. This study aimed to assess its safety and feasibility in pediatric living-donor liver transplantation (LDLT) by comparing the surgical and longterm survival outcomes on both the donor and recipient sides between open and laparoscopic groups. Methods: The medical records of 100 patients (≤17 years old) who underwent ABOcompatible LDLT using a left lateral liver graft between May 2008 and June 2016 were analyzed. Thirty-one donors who underwent pure laparoscopic hepatectomy and their corresponding recipients were included in the study. Sixty-nine patients who underwent open living-donor hepatectomy during the same period were included as a comparison group. To overcome bias from the different distributions of covariables among the patients in the two study groups, a 1:1 propensity score matching analysis was performed. Results: The mean follow-up periods were 92.9 and 92.7 months in the open and laparoscopic groups, respectively. The mean postoperative hospital stay of the donors was significantly shorter in the laparoscopic group (8.1 days) than in the open group (10.6 days; p<0.001). Overall, the surgical complications in the donors and overall survival rate of recipients did not differ between the groups. Conclusion: Our data suggests that the laparoscopic environment was not associated with long-term graft survival during pediatric LDLT. In addition, the laparoscopic approach for the donors did not adversely affect the corresponding recipient's outcome. Laparoscopic left lateral sectionectomy for living donors is a safe, feasible, and reproducible procedure for pediatric liver transplantation.

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Laparoscopic vs. open left lateral sectionectomy: An update meta-analysis of randomized and non-randomized controlled trials

Cited by 45 publications

References 46 publications

Phlebotomy resulting in controlled hypovolaemia to prevent blood loss in major hepatic resections (PRICE-1): a pilot randomized clinical trial for feasibility

Phlebotomy resulting in controlled hypovolaemia to prevent blood loss in major hepatic resections (PRICE-1): a pilot randomized clinical trial for feasibility

Minimally invasive versus open right hepatectomy: Comparative study with propensity score matching analysis

Long‐Term Safety and Efficacy of Pure Laparoscopic Donor Hepatectomy in Pediatric Living Donor Liver Transplantation

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