Short- and long-term outcomes after laparoscopic and open hepatic resection: systematic review and meta-analysis

Mirnezami, Reza; Mirnezami, Alexander; Chandrakumaran, Kandiah; Hilal, Mohammed Abu; Pearce, Neil; Primrose, John; Sutcliffe, Robert P.

doi:10.1111/j.1477-2574.2011.00295.x

Cited by 199 publications

(150 citation statements)

References 54 publications

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“…Note however, that the vast majority of studies were retrospective studies, with no randomised controlled trials, and therefore there may be significant selection bias. Unsurprisingly, these findings echo those of an earlier meta-analysis of 26 studies [38] . However, in relation to oncological outcomes, this meta-analysis analysed HCC outcomes separately to other malignant diseases and found that there was a significant trend for improved overall survival (OR: 1.5 -1.0-2.2; P = 0.049) in the laparoscopic group.…”

Section: Laparoscopic Liver Resectionsupporting

confidence: 85%

Surgical management of hepatocellular carcinoma

Pang

Lam

2014

WJH

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Hepatocellular carcinoma (HCC) is the second most common cause of death from cancer worldwide. Standard potentially curative treatments are either resection or transplantation. The aim of this paper is to provide an overview of the surgical management of HCC, as well as highlight current issues in hepatic resection and transplantation. In summary, due to the relationship between HCC and chronic liver disease, the management of HCC depends both on tumourrelated and hepatic function-related considerations. As such, HCC is currently managed largely through nonsurgical means as the criteria, in relation to the above considerations, for surgical management is still largely

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Section: Laparoscopic Liver Resectionsupporting

confidence: 85%

Surgical management of hepatocellular carcinoma

Pang

Lam

2014

WJH

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“…In a comprehensive meta-analysis study, laparoscopic hepatectomy was compared to open hepatic resection in 1678 patients across 26 studies. While it is associated with longer operating times and no differences in oncological outcomes, it is advantageous in several aspects [3] . Laparoscopic hepatectomy is associated reduced blood loss, decreased portal clamp time, a decrease in overall and liver-specific complications, and shorter postoperative hospital stays [3] .…”

Section: Introductionmentioning

confidence: 99%

“…While it is associated with longer operating times and no differences in oncological outcomes, it is advantageous in several aspects [3] . Laparoscopic hepatectomy is associated reduced blood loss, decreased portal clamp time, a decrease in overall and liver-specific complications, and shorter postoperative hospital stays [3] . Recent technological development of devices and accumulation of experiences have facilitated the expansion of the indication of the procedure [4,5] .…”

Section: Introductionmentioning

confidence: 99%

Pure laparoscopic hepatectomy for hepatocellular carcinoma with chronic liver disease

Morise¹,

Kawabe

Kawase

et al. 2013

WJH

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Pure laparoscopic hepatectomy is a less invasive procedure than conventional open hepatectomy for the resection of hepatic lesions. Increases in experiences with the technique, in combination with advances in technology, have promoted the popularity of pure laparoscopic hepatectomy. However, indications for usage and potential contraindications of the procedure remain unresolved. The characteristics and specific advantages of the procedure, especially for hepatocellular carcinoma (HCC) patients with chronic liver diseases, are reviewed and discussed in this paper. For cirrhotic patients with liver tumors, pure laparoscopic hepatectomy minimizes destruction of the collateral blood and lymphatic flow from laparotomy and mobilization, and mesenchymal injury from compression. Therefore, pure laparoscopic hepatectomy has the specific advantage of minimal postoperative ascites production that leads to lowering the risk of disturbance in water or electrolyte balance and hypoproteinemia. It minimizes complications that routinely trigger postoperative serious liver failure. Under adequate patient positioning and port arrangement, the partial resection of the liver in the area of subphrenic space, peri-inferior vena cava area or next to the attachment of retro-peritoneum is facilitated in pure laparoscopic surgery by providing good vision and manipulation in the small operative field. Furthermore, the features of reduced post-operative adhesion, good vision, and manipulation within the small area between the adhesions make this procedure safer in the context of repeat hepatectomy procedures. These improved features are especially advantageous for patients with liver cirrhosis and multicentric and/or metachronous HCCs. Key words: Laparoscopic hepatectomy; Hepatocellular carcinoma; Liver cirrhosis; Chronic liver disease; Liver Tumor; Liver resection; Repeat hepatectomy; Bridging therapy to transplantation; Ascites; Postoperative liver failure Core tip: For cirrhotic patients with liver tumor, pure laparoscopic hepatectomy minimizes destruction of the collateral blood/lymphatic flow from laparotomy and mobilization, and has advantage of minimal postoperative ascites. It restrains the complications, which trigger the postoperative liver failure. The partial resection in the area of subphrenic space, peri-inferior vena cava area or next to the attachment of retro-peritoneum is facilitated with good vision and manipulation in the small operative field. Furthermore, repeat pure laparoscopic hepatectomy for patients with multicentric/ metachronous hepatocellular carcinomas was feasible and safe with the advantages of less post-operative adhesion and good vision and manipulation between the adhesions.

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“…Furthermore, these were found to be lower after LLR in 40 and 11 studies, respectively. Twelve meta-analyses and one Cochrane report were also analyzed [35][36][37][38][39][40][41][42][43][44][45][46][47] and consistent results included reduced blood loss and transfusions requirements when studied. This clearly shows that, in selected patients LLR when compared with open surgery is associated with reduced blood loss and subsequent transfusion rates.…”

Section: Discussionmentioning

confidence: 99%

Bleeding control during laparoscopic liver resection: a review of literature

Tranchart

O’Rourke

Dam

et al. 2015

J Hepatobiliary Pancreat Sci

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Despite the established advantages of laparoscopy, bleeding control during laparoscopic liver resection (LLR) is a liver-specific improvement. The 2nd International Consensus Conference on Laparoscopic Liver Resection was held in October 2014 at Morioka, Japan. One of the most capital questions was: What is essential in bleeding control during LLR? In order to correctly address this question, we conducted a comprehensive review of the literature. Essential points based on personal experience of the expert panel are also discussed. A total of 54 publications were identified. Based on this analysis, the working group built these recommendations: (1) a pneumoperitoneum of 10-14 mmHg should be used as it allows a good control of the bleeding without significant modifications of hemodynamics; (2) a low central venous pressure (<5 mmHg) should be used; (3) laparoscopy facilitates inflow and outflow control; and (4) surgeons should be experienced with the use of all surgical devices for liver transection and should master laparoscopic suture before starting LLR. Precoagulation with radiofrequency can be useful, particularly in cases of atypical resection. These recommendations are mostly based on experts' opinions and on B or C quality of evidence grade studies. More prospective data are required to confirm these results.

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Short- and long-term outcomes after laparoscopic and open hepatic resection: systematic review and meta-analysis

Abstract: LLR has short-term advantages and seemingly equivalent long-term outcomes and can be considered a feasible alternative to open surgery in experienced hands.

Cited by 199 publications

References 54 publications

Surgical management of hepatocellular carcinoma

Surgical management of hepatocellular carcinoma

Pure laparoscopic hepatectomy for hepatocellular carcinoma with chronic liver disease

Bleeding control during laparoscopic liver resection: a review of literature

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