Technical feasibility and short-term outcomes of laparoscopic isolated caudate lobe resection: an IgoMILS (Italian Group of Minimally Invasive Liver Surgery) registry-based study

Abstract

Background Although isolated caudate lobe (CL) liver resection is not a contraindication for minimally invasive liver surgery (MILS), feasibility and safety of the procedure are still poorly investigated. To address this gap, we evaluate data on the Italian prospective maintained database on laparoscopic liver surgery (IgoMILS) and compare outcomes between MILS and open group. Methods Perioperative data of patients with malignancies, as colorectal liver metastases (CRLM), hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), non-colorectal liver metastases (NCRLM) and benign liver disease, were retrospectively analyzed. A propensity score matching (PSM) analysis was performed to balance the potential selection bias for MILS and open group. Results A total of 224 patients were included in the study, 47 and 177 patients underwent MILS and open isolated CL resection, respectively. The overall complication rate was comparable between the two groups; however, severe complication rate (Dindo–Clavien grade ≥ 3) was lower in the MILS group (0% versus 6.8%, P = ns). In-hospital mortality was 0% in both groups and mean hospital stay was significantly shorter in the MILS group (P = 0.01). After selection of 42 MILS and 43 open CL resections by PSM analysis, intraoperative and postoperative outcomes remained similar except for the hospital stay which was not significantly shorter in MILS group. Conclusions This multi-institutional cohort study shows that MILS CL resection is feasible and safe. The surgical procedure can be technically demanding compared to open resection, whereas good perioperative outcomes can be achieved in highly selected patients.

Procedural outcomes of laparoscopic caudate lobe resection: A systematic review and meta-analysis

“…Full texts of the remaining 15 articles were evaluated, which resulted in exclusion of another three articles which were review articles. Consequently, 12 articles [6,[10][11][12][13][14][15][16][17][18][19][20] consisting of four retrospective cohort studies [17][18][19][20] and eight case-series [6,[10][11][12][13][14][15][16] including 196 patients were considered eligible for inclusion. The study flow chart is shown in Fig.…”

Laparoscopic versus open caudate lobe liver resections: a 1:2 propensity score‐matched controlled study based on a single institution experience

“…L-CLR is a technically challenging procedure and is only performed routinely by highly experienced laparoscopic liver surgeons. 11,12,34,35 The main challenge of L-CLR is the risk for massive blood loss and the difficulty in obtaining clear resection margins. Despite these technical challenges, L-CLR when performed safely has been shown to offer all the advantages of LLR 36 such as decreased surgical blood loss and length of stay.…”

“…Unsurprisingly, most resections for caudate lobe lesions are still performed via the open approach. L‐CLR is a technically challenging procedure and is only performed routinely by highly experienced laparoscopic liver surgeons 11,12,34,35 . The main challenge of L‐CLR is the risk for massive blood loss and the difficulty in obtaining clear resection margins.…”

“…10 These result in a lack of space for visualization, manipulation and dissection which are rendered even more arduous when approached laparoscopically. [11][12][13] Despite proposed strategies for laparoscopic caudate lobe resection (L-CLR) such as the high dorsal resection or the splitting anterior resection, [14][15][16] there is no standard approach at the present due to their high difficulty level. In cases with sufficient functional liver remnant (FLR), a combined caudate and hemi-liver or adjacent segments is sometimes considered as the safest approach albeit the lack of parenchymal preservation.…”

“…The difficulty of a caudate lobectomy is attributed to its deep and posterior location, amidst critical structures namely the hepatic veins, the hepatic hilum and the inferior vena cava (IVC) 10 . These result in a lack of space for visualization, manipulation and dissection which are rendered even more arduous when approached laparoscopically 11–13 …”