Laparoscopic Caudate Hepatectomy for Cancer-An Innovative Approach to the No-Man's Land
Department of Surgery, Far Eastern Memorial Hospital, 220, 21, Sec. 2, Nan-Ya S. Road, Ban Ciao, Taipei, Taiwan. Journal of Gastrointestinal Surgery
(Impact Factor: 2.8).
01/2013; 17(3). DOI: 10.1007/s11605-012-2115-z
Caudate hepatectomy remains a surgical challenge in spite of recent advances in laparoscopic technique. Hepatic tumor in the caudate lobe is usually deeply located in the center of the liver and close to the vena cava and hepatic hilum. Thus, lesion in this region was considered as a contraindication of laparoscopic hepatectomy. Only sporadic reports could be found in the literature. The aim of this study is to review the safety and feasibility of laparoscopic hepatectomy for lesions in the caudate lobe.
Nine consecutive patients with caudate hepatic tumor received laparoscopic caudate hepatectomy in our institute from February 2006 to July 2010. One patient with hepatic adenoma was excluded from the analysis. Demographic data, intraoperative parameters, and postoperative outcomes of the remaining eight patients were assessed.
All procedure for these eight patients with caudate hepatic tumors (size 0.9-4.5 cm) were completed with totally laparoscopic technique except one in which additional left hepatectomy was also done. The average operative time was 254 min (range 210-345 min) and estimated blood loss was 202 ml (range 10-1,000 ml), and average length of postoperative hospital stay was 6.9 days (range 4-11 days). There was no perioperative complications and patient mortality in this series.
Our experience demonstrated that laparoscopic hepatectomy is a safe and feasible procedure for caudate hepatic tumors in selected patients.
Available from: Prejesh Philips
- "Better transections techniques, improved preoperative planning adjuncts, and ever evolving and improving surgical techniques inherent to complex surgery such as caudatectomies are reflected in our temporal subgroup analysis. None of the patients in this series underwent laparoscopic caudate lobe resections, which recent publications suggest is being performed in high-volume centers and is feasible [29,30]. "
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ABSTRACT: Despite the increasing frequency of liver resection for multiple types of disease, caudate lobe resection remains a rare surgical event. The goal of this study is to review our experience and evaluate possible predictors of adverse outcomes in patients undergoing caudate lobectomy.
We reviewed a 1,900-patient prospective hepato-pancreatico-biliary database from January 2000 to December 2011, identifying 36 hepatectomy patients undergoing caudate lobe resection. Clinicopathologic characteristic and outcome data were compared using chi-square, T-test, ANOVA, Kaplan-Meier, and Cox regression analysis. Primary endpoints were the incidence and severity of complications, and secondary endpoints were blood loss, hospital stay, and transfusion requirements. Patients were also divided in two groups with group A being patients operated on before December 2007 and group B after 2007. We compared the demographics, risk factors, complication rates, and operative details between the two groups.
Thirty-six patients underwent caudate lobe resection for cholangiocarcinoma (47.2%), metastatic colorectal cancer (36.1%), hepatocellular carcinoma (8.3%), or benign disease (8.3%). Nine patients (29%) had additional liver resection. Median overall survival (OS) was 21 months. Complications occurred in 52.7% (19/36) of patients with a median grade of 2. Tobacco abuse was associated with an increased risk of operative complications (73.3% vs. 38.9%, p = 0.03). Prior history of cardiac disease was associated with a higher complication rate (87% vs. 42%, p = 0.03). Neoadjuvant chemotherapy, biliary procedures, hepatitis, and prior major abdominal surgery were not predictive of complications. Major complication was also predicted by the volume of RBC transfusion (2.7 vs. 4.1 units, p = 0.003). In our subgroup analysis of the patients undergoing surgery before and after 2007, the two groups were well matched based on age, comorbidities, and risk factors. The complication rates and rates of high-grade complications were similar, but blood loss (600 ml vs. 400 ml, p = -0.03), inflow occlusion time (Pringle time 12.6 vs. 6, p = 0.00), and hospital stay (9.5 vs. 7 days, p = 0.01) were significantly lower in group B.
With appropriate patient selection, caudate lobe resection is an effective component of surgery for hepatic disease. Tobacco use and prior cardiac history increase the risk of complications.
Available from: Michael D Kluger
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ABSTRACT: Laparoscopic liver surgery has evolved over the last two decades. Advancements in surgical technology, surgical technique, and postoperative care have aided in lifting barriers to laparoscopic liver resection (LLR). In this review, the authors highlight the modern indications, benefits, safety, and feasibility of laparoscopic liver resections. Moreover, they analyze various studies comparing laparoscopic major hepatectomies to open surgery. Morbidity and mortality rates are at an all-time low in this era of laparoscopic liver surgery. The role of laparoscopy for oncologic resections is compared with open liver resections. Attention is given to oncologic margins and survival rates. In addition, the authors examine the safety and efficacy of LLR for nontraditional laparoscopic segments and tumors abutting major hepatic vasculature. Various resection techniques are reviewed including the use of the hanging-maneuver and modern stapling devices. Finally, they examine several novel techniques for laparoscopic liver resections including the hybrid technique, as is used in laparoscopic living donor hepatectomies, the use of hand-assistance to avoid conversion to open surgery, and the use of the robotic platform to aid in complex biliary or vascular reconstructions. Current barriers to laparoscopic liver surgery will continue to fall over the next decade.
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ABSTRACT: Laparoscopic hepatectomy and hepaticojejunostomy remain a surgical challenge despite the recent advances in minimally invasive surgery. A robotic surgical system has been developed to overcome the inherent limitations of the traditional laparoscopic approach. However, techniques of robotic hepatectomy have not been well described, and a description of robotic major hepatectomy with bilioenteric anastomosis can be found only in two previous reports. Here, we report a 33-year-old man with a history of choledochocyst resection. The patient experienced repeat cholangitis with left hepatolithiasis during follow-up. Robotic left hepatectomy and revision of hepaticojejunostomy were performed smoothly. The patient recovered uneventfully and remained symptoms-free at a follow-up of 20 months. The robotic approach is beneficial in the fine dissection of the hepatic hilum and revision of hepaticojejunostomy in this particular patient.
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