Laparoscopic versus open left lateral hepatectomy

ArticleinExpert review of gastroenterology & hepatology 3(4):345-51 · September 2009with25 Reads
DOI: 10.1586/egh.09.36 · Source: PubMed
Abstract
Laparoscopic liver surgery is becoming more popular, and many high-volume liver centers are now gaining expertise in this area. Laparoscopic left lateral hepatectomy (LLLH) is a standardized and anatomically well-defined resection and may transform into a primarily laparoscopic procedure for cancer surgery or living donor hepatectomy for transplantation. Five case-control series were identified comparing a total of 167 cases (86 cases of LLLH plus 81 cases of open left lateral hepatectomy). Groups were matched by age and sex, with broadly similar indications for surgery and resection techniques. LLLH is associated with shorter hospital stays and less blood loss without compromising the margin status or increasing complication rates. Donors of LLLH grafts did not have higher graft-related morbidity. Prospective studies are required to define the safety in terms of disease-free and overall survival in this new avenue in laparoscopic liver surgery.
    • "Therefore, meta-analyses have been performed only quite recently from the selected studies [8–10, 18, 27, 34–37]. Nevertheless, there has been no reported prospective, randomized controlled study of LR versus OR for HCC [9,[17][18][19], and only one trial is currently underway recruiting participants from the Republic of Korea [38]. In addition, the oncologic results of LR for HCC remain a matter of debate [5, 18], and studies for long-term oncologic outcomes and for HCC accompanying liver cirrhosis are insufficient [10, 12–15, 17, 20–22]. "
    [Show abstract] [Hide abstract] ABSTRACT: Laparoscopic liver resection (LR) for hepatocellular carcinoma (HCC) is usually applied to superficial and left-side small lesions. Therefore, well designed comparative studies about the results of LR versus open liver resection (OR) for HCC are difficult and still uncommon. The aim of this study was to compare the perioperative and long-term oncologic outcomes of LR versus OR for HCC between well-matched patient groups. Between January 2000 and March 2012, 205 patients (43 with intent-to-treat with LR, 162 OR) underwent primary liver resection of less than three segments for HCC in our center. To select a comparison group, propensity score matching (PSM) was used at 1:1 ratio with covariates of baseline characteristics, including tumor characteristics. Outcomes were compared between the matched groups. The two groups were well balanced by PSM and 29 patients were matched respectively. In LR, there was more non-anatomical resection (65.5 vs. 34.5 %; p = 0.012), less postoperative ascites (0.0 vs. 17.2 %; p = 0.025), and shorter hospital stay (7.69 ± 2.94 vs. 13.38 ± 7.37 days; p < 0.001). With the exception of these, there were no significant differences in perioperative and long-term outcomes. The 1-, 3- and 5-year survivals were 100, 100 and 92.2 % in LR, and 96.5, 92.2 and 87.7 % in OR (p = 0.267), respectively. The 1-, 3- and 5-year disease-free survivals were 81.7, 61.7 and 54.0 % in LR, and 78.6, 60.9 and 40.1 % in OR, respectively (p = 0.929). The outcome of LR for HCC was technically feasible and safe in selected patients, and LR showed similar perioperative and long-term oncologic outcomes when compared with OR matched with PSM.
    Full-text · Article · Oct 2013
    • "Since the publication of the first nonanatomic liver resection and the first left lateral lobectomy, laparoscopic liver resection has been widely and increasingly performed for a variety of benign and malignant diseases [18, 19]. The development of this technique has been limited during this time due to difficulty reproducing basic open liver surgery maneuvers, risks of bleeding and pulmonary embolism, and fear of compromising oncologic resection by tumoral cell seeding [20, 21]. Laparoscopic LLS occupies a privileged position in laparoscopic liver surgery since it gained rapid popularity (as witnessed by several published series) for its well-defined anatomic surgical landmarks and relatively standardized technique. "
    [Show abstract] [Hide abstract] ABSTRACT: Laparoscopic left lateral sectionectomy (LLS) has gained popularity in its use for benign and malignant tumors. This report describes the evolution of the authors' experience using laparoscopic LLS for different indications including living liver donation. Between January 2004 and January 2009, 37 consecutive patients underwent laparoscopic LLS for benign, primary, and metastatic liver diseases, and for one case of living liver donation. Resection of malignant tumors was indicated for 19 (51%) of the 37 patients. All but three patients (deceased due to metastatic cancer disease) are alive and well after a median follow-up period of 20 months (range, 8-46 months). Liver cell adenomas (72%) were the main indication among benign tumors, and colorectal liver metastases (84%) were the first indication of malignancy. One case of live liver donation was performed. Whereas 16 patients (43%) had undergone a previous abdominal surgery, 3 patients (8%) had LLS combined with bowel resection. The median operation time was of 195 min (range, 115-300 min), and the median blood loss was of 50 ml (range, 0-500 ml). Mild to severe steatosis was noted in 7 patients (19%) and aspecific portal inflammation in 11 patients (30%). A median free margin of 5 mm (range, 5-27 mm) was achieved for all cancer patients. The overall recurrence rate for colorectal liver metastases was of 44% (7 patients), but none recurred at the surgical margin. No conversion to laparotomy was recorded, and the overall morbidity rate was 8.1% (1 grade 1 and 2 grade 2 complications). The median hospital stay was 6 days (range, 2-10 days). Laparoscopic LLS without portal clamping can be performed safely for cases of benign and malignant liver disease with minimal blood loss and overall morbidity, free resection margins, and a favorable outcome. As the ultimate step of the learning curve, laparoscopic LLS could be routinely proposed, potentially increasing the donor pool for living-related liver transplantation.
    Full-text · Article · Jan 2011
    • "We believe that only LLH rather than common bile duct exploration is required for simple left hepatolithiasis. Chen et al [16] has described that endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) for left hepatolithiasis with extrahepatic bile duct stones, can completely remove common bile duct stones followed by laparoscopic hepatectomy. However, ERCP easily causes acute pancreatitis, thus making cholelithiasis heavier and EST destroys the integrity of duodenal papilla and sphincter Oddi, easily leading to biliary tract infection and difficulty to remove the stones with a diameter > 1.5 cm. "
    Article · Jan 2010
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