• Humans
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/surgery
• Carcinoma, Hepatocellular/pathology
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/surgery
• Liver Neoplasms/pathology
• Retrospective Studies
• Hepatectomy/adverse effects
• Laparoscopy/adverse effects
• Propensity Score
• Length of Stay
• Treatment Outcome

• Conversion
• Hepatectomy
• Intrahepatic cholangiocarcinoma
• Laparoscopic liver resection
• Minimally invasive hepatectomy

• Humans
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Postoperative Complications/surgery
• Hepatectomy/adverse effects
• Cholangiocarcinoma/complications
• Risk Factors
• Laparoscopy/adverse effects
• Bile Ducts, Intrahepatic/pathology
• Bile Duct Neoplasms/complications
• Liver Neoplasms/surgery
• Retrospective Studies
• Length of Stay

• No. 82072625 National Natural Science Foundation of China
• No. 2021C03127 Key Research and Development Project of Zhejiang Province

• Hepatectomy
• Hepatocellular carcinoma
• Minimally invasive
• Robotic

• Humans
• Carcinoma, Hepatocellular/surgery
• Carcinoma, Hepatocellular/pathology
• Liver Neoplasms/surgery
• Liver Neoplasms/pathology
• Robotic Surgical Procedures/methods
• Operative Time
• Robotics

• Difficulty score
• Minimally invasive techniques
• Robotic-assisted hepatectomy
• Validation study

• Humans
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods
• East Asian People
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Postoperative Complications/surgery
• Length of Stay
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Liver Failure
• Operative Time
• Retrospective Studies
• Hepatic Insufficiency
• Liver Neoplasms
• Treatment Outcome

• hepatocellular carcinoma
• laparoscopy
• propensity matching
• recurrence
• right hepatectomy
• surgical complications

• hepatocellular carcinoma
• laparoscopic liver resection
• long-term outcomes
• robot-assisted

Recently, the effectiveness of “textbook outcomes (TO)” in the evaluation of surgical quality has been recognized by more and more scholars. This study tended to examine the association between preoperative albumin–bilirubin (ALBI) grades and the incidence of achieving or not achieving TO (non-TO) in patients with hepatocellular carcinoma (HCC) undergoing laparoscopic hepatectomy.

The patients were stratified into two groups: ALBI grade 1 (ALBI ≤ -2.60) and ALBI grade 2/3 (ALBI > -2.60). The characteristics of patients and the incidence of non-TO were compared. Multivariate analyses were performed to determine whether ALBI grade was independently associated with TO.

In total, 378 patients were enrolled, including 194 patients (51.3%) in the ALBI grade 1 group and 184 patients (48.7%) in the ALBI grade 2/3 group. In the whole cohort, 198 patients (52.4%) did not achieve TO, and the incidence of non-TO in the ALBI grade 2/3 group was obviously higher than that in the ALBI grade 1 group (n = 112, 60.9% vs. n = 86, 44.3%, P = 0.001). The multivariate analyses showed that ALBI grade 2/3 was an independent risk factor for non-TO (OR: 1.95, 95%CI: 1.30–2.94, P = 0.023).

More than half (52.4%) of the patients with hepatocellular carcinoma did not achieve TO after laparoscopic hepatectomy, and preoperative ALBI grade 2/3 was significantly associated with non-TO. Improving the liver function reserve of patients before operation, thereby reducing the ALBI grade, may increase the probability for patients to reach TO and enable patients to benefit more from surgery.

• hepatocellular carcinoma
• laparoscopic liver resection
• review

• Carcinoma, Hepatocellular/surgery
• Hepatectomy
• Humans
• Laparoscopy
• Length of Stay
• Liver Neoplasms/surgery
• Neoplasm Recurrence, Local
• Postoperative Complications
• Treatment Outcome

• Enhanced Recovery After Surgery
• Hepatectomy
• Humans
• Length of Stay
• Liver Cirrhosis/complications
• Postoperative Complications/epidemiology
• Treatment Outcome

• intrahepatic cholangiocarcinoma
• laparoscopy
• liver resection
• lymphadenectomy

• cirrhosis
• hepatectomy
• hepatocellular carcinoma
• laparoscopy
• liver surgery
• portal hypertension
• robotic

• Hepatocellular carcinoma
• Laparoscopic
• Liver resection

• Laparoscopic liver resection (LLR)
• indication
• minimally invasive
• technique

• hepatocellular carcinoma
• laparoscopic
• open liver resection

• Hepatocellular carcinoma
• laparoscopy
• metastasis

• Endobronchial ultrasonography
• laparoscopic liver segmentectomy
• portal vein staining

• Hepatocellular carcinoma
• Laparoscopy
• Minimally invasive liver resection
• Open
• Resection

Liver resection represents the treatment of choice for a small proportion of patients with hepatocellular carcinoma (HCC), amenable to surgery. The remarkable evolution in surgical techniques during the last decades introduced laparoscopic hepatectomy in the operative management of HCC, even in the presence of liver cirrhosis. No comparative study on laparoscopic or open liver resection for HCC has been conducted in Greece yet.

Patients undergoing liver resection for HCC by one senior hepatobiliary surgeon in our Institution during the period 11/2011-02/2016 were prospectively sampled and retrospectively analyzed for the purposes of this study. Statistical analysis encompassed Student’s t-test, Fisher’s exact test, the Kaplan-Meier method/log rank test and Cox proportional hazard regression analyses.

Eleven patients underwent laparoscopic and 21 open liver resection, respectively. Statistical differences between the 2 groups were observed for tumor size (P=0.04), major resections (P=0.01), Pringle maneuver (P=0.008), intraoperative blood transfusion (P=0.03), and duration of operation (P=0.004). Resection margins, and tumor recurrence showed no statistical differences. Three-year postoperative survival after laparoscopic and open hepatectomy was 100%, and 67%, respectively (P=0.06). Regression analysis for patient survival revealed prognostic value for BCLC staging, γ-glutamyl transferase levels, laparoscopic hepatectomy, UICC stage, Dindo-Clavien classification, and hospital stay. Laparoscopic hepatectomy remained as independent predictor of survival by multivariate analysis (P=0.0142).

Laparoscopic hepatectomy for HCC in chronic liver disease represents a safe and innovative treatment tool in the management of these patients under the presupposition of careful patient selection.

• Laparoscopic hepatectomy
• hepatocellular carcinoma
• hospital stay
• liver cirrhosis
• liver resection

• Hepatectomy
• Laparoscopic cholecystectomy
• Minimally invasive surgical procedures
• Robotic surgical procedures

• Colorectal liver metastases
• hepatocellular carcinoma (HCC)
• laparoscopic liver resection (LLR)
• learning curve
• liver cancer

AIM: To compare the surgical outcomes between laparoscopic liver resection (LLR) and open liver resection (OLR) as a curative treatment in patients with hepatocellular carcinoma (HCC).

METHODS: A PubMed database search was performed systematically to identify comparative studies of LLR vs OLR for HCC from 2000 to 2014. An extensive text word search was conducted, using combinations of search headings such as “laparoscopy”, “hepatectomy”, and “hepatocellular carcinoma”. A comparative study was also performed in our institution where we analysed surgical outcomes of 152 patients who underwent liver resection between January 2005 to December 2012, of which 42 underwent laparoscopic or hand-assisted laparoscopic resection and 110 underwent open resection.

RESULTS: Analysis of our own series and a review of 17 high-quality studies showed that LLR was superior to OLR in terms of short-term outcomes, as patients in the laparoscopic arm were found to have less intraoperative blood loss, less blood transfusions, and a shorter length of hospital stay. In our own series, both LLR and OLR groups were found to have similar overall survival (OS) rates, but disease-free survival (DFS) rates were higher in the laparoscopic arm.

CONCLUSION: LLR is associated with better short-term outcomes compared to OLR as a curative treatment for HCC. Long-term oncologic outcomes with regards to OS and DFS rates were found to be comparable in both groups. LLR is hence a safe and viable option for curative resection of HCC.

• Hepatocellular carcinoma
• Laparoscopy
• Open liver resection
• Hepatectomy
• Surgery

Since 1993, we have performed minimally invasive laparoscopic liver resection (LLR) to treat malignant liver cancer, including colorectal liver metastases (CLM). However, further studies are needed to accumulate sufficient evidence on the oncological outcome of LLR for CLM.

To elucidate the efficacy of LLR for CLM, this study comparatively analyzed the invasiveness and short-term prognosis of LLR (n = 43 cases) and open liver resection (OR) (n = 62 cases) performed for CLM after 2006 and also investigated the safety of LLR following chemotherapy.

Compared with the OR group, the LLR group had significantly less blood loss (P < 0.001) and a shorter hospital stay (P < 0.001). The E-PASS scoring system was used to compare surgical invasiveness, and although the preoperative risk score did not differ between the groups, the surgical stress score and comprehensive risk score were significantly lower in the LLR group (P < 0.001). Concerning the survival rate and disease-free survival rate, there were no significant differences between procedures. However, more clinical cases and longer follow-up periods are needed to reach a definitive conclusion.

Preoperative hemanalysis, intraoperative bleeding, complications, and postoperative length of stay did not differ significantly between LLR patients with preoperative chemotherapy and those with surgery alone, indicating no adverse effects of chemotherapy.

LLR can be an effective minimally invasive surgery in CLM patients receiving both perioperative chemotherapy and surgery. Because LLR is comparable with OR with regard to short-term oncological outcome, LLR may be a valuable option for CLM.

The laparoscopic technique was introduced in gastrointestinal surgery in the mid 1980s. Since then, the development of this technique has been extraordinary. Triggered by technical innovations (stapling devices or coagulation/dissecting devices), nowadays any type of gastrointestinal resection has been successfully performed laparoscopically and can be performed laparoscopically dependent on the patient’s condition. This summary gives an overview over 30 years of laparoscopic surgery with focus on today’s indications and evidence. Main indications remain the more common procedures, e.g., appendectomy, cholecystectomy, bariatric procedures or colorectal resections. For all these indications, the laparoscopic approach has become the gold standard with less perioperative morbidity. Regarding oncological outcome there have been several high-quality randomized controlled trials which demonstrated equivalency between laparoscopic and open colorectal resections. Less common procedures like esophagectomy, oncological gastrectomy, liver and pancreatic resections can be performed successfully as well by an experienced surgeon. However, the evidence for these special indications is poor and a general recommendation cannot be given. In conclusion, laparoscopic surgery has revolutionized the field of gastrointestinal surgery by reducing perioperative morbidity without disregarding surgical principles especially in oncological surgery.

• Laparoscopy
• Gastrointestinal surgery
• Esophagus
• Stomach
• Cholecystectomy, Colorectal surgery
• Liver resection
• Pancreas resection
• Laparoscopic resection of gastrointestinal

• Digestive System Diseases/diagnosis
• Digestive System Diseases/mortality
• Digestive System Diseases/surgery
• Digestive System Neoplasms/diagnosis
• Digestive System Neoplasms/mortality
• Digestive System Neoplasms/surgery
• Digestive System Surgical Procedures/adverse effects
• Digestive System Surgical Procedures/methods
• Digestive System Surgical Procedures/mortality
• Evidence-Based Medicine
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/mortality
• Risk Factors
• Treatment Outcome

Hepatic tumors in the lower edge and lateral segments are commonly treated by laparoscopic liver resection. Tumors in the anterosuperior and posterior segments are often large and locally invasive, and resection is associated with a higher risk of insufficient surgical margins, massive intraoperative bleeding, and breaching of the tumor. Laparoscopic surgery for such tumors often involves major hepatectomy, including resection of a large volume of normal liver tissue. We developed a novel method of laparoscopic resection of tumors in these segments with the patient in the semiprone position, using a dual-handling technique with an intercostal transthoracic port. The aim of this study was to evaluate the safety and usefulness of our technique.

Of 160 patients who underwent laparoscopic liver resection at our center from June 2008 to May 2013, we retrospectively reviewed those with tumors in the anterosuperior and posterior segments. Patients were placed supine or semilateral during surgery until January 2010 and semiprone from February 2010.

Before the introduction of the semiprone position in February 2010, a total of 7 of 40 patients (17.5 %) with tumors in the anterosuperior and posterior segments underwent laparoscopic liver resection, and after introduction of the semiprone position, 69 of 120 patients (57.5 %) with tumors in the anterosuperior and posterior segments underwent laparoscopic liver resection (P < 0.001). There were no conversions to open surgery, reoperations, or deaths. The semiprone group had a significantly higher proportion of patients who underwent partial resection or segmentectomy of S7 or S8, lower intraoperative blood loss, and shorter hospital stay than the supine group (all P < 0.05). Postoperative complication rates were similar between groups.

Laparoscopic liver resection in the semiprone position is safe and increases the number of patients who can be treated by laparoscopic surgery without increasing the frequency of major hepatectomy.

The online version of this article (doi:10.1007/s00464-014-3469-y) contains supplementary material, which is available to authorized users.

Surgical resection for hepatocellular carcinoma (HCC) in cirrhotic patients remains controversial because of high morbidity and recurrence rates. Laparoscopic resection of liver tumors has recently been developed and could reduce morbidity. The aim of this study was to evaluate retrospectively our results for laparoscopic liver resection (LLR) for HCC including lesions in the posterosuperior segments of the liver in terms of feasibility, outcome, recurrence and survival.

Between June 2005 and February 2009, we performed 20 LLR for HCC. Median age of the patients was 66 years. The underlying cirrhosis was staged as Child A in 17 cases and Child B in 3.

LLR included anatomic resection in six cases and nonanatomic resection in 14. Eleven procedures were associated in nine (45%) patients. Median tumor size and surgical margins were 3.1 cm and 15 mm, respectively. A conversion to laparotomy occurred in one (5%) patient for hemorrhage. Mortality and morbidity rates were 0% and 15% (3/20). Median hospital stay was 8 days (range: 5-16 days). Over a mean follow-up period of 26 months (range: 19–62 months), 10 (50%) patients presented recurrence, mainly at distance from the surgical site. Treatment of recurrence was possible in all the patients, including orthotopic liver transplantation in three cases.

LLR for HCC in selected patients is a safe procedure with good short-term results. It can also be proposed in tumor locations with a difficult surgical access maintaining a low morbidity rate and good oncological adequacy. This approach could have an impact on the therapeutic strategy of HCC complicating cirrhosis as a treatment with curative intent or as a bridge to liver transplantation.

• Cirrhosis
• hepatocarcinoma
• laparoscopy
• liver resection

AIM: To determine if liver regeneration (LR) could be disturbed following radiofrequency (RF) ablation and whether modification of LR by steroid administration occurs.

METHODS: Sham operation, partial hepatectomy (PH), and partial hepatectomy with radiofrequency ablation (PHA) were performed on adult Fisher 344 rats. We investigated the recovery of liver volume, DNA synthetic activities, serum cytokine/chemokine levels and signal transducers and activators of transcription 3 DNA-binding activities in the nucleus after the operations. Additionally, the effects of steroid (dexamethasone) pretreatment in the PH group (S-PH) and the PHA group (S-PHA) were compared.

RESULTS: The LR after PHA was impaired, with high serum cytokine/chemokine induction compared to PH, although the ratio of the residual liver weight to body weight was not significantly different. Steroid pretreatment disturbed LR in the S-PH group. On the other hand, low-dose steroid pretreatment improved LR and suppressed tumor necrosis factor (TNF)-α elevation in the S-PHA group, with recovery of STAT3 DNA-binding activity. On the other hand, low-dose steroid pretreatment improved LR and suppressed TNF-α elevation in the S-PHA group, with recovery of STAT3 DNA-binding activity.

CONCLUSION: LR is disturbed after RF ablation, with high serum cytokine/chemokine induction. Low-dose steroid administration can improve LR after RF ablation with TNF-α suppression.

• Liver regeneration
• Radiofrequency ablation
• Steroid
• Tumor necrosis factor
• Hepatectomy