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Troisi RI, Rompianesi G, D'Hondt M, Vanlander A, Bertrand C, Hubert C, Detry O, Van den Bossche B, Malvaux P, Weerts J, Sablon T, Vermeiren K, Biglari M, Gryspeerdt F, De Meyere C, Dili A, Boterbergh K, Lucidi V. Multicenter Belgian prospective registry on minimally invasive and open liver surgery (BReLLS): experience from 1342 consecutive cases. Langenbecks Arch Surg 2025; 410:86. [PMID: 40029488 DOI: 10.1007/s00423-025-03661-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Accepted: 02/24/2025] [Indexed: 03/05/2025]
Abstract
PURPOSE Minimally invasive liver surgery (MILS) still appears to be adopted with significant variability. We aimed to investigate the diffusion, indications, and short-term outcomes of MILS compared to the open approach. METHODS A prospective registry of all liver resections performed for any indication and using any technique between January 1, 2017, and December 31, 2019, was established (BReLLS) and analyzed. RESULTS A total of 1342 consecutive liver resections were included, 684 (51%) MILS and 658 (49%) open procedures. MILS was not attempted due to technical complexity in the 46.2% of cases, followed by previous abdominal surgery (22.5%). Patients undergoing MILS had a higher proportion of benign indications and of hepatocellular carcinomas, patients affected by liver cirrhosis with portal hypertension and a lower proportion of major hepatectomies (all p < 0.001). After propensity-score matching, MILS showed better results in terms of surgery duration (p < 0.001), blood loss (p = 0.015), complication rate (p < 0.001), rate of Clavien-Dindo grade ≥ 3 complications (p = 0.012), comprehensive complication index (p < 0.001), length of stay (p < 0.001), readmissions (p = 0.016). Centers performing over 50 liver resections per year had a higher proportion of overall MILS cases (p < 0.001), a similar proportion of major resections (p = 0.362), but a higher prevalence of MILS major resections (p = 0.004), lower 90-day mortality rates (p < 0.001), lower overall complication rates (p < 0.001), and shorter hospital length of stay (p < 0.001). CONCLUSION MILS was the preferred technique in half of the cases, particularly in patients with cirrhosis and portal hypertension, and benign lesions. It provided superior short-term outcomes compared to the open approach for both minor and major liver resections in selected patients.
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Affiliation(s)
- Roberto Ivan Troisi
- Faculty of Medicine, Ghent University, Ghent, Belgium.
- Federico II University Hospital, via S. Pansini 5, 80131, Naples, Italy.
| | | | | | | | | | | | - Olivier Detry
- Department of Abdominal Surgery and Transplantation - CHU Liege, University of Liege, Liège, Belgium
| | | | - Philippe Malvaux
- Centre Hospitalier de Wallonie Picard site Notre-Dame, Tournai, Belgium
| | | | | | | | | | | | | | | | | | - Valerio Lucidi
- Universite Libre de Bruxelles- Erasme Hospital, Brussels, Belgium
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2
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Zhang J, Shi M, Ding W, Duan M, Dai Z, Chen Y. Effect of minimally invasive versus open surgery in hepatectomy on postoperative wound complications in patients with hepatocellular carcinoma: A meta-analysis. Int Wound J 2023; 20:4159-4165. [PMID: 37442783 PMCID: PMC10681463 DOI: 10.1111/iwj.14313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
In a meta-analysis, we assessed the impact of different surgical approaches on the outcome of hepatectomy with hepatocellular carcinoma. Four databases, including PubMed, Embase, Cochrane Library, and the Web of Science, have been critically reviewed through the full literature through June 2023. Eleven related trials were examined once they had met the trial's classification and exclusion criteria, as well as the assessment of the quality. A random effects approach was applied to analysis of operative organ infections, and a fixed-effect model was applied to determine the 95% CI and OR. Analysis of the data was done with RevMan 5.3. Our findings indicated that patients undergoing minimally invasive liver cancer surgery had significantly lower risks of surgical organ infection (OR, 0.35; 95% CI, 0.16-0.77; p = 0.009) and wound infection (OR, 0.19; 95% CI, 0.13-0.28; p < 0.001) compared to those undergoing open surgery. There was no heterogeneity observed between the two groups (I2 = 0) in wound infection. Nevertheless, because of the limited number of randomised controlled trials in this meta-analysis, care should be taken and carefully considered in the treatment of these values. Further high-quality studies involving a large number of samples are needed to validate and reinforce the results.
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Affiliation(s)
- Junli Zhang
- Department of AnesthesiologyThe Sixth Medical Center of PLA General HospitalBeijingChina
| | - Meiping Shi
- Department of AnesthesiologyThe Sixth Medical Center of PLA General HospitalBeijingChina
| | - Wan Ding
- Department of AnesthesiologyThe Sixth Medical Center of PLA General HospitalBeijingChina
| | - Mingda Duan
- Department of AnesthesiologyHainan Branch of General Hospital of People's Liberation ArmySanyaChina
| | - Ziqing Dai
- Department of Medical RecordsThe Sixth Medical Center of PLA General HospitalBeijingChina
| | - Yu Chen
- Department of AnesthesiologyThe Sixth Medical Center of PLA General HospitalBeijingChina
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3
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Furumaya A, van Rosmalen BV, de Graeff JJ, van der Poel MJ, Ramsoekh DS, Kazemier G, Verheij J, Takkenberg RB, Besselink MG, Erdmann JI, van Gulik TM. Relief of symptoms and quality of life after conservative versus surgical treatment of benign liver tumors (CONSULT): a retrospective propensity score matched study. HPB (Oxford) 2023:S1365-182X(23)00073-4. [PMID: 36990916 DOI: 10.1016/j.hpb.2023.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Surgery can be considered for selected patients with benign liver tumours (BLT). The aim of this study was to compare symptoms and quality of life (QoL) after conservative and surgical management of BLT. METHODS In this dual-site cross-sectional retrospective study, adult patients with BLT diagnosed between 2000 and 2019 completed EORTC QLQ-C30 questionnaires on current symptoms and symptoms at diagnosis. Summary scores (SumScores) and QoL scores at follow-up were compared between surgically and conservatively treated patients by matched t-tests. Propensity score matching attempted to reduce confounding. Higher scores indicate less symptoms and higher QoL. RESULTS Fifty surgically (22.6%) and 171 (77.4%) conservatively treated patients were included at median 95 (IQR:66-120) and 91 (IQR:52-129) months, respectively. Most surgically treated patients reported stable, improved or disappeared symptoms (87%) and would undergo surgery again (94%). After propensity score matching, surgical patients had higher SumScores (mean difference 9.2, 95%CI:1.0-17.4, p = 0.028) but not higher QoL scores (p = 0.331) at follow-up than conservatively treated counterparts (31 patients in both groups). DISCUSSION Patients who had undergone surgery often reported they would undergo surgery again. Moreover, they had less symptoms than conservatively managed patients while they were propensity score matched on relevant variables, including baseline symptoms.
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Affiliation(s)
- Alicia Furumaya
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.
| | - Belle V van Rosmalen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Jan Jaap de Graeff
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Marcel J van der Poel
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - D Sandjai Ramsoekh
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Geert Kazemier
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Joanne Verheij
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Department of Pathology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - R Bart Takkenberg
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC Location University of Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Joris I Erdmann
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
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4
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Sood D, Kuchta K, Paterakos P, Schwarz JL, Rojas A, Choi SH, Vining CC, Talamonti MS, Hogg ME. Extended postoperative thromboprophylaxis after pancreatic resection for pancreatic cancer is associated with decreased risk of venous thromboembolism in the minimally invasive approach. J Surg Oncol 2023; 127:413-425. [PMID: 36367398 DOI: 10.1002/jso.27135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/17/2022] [Accepted: 10/23/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is associated with increased venous thromboembolism (VTE). We sought to compare rates of bleeding complications and VTE in patients receiving extended postoperative thromboprophylaxis (EPT) to those who did not, and identify risk factors for VTE after pancreatectomy for PDAC. METHODS This is a retrospective review of pancreatectomies for PDAC. EPT was defined as 28 days of low molecular weight heparin. Multivariable analysis (MVA) was performed to identify independent risk factors of VTE. RESULTS Of 269 patients included, 142 (52.8%) received EPT. Of those who received EPT, 7 (4.9%) suffered bleeding complications, compared to 6 (4.7%) of those who did not (p = 0.938). There was no significant difference in VTE rate at 90 days (2.8% vs. 2.4%, p = 0.728) or at 1 year (6.3% vs. 7.9%, p = 0.624). On MVA, risk factors for VTE included worse performance status, lower preoperative hematocrit, R1/R2 resection, and minimally invasive (MIS) approach. Among those who received EPT, there was no difference in VTE rate between MIS and open approach. CONCLUSIONS EPT was not associated with a difference in VTE risk or bleeding complications. MIS approach was associated with a higher risk of VTE; however, this was significantly lower among those who received EPT.
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Affiliation(s)
- Divya Sood
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Kristine Kuchta
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Pierce Paterakos
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Jason L Schwarz
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Aram Rojas
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Sung H Choi
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Charles C Vining
- Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Mark S Talamonti
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Melissa E Hogg
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
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5
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Elfrink AKE, Haring MPD, de Meijer VE, Ijzermans JNM, Swijnenburg RJ, Braat AE, Erdmann JI, Terkivatan T, Te Riele WW, van den Boezem PB, Coolsen MME, Leclercq WKG, Lips DJ, de Wilde RF, Kok NFM, Grünhagen DJ, Klaase JM. Surgical outcomes of laparoscopic and open resection of benign liver tumours in the Netherlands: a nationwide analysis. HPB (Oxford) 2021; 23:1230-1243. [PMID: 33478819 DOI: 10.1016/j.hpb.2020.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/18/2020] [Accepted: 12/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data on surgical outcomes of laparoscopic liver resection (LLR) versus open liver resection (OLR) of benign liver tumour (BLT) are scarce. This study aimed to provide a nationwide overview of postoperative outcomes after LLR and OLR of BLT. METHODS This was a nationwide retrospective study including all patients who underwent liver resection for hepatocellular adenoma, haemangioma and focal nodular hyperplasia in the Netherlands from 2014 to 2019. Propensity score matching (PSM) was applied to compare 30-day overall and major morbidity and 30-day mortality after OLR and LLR. RESULTS In total, 415 patients underwent BLT resection of whom 230 (55.4%) underwent LLR. PSM for OLR and LLR resulted in 250 matched patients. Median (IQR) length of stay was shorter after LLR than OLR (4 versus 6 days, 5.0-8.0, p < 0.001). Postoperative 30-day overall morbidity was lower after LLR than OLR (12.0% vs. 22.4%, p = 0.043). LLR was associated with reduced 30-day overall morbidity in multivariable analysis (aOR:0.46, CI:0.22-0.95, p = 0.043). Both 30-day major morbidity and 30-day mortality were not different. CONCLUSIONS LLR for BLT is associated with shorter hospital stay and reduced overall morbidity and is preferred if technically feasible.
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Affiliation(s)
- Arthur K E Elfrink
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden; Department of Surgery, University of Groningen and University Medical Center Groningen, Groningen.
| | - Martijn P D Haring
- Department of Surgery, University of Groningen and University Medical Center Groningen, Groningen; Dutch Benign Liver Tumour Group
| | - Vincent E de Meijer
- Department of Surgery, University of Groningen and University Medical Center Groningen, Groningen; Dutch Benign Liver Tumour Group
| | - Jan N M Ijzermans
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam; Dutch Benign Liver Tumour Group
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam
| | - Andries E Braat
- Department of Surgery, Leiden University Medical Center, Leiden; Dutch Benign Liver Tumour Group
| | - Joris I Erdmann
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam; Dutch Benign Liver Tumour Group
| | | | - Wouter W Te Riele
- Department of Surgery, University Medical Center Utrecht, Utrecht; Department of Surgery, Isala, Zwolle; St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Marielle M E Coolsen
- Department of Surgery, Maastricht University Medical Center, Maastricht; Dutch Benign Liver Tumour Group
| | | | - Daan J Lips
- Department of Surgery, Medisch Spectrum Twente, Enschede
| | | | - Niels F M Kok
- Department of Surgery, Antoni van Leeuwenhoek - Dutch Cancer Institute, Amsterdam
| | | | - Joost M Klaase
- Department of Surgery, University of Groningen and University Medical Center Groningen, Groningen
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Serum thymidine kinase 1 protein concentration for predicting early progression and monitoring the response to TACE in hepatocellular carcinomas: a network meta-analysis. Future Sci OA 2021; 7:FSO717. [PMID: 34258026 PMCID: PMC8256325 DOI: 10.2144/fsoa-2021-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/26/2021] [Indexed: 01/30/2023] Open
Abstract
Aim: A meta-analysis was conducted to evaluate the clinical significance of serum thymidine kinase 1 protein concentration (STK1p) in distinguishing between hepatocellular carcinomas (HCC) and non-HCC for predicting early progression and monitoring the response to transarterial chemoembolization in HCC. Materials & methods: A total of 24 eligible studies were included, containing 1849 HCC patients and 1069 healthy subjects. Results: The STK1p level significantly increased from normal controls to benign/pre-HCC and HCC (p < 0.0001). STK1p also increased significantly in sub-malignant groups: control being the lowest, followed consecutively by hepatic hemangioma, hepatitis B virus infection and hepatic cirrhosis (p < 0.05). After 1 month of transarterial chemoembolization treatment, STK1p level declined significantly, by 44.4% (p < 0.0001). Conclusion: STK1p is a useful prognostic biomarker in HCC. There is a need for reliable prognostic biomarkers in liver cancer, to support therapy efforts. In this study we investigated if thymidine kinase 1 in blood could be used to discover patients with hepatocellular carcinoma and show the results of their treatment. The results are based on 1847 hepatocellular carcinoma patients and 1069 healthy people. We conclude that serum thymidine kinase 1 protein concentration is a reliable biomarker in liver cancer.
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7
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Lim M, Kim JM, Kwon JE, Jeong ES, Yang J, Lee O, Kim KD, Kim SJ, Rhu J, Choi GS, Joh JW. Hepatocellular Carcinoma Arising from Hepatocellular Adenoma in an Elderly Male Patient. JOURNAL OF LIVER CANCER 2021; 21:87-91. [PMID: 37384277 PMCID: PMC10035722 DOI: 10.17998/jlc.21.1.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 06/30/2023]
Abstract
Hepatocellular adenoma is a benign tumor of the liver occurring predominantly in young women taking oral contraceptives. The malignant transformation of hepatocellular adenoma into hepatocellular carcinoma has rarely been reported. Herein, we report the case of an elderly male patient with hepatocellular carcinoma that developed from hepatocellular adenoma. The patient's high risk for surgery and conflicting biopsy and imaging results made it difficult to determine the treatment direction. Eventually, the mass was completely removed by laparoscopic left hemi-hepatectomy without complications.
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Affiliation(s)
- Manuel Lim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Eun Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sung Jeong
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaehun Yang
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Okjoo Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeong Deok Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Jin Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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8
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Duarte VC, Coelho FF, Valverde A, Danoussou D, Kruger JAP, Zuber K, Fonseca GM, Jeismann VB, Herman P, Lupinacci RM. Minimally invasive versus open right hepatectomy: comparative study with propensity score matching analysis. BMC Surg 2020; 20:260. [PMID: 33126885 PMCID: PMC7602349 DOI: 10.1186/s12893-020-00919-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/20/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Minimally invasive liver resections (MILRs) have been increasingly performed in recent years. However, the majority of MILRs are actually minor or limited resections of peripheral lesions. Due to the technical complexity major hepatectomies remain challenging for minimally invasive surgery. The aim of this study was to compare the short and long-term outcomes of patients undergoing minimally invasive right hepatectomies (MIRHs) with contemporary patients undergoing open right hepatectomies (ORHs) METHODS: Consecutive patients submitted to anatomic right hepatectomies between January 2013 and December 2018 in two tertiary referral centers were studied. Study groups were compared on an intention-to-treat basis after propensity score matching (PSM). Overall survival (OS) analyses were performed for the entire cohort and specific etiologies subgroups RESULTS: During study period 178 right hepatectomies were performed. After matching, 37 patients were included in MIRH group and 60 in ORH group. The groups were homogenous for all baseline characteristics. MIRHs had significant lower blood loss (400 ml vs. 500 ml, P = 0.01), lower rate of minor complications (13.5% vs. 35%, P = 0.03) and larger resection margins (10 mm vs. 5 mm, P = 0.03) when compared to ORHs. Additionally, a non-significant decrease in hospital stay (ORH 9 days vs. MIRH 7 days, P = 0.09) was observed. No differences regarding the use of Pringle's maneuver, operative time, overall morbidity or perioperative mortality were observed. OS was similar between the groups (P = 0.13). Similarly, no difference in OS was found in subgroups of patients with primary liver tumors (P = 0.09) and liver metastasis (P = 0.80). CONCLUSIONS MIRHs are feasible and safe in experienced hands. Minimally invasive approach was associated with less blood loss, a significant reduction in minor perioperative complications, and did not negatively affect long-term outcomes.
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Affiliation(s)
- Vinícius Campos Duarte
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Rua Dr. Enéas de Carvalho Aguiar, 255-9º Andar-sala 9025, São Paulo, SP, CEP 05403-900, Brazil.
| | - Fabricio Ferreira Coelho
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Rua Dr. Enéas de Carvalho Aguiar, 255-9º Andar-sala 9025, São Paulo, SP, CEP 05403-900, Brazil
| | - Alain Valverde
- Digestive Surgery Unit, Diaconesses Croix Saint Simon Hospital, 125, Rue d'Avron, 75020, Paris, France
| | - Divia Danoussou
- Digestive Surgery Unit, Diaconesses Croix Saint Simon Hospital, 125, Rue d'Avron, 75020, Paris, France
| | - Jaime Arthur Pirola Kruger
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Rua Dr. Enéas de Carvalho Aguiar, 255-9º Andar-sala 9025, São Paulo, SP, CEP 05403-900, Brazil
| | - Kevin Zuber
- Research and Biostatistics Unit, Rothschild Foundation Hospital, Paris, France
| | - Gilton Marques Fonseca
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Rua Dr. Enéas de Carvalho Aguiar, 255-9º Andar-sala 9025, São Paulo, SP, CEP 05403-900, Brazil
| | - Vagner Birk Jeismann
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Rua Dr. Enéas de Carvalho Aguiar, 255-9º Andar-sala 9025, São Paulo, SP, CEP 05403-900, Brazil
| | - Paulo Herman
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Rua Dr. Enéas de Carvalho Aguiar, 255-9º Andar-sala 9025, São Paulo, SP, CEP 05403-900, Brazil
| | - Renato Micelli Lupinacci
- Digestive Surgery Unit, Diaconesses Croix Saint Simon Hospital, 125, Rue d'Avron, 75020, Paris, France.,AP-HP, Department of Digestive, Oncologic and Metabolic Surgery, Ambroise Paré Hospital, Boulogne-Billancourt, France.,Versailles St-Quentin-en-Yvelines/Paris Saclay University, UFR des Sciences de la Santé Simone Veil, Montigny-Le-Bretonneux, France
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9
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Surgical Management of Hepatic Benign Disease: Have the Number of Liver Resections Increased in the Era of Minimally Invasive Approach? Analysis from the I Go MILS (Italian Group of Minimally Invasive Liver Surgery) Registry. J Gastrointest Surg 2020; 24:2233-2243. [PMID: 31506894 DOI: 10.1007/s11605-019-04260-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/01/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Increased expertise with minimally invasive liver surgery (MILS) could cause an unjustified extension of indications to resect liver benign disease (BD). The aim of this study was to evaluate the operative risk of MILS for BD and if implementation and diffusion of MILS have widened indications for BD resection. METHODS A prospective study including centers with > 6 MILS for BD, enrolled in the I Go MILS registry from January 2015 to October 2016. Cysts fenestrations were excluded. RESULTS Eight hundred eighteen MILS were performed in 15 centers. One hundred seventy-three of these (21.1%) were for BD: conversion rate was 6.9%, postoperative mortality and morbidity rates were 0 and 13.9%. During the same period, 3713 liver resections (open + MILS) were performed and 407 (11.0%) were for BD. A time-trend analysis showed that the total number of MILS and the number of MILS for malignant disease significantly increased, but this increasing trend was not documented for the number of MILS for BD, which remained stable during the study period of time. This trend was confirmed for the overall rate of resected BD (open + MILS) that remained stable. DISCUSSION BD represents a valid indication for MILS. For BD, 21.1% of MILS was performed, rate significantly lower than that previously reported in Italy. Although an evident growth of the use of MILS was observed during the time period analysis in Italy, this trend did not correspond to an increased number of MILS for BD, and the overall rate of resected BD was comparable to that reported in previous large open series.
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10
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Valverde A, Abdallah S, Danoussou D, Goasguen N, Jouvin I, Oberlin O, Lupinacci RM. Transitioning From Open to Robotic Liver Resection. Results of 46 Consecutive Procedures Including a Majority of Major Hepatectomies. Surg Innov 2020; 28:309-315. [PMID: 32857664 DOI: 10.1177/1553350620954580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aims. Minimally invasive liver resection is a complex and challenging operation. Although authors have reported robotic liver resection shows improved safety and efficacy compared with open liver resection, robotic major liver resections for malignant liver lesions treatment remain inadequately evaluated. The aims of the present study were to evaluate the feasibility and safety of transitioning from open to robotic liver resection in a nonuniversity hospital. Patients and Methods. From December 2015 to March 2020, 46 patients underwent totally robotic-assisted liver resections out of 446 robotic procedures. Also, we retrospectively reviewed the last 27 open right hepatectomies (ORHs) and compared then with the first 25 anatomic robotic-assisted right hepatectomies (RRHs). Results. Mean operative time, mean blood lost, rate of complications, and mean hospital stay were associated with the complexity of the procedure. The comparison between ORH and RRH showed that intraoperative complications were less frequently observed during ORH whereas RRH showed a trend in favor of less blood loss. ORH had a trend toward smaller surgical margins and higher rate of R1 resections. Recurrence occurred in 31 (59%) patients and was more frequently observed after ORH. However, the mean follow-up was significantly shorter after RRH. Conclusion. Our study demonstrated the technical feasibility and safety of transitioning from open to robotic liver resection (including major hepatectomies) in a nonuniversity setting. Higher costs remain an important drawback for robotic surgery.
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Affiliation(s)
- Alain Valverde
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Solafah Abdallah
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Divya Danoussou
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Nicolas Goasguen
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Ingrid Jouvin
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Olivier Oberlin
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Renato M Lupinacci
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France.,Service de Chirurgie Digestive, Oncologique et Métabolique, Hôpital Ambroise Paré - APHP, Boulogne-Billancourt, France.,UFR des Sciences de la Santé Simone Veil, Université de Versailles-Saint-Quentin-en-Yvelines et Université Paris-Saclay, France
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11
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Pekolj J, Clariá Sánchez R, Salceda J, Maurette RJ, Schelotto PB, Pierini L, Cánepa E, Moro M, Stork G, Resio N, Neffa J, Mc Cormack L, Quiñonez E, Raffin G, Obeide L, Fernández D, Pfaffen G, Salas C, Linzey M, Schmidt G, Ruiz S, Alvarez F, Buffaliza J, Maroni R, Campi O, Bertona C, de Santibañes M, Mazza O, Belotto de Oliveira M, Diniz AL, Enne de Oliveira M, Machado MA, Kalil AN, Pinto RD, Rezende AP, Ramos EJB, Talvane T Oliveira A, Torres OJM, Jarufe Cassis N, Buckel E, Quevedo Torres R, Chapochnick J, Sanhueza Garcia M, Muñoz C, Castro G, Losada H, Vergara Suárez F, Guevara O, Dávila D, Palacios O, Jimenez A, Poggi L, Torres V, Fonseca GM, Kruger JAP, Coelho FF, Russo L, Herman P. Laparoscopic Liver Resection: A South American Experience with 2887 Cases. World J Surg 2020; 44:3868-3874. [PMID: 32591841 DOI: 10.1007/s00268-020-05646-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers. METHODS From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results. RESULTS Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%. CONCLUSIONS This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers.
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Affiliation(s)
- J Pekolj
- HPB Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - R Clariá Sánchez
- HPB Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Salceda
- Hospital Ramón Santamarina, Tandil, Argentina
| | | | | | - L Pierini
- Clínica Nefrología, Clínica Uruguay, Hospital Iturraspe, Santa Fe, Argentina
| | - E Cánepa
- Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - M Moro
- Hospital Italiano - Regional Sur, Bahía Blanca, Argentina
| | - G Stork
- Hospital Italiano - Regional Sur, Bahía Blanca, Argentina
| | - N Resio
- Unidad HPB Sur, General Roca, Argentina
| | - J Neffa
- Hospital Italiano de Mendoza, Mendoza, Argentina
| | | | - E Quiñonez
- Hospital El Cruce, Buenos Aires, Argentina
| | - G Raffin
- Hospital Argerich, Buenos Aires, Argentina
| | - L Obeide
- Hospital Universitario Privado, Córdoba, Argentina
| | - D Fernández
- Clínica Pueyrredón, Mar del Plata, Argentina
| | - G Pfaffen
- Sanatorio Güemes, Buenos Aires, Argentina
| | - C Salas
- Sanatorio 9 de Julio, Santiago del Estero, Argentina, Hospital Centro de Salud, San Miguel de Tucumán, Argentina
| | - M Linzey
- Hospital Angel C. Padilla, San Miguel de Tucumán, Argentina
| | - G Schmidt
- Hospital Escuela Gral, Corrientes, Argentina
| | - S Ruiz
- Clínica Colón, Mar del Plata, Argentina
| | - F Alvarez
- Clínica Reina Fabiola, Hospital Italiano, Córdoba, Argentina
| | | | - R Maroni
- Hospital Papa Francisco, Salta, Argentina
| | - O Campi
- Clínica Regional General Pico, Santa Rosa, Argentina
| | - C Bertona
- Hospital Español, Mendoza, Argentina
| | - M de Santibañes
- HPB Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - O Mazza
- HPB Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - A L Diniz
- A.C. Camargo Cancer Center, São Paulo, Brazil
| | | | | | - A N Kalil
- Santa Casa de Porto Alegre, Universidade Federal de Ciências da Saúde, Porto Alegre, Brazil
| | - R D Pinto
- Hospital Santa Catarina de Blumenau, Blumenau, Brazil
| | | | - E J B Ramos
- Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | | | - O J M Torres
- Hospital Universitario HUUFMA, Hospital São Domingos, UDI Hospital, Fortaleza, Brazil
| | | | - E Buckel
- Clínica Las Condes, Santiago, Chile
| | | | | | | | - C Muñoz
- Hospital de Talca, Talca, Chile
| | | | - H Losada
- Hospital de Temuco, Temuco, Chile
| | - F Vergara Suárez
- Clínica Vida - Fundación Colombiana de Cancerología, Medellin, Colombia
| | - O Guevara
- Instituto Nacional de Cancerologia, Bogotá, Colombia
| | | | | | - A Jimenez
- Hospital Clínicas, Asunción, Paraguay
| | - L Poggi
- Clínica Anglo Americana, Lima, Peru
| | - V Torres
- Hospital Guillermo Almenara ESSALUD, Lima, Peru
| | - G M Fonseca
- Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil
| | - J A P Kruger
- Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil
| | - F F Coelho
- Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil
| | - L Russo
- Hospital Maciel, Casmu, Montevideo, Uruguay
| | - P Herman
- Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil.
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12
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Carnevale A, Pellegrino F, Cossu A, Ierardi AM, Parenti GC, Carrafiello G, Giganti M. Current concepts in ablative procedures for primary benign liver lesions: a step forward to minimize the invasiveness of treatment when deemed necessary. Med Oncol 2020; 37:31. [PMID: 32193648 PMCID: PMC7102179 DOI: 10.1007/s12032-020-01355-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/28/2020] [Indexed: 12/31/2022]
Abstract
With increased use of medical imaging, the incidental detection of benign solid liver tumors has become more frequent. Facing with benign disease, the indications for surgery are still object of discussion in light of the stable natural course of most lesions and obvious drawbacks of any surgical intervention; therefore, in most situations, a conservative approach is recommended, and surgery is mainly reserved for those cases with persistent or worsening symptoms, or who are at risk for complications as malignant transformation. The advent of ablative techniques has widened the range of treatment options available to these patients, presenting as a valid alternative to resection in terms of safety and efficacy in selected cases, particularly in patients who are considered poor surgical candidates and with smaller lesions. This review outlines the role of percutaneous ablative methods for benign solid liver tumors that are encountered in adults, providing a per histology analysis of the existing evidence. The up-to-date strategies for management of the most common benign solid tumors are recapitulated.
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Affiliation(s)
- Aldo Carnevale
- University Radiology Unit, Radiology Department, Arcispedale Sant'Anna, Via A. Moro 8, Ferrara, 44123, Italy
| | - Fabio Pellegrino
- Department of Morphology, Surgery and Experimental Medicine, Radiology Section, University of Ferrara, Via L. Ariosto 35, Ferrara, 44121, Italy
| | - Alberto Cossu
- University Radiology Unit, Radiology Department, Arcispedale Sant'Anna, Via A. Moro 8, Ferrara, 44123, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo E Carlo, San Paolo Hospital, University of Milan, Via A di Rudinì 8, Milan, 20142, Italy
| | - Gian Carlo Parenti
- Department of Diagnostic Imaging of Romagna, Ospedale Civile Santa Maria Delle Croci, Ravenna, 48100, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo E Carlo, San Paolo Hospital, University of Milan, Via A di Rudinì 8, Milan, 20142, Italy
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Radiology Section, University of Ferrara, Via L. Ariosto 35, Ferrara, 44121, Italy.
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13
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Tran Cao HS, Marcal LP, Mason MC, Yedururi S, Joechle K, Wei SH, Vauthey JN. Benign hepatic incidentalomas. Curr Probl Surg 2019; 56:100642. [DOI: 10.1067/j.cpsurg.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/09/2019] [Indexed: 12/13/2022]
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14
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Ransome E, Tong L, Espinosa J, Chou J, Somnay V, Munene G. Trends in surgery and disparities in receipt of surgery for intrahepatic cholangiocarcinoma in the US: 2005-2014. J Gastrointest Oncol 2019; 10:339-347. [PMID: 31032103 PMCID: PMC6465498 DOI: 10.21037/jgo.2018.12.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Intrahepatic cholangiocarcinoma (IHC) is a malignancy with an increasing incidence. Surgery is the only treatment modality associated with long term survival. The objective of this study is to utilize a nationwide representative database to quantify the trends in incidence, and surgery for IHC in the United States from 2004-2014, as well as identify any disparities in the receipt of surgery. METHODS All patients admitted with a diagnosis of IHC between 2005 and 2014 were identified from the Nationwide Inpatient Sample (NIS) database. Trends in the number of IHC admissions and surgery procedures as well as outcomes were examined, and a multivariate analysis was used to determine the effects of demographic and clinical co-variables on resection rates. RESULTS An estimated total of 104,045 IHC related admissions occurred between 2005 and 2014. The hospitalization rate for IHC increased by nearly 2-fold in 2014 [38.9 per 100,000 (95% CI, 35.7-42.2)] from 18.1 per 100,000 (95% CI, 15.8-20.3) in 2005. Liver resections increased 248% (P<0.01) with an increasing majority being performed at teaching hospitals and 56% being minor resections. There was an increase in estimated hospital charges from $87,124 to $148,613 (P<0.001) and decrease in LOS from 12 days to 10 days (P<0.01). Inpatient mortality for IHC decreased significantly from 11% to 8.4% (P=0.004), from year 2005 to 2014 respectively. Age >80 years (OR =0.45; 95% CI, 0.33-0.60), Black race (OR =0.50; 95% CI, 0.39-063), Hispanic race (OR =0.59; 95% CI, 0.45-0.79), Medicaid insurance (OR =0.58; 95% CI, 0.42-0.79) and Elixhauser comorbidity score >3 (OR =0.58; 95% CI, 0.47-0.73) were associated with decreased rates of resection. CONCLUSIONS Overall hospitalization and volume of surgery for IHC has increased dramatically over the past decade. There has been an increase in cost, decrease in LOS and inpatient mortality during the period. Socioeconomic and racial disparities were observed in the receipt of surgery for IHC. Additional work is needed to understand the complex interplay between socioeconomic status and race in in the treatment of IHC.
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Affiliation(s)
- Eke Ransome
- Division of Epidemiology and Biostatistics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Li Tong
- Division of Epidemiology and Biostatistics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Jairo Espinosa
- Department of General Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Jesse Chou
- Western Michigan Cancer Center, Kalamazoo, MI, USA
| | | | - Gitonga Munene
- Department of General Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
- Western Michigan Cancer Center, Kalamazoo, MI, USA
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15
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Chen PD, Hu RH, Liang JT, Huang CS, Wu YM. Toward a fully robotic surgery: Performing robotic major liver resection with no table-side surgeon. Int J Med Robot 2019; 15:e1985. [PMID: 30659758 DOI: 10.1002/rcs.1985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/04/2019] [Accepted: 01/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Evidence has suggested that robotic system helps perform more major liver resections. However, the required table-side surgeon has remained a concern because of the uncertain performance and the incomplete control of console surgeon. METHODS Data were reviewed for consecutive 333 robotic liver resections, of which 56 patients underwent left liver resection with the usual setting, and 35 with no table-side surgeon. RESULTS No conversion was required in the setting with no table-side surgeon. The group without the table-side surgeon had similar complication rates, blood loss, and operative time compared with that of the normal settings, as well as focused analysis on major left hemihepatectomy. CONCLUSION Our data suggest that performing robotic major liver resection without the presence of the table-side surgeon is safe and feasible. The concise performance of robotic platforms might accelerate the machine learning process along with the ability to predict patterns of future autonomous surgery.
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Affiliation(s)
- Po-Da Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Rey-Heng Hu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Tung Liang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chiun-Sheng Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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16
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Sinkler MA, Bosley M. Massive hepatic adenoma response to bland embolization: A case study. Radiol Case Rep 2019; 14:48-51. [PMID: 30338010 PMCID: PMC6187088 DOI: 10.1016/j.radcr.2018.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 12/29/2022] Open
Abstract
Hepatic adenomas are rare, benign liver masses of rising incidence in the United States. We present a report of a 22-year-old asymptomatic female with a massive (14.2 × 11.4 cm), centrally located hepatic adenoma. The unique presentation of the adenoma in close proximity to the hepatic vasculature meant the patient was not a candidate for surgical resection. An arterial embolization was used as an alternative approach to initial treatment. Arterial branches supplying the adenoma were identified via computed tomography and embolized with embospheres and coils. The treatment resulted in a large reduction in size and density of the adenoma identified at a 1-month follow-up. The case supports further use of arterial embolization as an initial treatment for large adenomas to improve the outcome of subsequent surgical approaches.
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Affiliation(s)
- Margaret A. Sinkler
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Corresponding author.
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17
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Macacari RL, Coelho FF, Bernardo WM, Kruger JAP, Jeismann VB, Fonseca GM, Cesconetto DM, Cecconello I, Herman P. Laparoscopic vs. open left lateral sectionectomy: An update meta-analysis of randomized and non-randomized controlled trials. Int J Surg 2018; 61:1-10. [PMID: 30496866 DOI: 10.1016/j.ijsu.2018.11.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/28/2018] [Accepted: 11/14/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Left lateral sectionectomy (LLS) is thought to be the anatomical liver resection most suitable for the laparoscopic approach. Despite increasing popularity, comparative analysis of laparoscopic and open LLS are mostly limited to retrospective, underpowered studies with small sample size. Recent population-based studies and prospective trials have generated new data; however, this new body of knowledge has not been submitted systematic reviews or meta-analyses and high quality evidence regarding the actual benefits of minimally invasive LLS is lacking. METHODS Systematic review of studies published until December 31st, 2017 and indexed in Medline, EMBASE, Cochrane Library Central and Scielo/LILACS databases. Randomized controlled trials and observational studies comparing perioperative results of laparoscopic and open LLS were included. Studies with patients submitted to LLS for living donation were excluded. Treatment outcomes, including conversion rates, estimated blood loss, transfusion rates, operative time, length of in-hospital stay, morbidity and mortality rates, were evaluated. RESULTS The primary search yielded 2838 articles, 23 of which (21 observational studies and 2 randomized controlled trials; 3415 patients) were included in the meta-analysis. Overall conversion rate was 7.4%. Patients submitted to laparoscopic LLS had less blood loss (mean difference, MD = -119.81 ml, 95% CI = -127.90, -111.72, P < .00001, I2 = 32%, N = 618), lower transfusion rates (4.1% vs. 10.1%; risk difference, RD = - 0.06, 95% CI = - 0.08, - 0.05, P < .00001, I2 = 13%, N = 2968) and shorter length of in-hospital stay (MD = - 2.02 days, 95% CI = - 2.15, - 1.89, P < .00001, I2 = 77%, N = 3160) compared to those undergoing open surgery. Marginally decreased overall complication (21.4% vs. 27.5%; RD = - 0.03, 95% CI = - 0.06, 0.00, P = .05, I2 = 0%, N = 3268) and perioperative mortality (0.3% vs. 1.5%; RD = - 0.01, 95% CI = - 0.02, - 0.00, P = .01, I2 = 0%; N = 3332) rates were also observed. Operative time and biliary, cardiac or pulmonary complication rates did not differ significantly between groups. CONCLUSION Current evidence supports the safety and feasibility of laparoscopic LLS. The laparoscopic approach is associated with reduced blood loss, lower transfusion rates and shorter length of in-hospital stay and should be considered the gold-standard for LLS.
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Affiliation(s)
- Rodrigo Luiz Macacari
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil.
| | - Fabricio Ferreira Coelho
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Wanderley Marques Bernardo
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Jaime Arthur Pirola Kruger
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil; Digestive Surgery Division, Department of Gastroenterology, Instituto do Câncer do Estado de Sao Paulo (ICESP), Sao Paulo, Brazil
| | - Vagner Birk Jeismann
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil; Digestive Surgery Division, Department of Gastroenterology, Instituto do Câncer do Estado de Sao Paulo (ICESP), Sao Paulo, Brazil
| | - Gilton Marques Fonseca
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Danielle Menezes Cesconetto
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Ivan Cecconello
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Paulo Herman
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
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18
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Beal EW, Tumin D, Chakedis J, Porter E, Moris D, Zhang XF, Abdel-Misih S, Dillhoff M, Manilchuk A, Cloyd J, Schmidt CR, Pawlik TM. Identification of patients at high risk for post-discharge venous thromboembolism after hepato-pancreato-biliary surgery: which patients benefit from extended thromboprophylaxis? HPB (Oxford) 2018; 20:621-630. [PMID: 29472105 DOI: 10.1016/j.hpb.2018.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/08/2017] [Accepted: 01/03/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The objective of the current study was to define risk factors associated with the 30-day post-operative risk of VTE after HPB surgery and create a model to identify patients at highest risk of post-discharge VTE. METHODS Patients who underwent hepatectomy or pancreatectomy in the ACS-NSQIP Participant Use Files 2011-2015 were identified. Logistic regression modeling was used; a model to predict post-discharge VTE was developed. Model discrimination was tested using area under the curve (AUC). RESULTS Among 48,860 patients, the overall 30-day incidence of VTE after hepatectomy and pancreatectomy was 3.2% (n = 1580) with 1.1% (n = 543) of VTE events occurring after discharge. Patients who developed post-discharge VTE were more likely to be white, had a higher median BMI, have undergone pancreatic surgery, had longer median operative times, and to have had a transfusion. A weighted prediction model demonstrated good calibration and fair discrimination (AUC = 0.63). A score of ≥-4.50 had maximum sensitivity and specificity, resulting in 44% of patients being treating with prophylaxis for an overall VTE risk of 1.1%. CONCLUSIONS Utilizing independent factors associated with post-discharge VTE, a prediction model was able to stratify patients according to risk of VTE and may help identify patients who are most likely to benefit from pharmacoprophylaxis.
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Affiliation(s)
- Eliza W Beal
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Dmitry Tumin
- The Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jeffery Chakedis
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Erica Porter
- Department of Quality and Patient Safety, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dimitrios Moris
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Xu-Feng Zhang
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Sherif Abdel-Misih
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Andrei Manilchuk
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Carl R Schmidt
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
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19
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Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R, Aroori S, Belli G, Besselink M, Briceno J, Gayet B, D'Hondt M, Lesurtel M, Menon K, Lodge P, Rotellar F, Santoyo J, Scatton O, Soubrane O, Sutcliffe R, Van Dam R, White S, Halls MC, Cipriani F, Van der Poel M, Ciria R, Barkhatov L, Gomez-Luque Y, Ocana-Garcia S, Cook A, Buell J, Clavien PA, Dervenis C, Fusai G, Geller D, Lang H, Primrose J, Taylor M, Van Gulik T, Wakabayashi G, Asbun H, Cherqui D. The Southampton Consensus Guidelines for Laparoscopic Liver Surgery: From Indication to Implementation. Ann Surg 2018; 268:11-18. [PMID: 29064908 DOI: 10.1097/sla.0000000000002524] [Citation(s) in RCA: 468] [Impact Index Per Article: 66.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The European Guidelines Meeting on Laparoscopic Liver Surgery was held in Southampton on February 10 and 11, 2017 with the aim of presenting and validating clinical practice guidelines for laparoscopic liver surgery. BACKGROUND The exponential growth of laparoscopic liver surgery in recent years mandates the development of clinical practice guidelines to direct the speciality's continued safe progression and dissemination. METHODS A unique approach to the development of clinical guidelines was adopted. Three well-validated methods were integrated: the Scottish Intercollegiate Guidelines Network methodology for the assessment of evidence and development of guideline statements; the Delphi method of establishing expert consensus, and the AGREE II-GRS Instrument for the assessment of the methodological quality and external validation of the final statements. RESULTS Along with the committee chairman, 22 European experts; 7 junior experts and an independent validation committee of 11 international surgeons produced 67 guideline statements for the safe progression and dissemination of laparoscopic liver surgery. Each of the statements reached at least a 95% consensus among the experts and were endorsed by the independent validation committee. CONCLUSION The European Guidelines Meeting for Laparoscopic Liver Surgery has produced a set of clinical practice guidelines that have been independently validated for the safe development and progression of laparoscopic liver surgery. The Southampton Guidelines have amalgamated the available evidence and a wealth of experts' knowledge taking in consideration the relevant stakeholders' opinions and complying with the international methodology standards.
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Affiliation(s)
| | | | | | - Bjorn Edwin
- The Intervention Centre, Department of HBP surgery, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | | | | | | | | | | | | | - Brice Gayet
- Institut Mutualiste Montsouris, Paris, France
| | | | | | | | - Peter Lodge
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | | | | | | | - Ronald Van Dam
- Maastricht University Medical Centre, Maastricht, Nehterlands
| | - Steve White
- Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | | | | | | | - Ruben Ciria
- University Hospital Reina, Sofia Cordoba, Spain
| | - Leonid Barkhatov
- The Intervention Centre, Department of HBP surgery, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | | | | | - Andrew Cook
- Southampton Clinical Trials Unit, University Hospital Southampton, Southampton, UK
| | - Joseph Buell
- Louisiana State University and Medical Center, New Orleans, LA
| | | | | | | | | | - Hauke Lang
- Mainz University Hospital, Mainz, Germany
| | | | | | | | | | | | - Daniel Cherqui
- Hepatobiliary Centre-Paul Brousse Hospital, Villejuif-Paris, France
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Fodor M, Primavesi F, Braunwarth E, Cardini B, Resch T, Bale R, Putzer D, Henninger B, Oberhuber R, Maglione M, Margreiter C, Schneeberger S, Öfner D, Stättner S. Indications for liver surgery in benign tumours. Eur Surg 2018; 50:125-131. [PMID: 29875801 PMCID: PMC5968066 DOI: 10.1007/s10353-018-0536-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/02/2018] [Indexed: 02/08/2023]
Abstract
Background Management of benign liver tumours (BLT) is still object of discussion. Uncertainty still exists about patient selection, details of management, indications for surgical intervention and potential surgery-related complications. The up-to-date strategies for management of the most common benign solid tumours are recapitulated in this article. In addition, recommendations concerning practical issues are presented. Methods Available data from peer-reviewed publications associated with the major controversies concerning treatment strategies of solid BLT were selected through a PubMed literature search. Results Non-randomized controlled trials, retrospective series and case reports dominate the literature. Conservative management in BLT is associated with low overall morbidity and mortality when applied in an appropriate patient population. Surgical intervention is indicated solely in the presence of progressive symptoms and suspicion of a malignant change. Linking abdominal symptoms to BLT should be interpreted with caution. No evidence is recorded for malignant transformation in haemangiomas and focal nodular hyperplasia (FNH), while a subgroup of hepatocellular adenoma (HCA) is associated with malignancy. Follow-up controls of BLT at 3 and 6 months should be sufficient to prove the stability of the lesion and its benign nature, after which no long-term follow-up is required routinely. However, many questions regarding this topic remain without definitive answers in the literature. Conclusion Conservative management of solid BLT is a worldwide trend, but the available literature does not provide high-grade evidence for this strategy. Consequently, further prospective investigations on the unclear aspects are required. Hence, this article summarises practical highlights of therapeutic strategies.
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Affiliation(s)
- Margot Fodor
- 1Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Florian Primavesi
- 1Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Eva Braunwarth
- 1Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Benno Cardini
- 1Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Thomas Resch
- 1Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Reto Bale
- 2Department of Radiology, Medical University of Innsbruck, Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Daniel Putzer
- 2Department of Radiology, Medical University of Innsbruck, Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Benjamin Henninger
- 2Department of Radiology, Medical University of Innsbruck, Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Rupert Oberhuber
- 1Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Manuel Maglione
- 1Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Christian Margreiter
- 1Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Stefan Schneeberger
- 1Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Dietmar Öfner
- 1Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Stefan Stättner
- 1Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
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21
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Stiles ZE, Behrman SW, Glazer ES, Deneve JL, Dong L, Wan JY, Dickson PV. Predictors and implications of unplanned conversion during minimally invasive hepatectomy: an analysis of the ACS-NSQIP database. HPB (Oxford) 2017; 19:957-965. [PMID: 28760630 DOI: 10.1016/j.hpb.2017.06.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 06/12/2017] [Accepted: 06/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Minimally-invasive hepatectomy (MIH) is increasingly utilized; however, predictors and outcomes for patients requiring conversion to an open procedure have not been adequately studied. METHODS The 2014-15 ACS-NSQIP database was analyzed. Unplanned conversion was compared to successful MIH and elective open hepatectomy. RESULTS Among 6918 hepatectomies, 1062 (15.4%) underwent attempted MIH: 989 laparoscopic, 73 robotic. Conversion occurred in 203 (19.1%). Compared to successful MIH, patients requiring unplanned conversion experienced higher rates of complications (34.5% vs 14.6%, p<0.001), including bile leaks (7.4% vs 2.8%, p=0.002), organ space infection (6.4% vs 2.9%, p=0.016), UTI (4.9% vs 1.2%, p=0.002), perioperative bleeding (21.2% vs 6.1%, p<0.001), DVT (3.0% vs 0.8%, p=0.024), and sepsis (5.9% vs 1.9%, p=0.001). Conversion led to greater LOS (5 days vs 3 days, p<0.001) and 30-day mortality (3.0% vs 0.5%, p=0.005). Compared to elective open hepatectomy, conversion was associated with greater perioperative bleeding (21.2% vs 15.3%, p = 0.037). On multivariate analysis, major hepatectomy (OR 2.21, p<0.001), concurrent ablation (OR 1.79, p=0.020), and laparoscopic approach (vs. robotic) (OR 3.22, p=0.014) were associated with conversion. CONCLUSION Analysis of this national database revealed unplanned conversion during MIH is associated with greater morbidity and mortality. MIH should be approached cautiously in patients requiring major hepatectomy.
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Affiliation(s)
- Zachary E Stiles
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Stephen W Behrman
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Evan S Glazer
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeremiah L Deneve
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lei Dong
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jim Y Wan
- Department of Preventive Medicine, Division of Biostatistics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Paxton V Dickson
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA.
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22
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Landi F, De' Angelis N, Scatton O, Vidal X, Ayav A, Muscari F, Dokmak S, Torzilli G, Demartines N, Soubrane O, Cherqui D, Hardwigsen J, Laurent A. Short-term outcomes of laparoscopic vs. open liver resection for hepatocellular adenoma: a multicenter propensity score adjustment analysis by the AFC-HCA-2013 study group. Surg Endosc 2017; 31:4136-4144. [PMID: 28281121 DOI: 10.1007/s00464-017-5466-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/13/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with hepatocellular adenomas are, in selected cases, candidates for liver resection, which can be approached via laparoscopy or laparotomy. The present study aimed to investigate the effects of the surgical approach on the postoperative morbidities of both minor and major liver resections. METHODS In this multi-institutional study, all patients who underwent open or laparoscopic hepatectomies for hepatocellular adenomas between 1989 and 2013 in 27 European centers were retrospectively reviewed. A multiple imputation model was constructed to manage missing variables. Comparisons of both the overall rate and the types of complications between open and laparoscopic hepatectomy were performed after propensity score adjustment (via the standardized mortality ratio weighting method) on the factors that influenced the choice of the surgical approach. RESULTS The laparoscopic approach was selected in 208 (38%) of the 533 included patients. There were 194 (93%) women. The median age was 38.9 years. After the application of multiple imputation, 208 patients who underwent laparoscopic operations were compared with 216 patients who underwent laparotomic operations. After adjustment, there were 20 (9.6%) major liver resections in the laparoscopy group and 17 (7.9%) in the open group. The conversion rate was 6.3%. The two surgical approaches exhibited similar postoperative morbidity rates and severities. Laparoscopic resection was associated with significantly less blood loss (93 vs. 196 ml, p < 0.001), a less frequent need for pedicle clamping (21 vs. 40%, p = 0.002), a reduced need for transfusion (8 vs. 24 red blood cells units, p < 0.001), and a shorter hospital stay (5 vs. 7 days, p < 0.001). The mortality was nil. CONCLUSIONS Laparoscopy can achieve short-term outcomes similar to those of open surgery for hepatocellular adenomas and has the additional benefits of a reduced blood loss, need for transfusion, and a shorter hospital stay.
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Affiliation(s)
- Filippo Landi
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Paris Est University, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France
| | - Nicola De' Angelis
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Paris Est University, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France
| | - Olivier Scatton
- Department of Liver Transplantation and HPB Surgery, Pitié-Salpêtrière Hospital, Paris, France
| | - Xavier Vidal
- Department of Clinical Pharmacology, Vall d'Hebron University Hospital, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Ahmet Ayav
- Department of Digestive, Hepato-Biliary, Endocrine Surgery, and Surgical Oncology, Nancy University Hospital, Lorraine University, Lorraine, France
| | - Fabrice Muscari
- Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France
| | - Safi Dokmak
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Guido Torzilli
- Department of General Surgery, Humanitas University and Research Hospital, Milan, Italy
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Olivier Soubrane
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Daniel Cherqui
- Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France
| | - Jean Hardwigsen
- Department of Surgery, la Timone Hospital, Aix-Marseille University, Marseille, France
| | - Alexis Laurent
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Paris Est University, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France.
- INSERM, UMR 955, Créteil, France.
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23
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Amini N, Margonis GA, Kim Y, Wilson A, Gani F, Pawlik TM. Complication timing impacts 30-d mortality after hepatectomy. J Surg Res 2016; 203:495-506. [DOI: 10.1016/j.jss.2016.04.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/12/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
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Douaiher J, Dhir M, Smith L, Are C. Differences in Perioperative Outcomes Between Right and Left Hepatic Lobectomy. Indian J Surg Oncol 2016; 7:44-51. [PMID: 27065681 DOI: 10.1007/s13193-015-0464-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022] Open
Abstract
The safety of hepatic resection is well documented, but outcome studies comparing right and left hepatic lobectomy are sparse, especially in the context of malignancy. This study analyzes the differences in outcomes between right and left hepatic lobectomy in patients with malignant diagnoses. All patients undergoing right and left hepatic lobectomies for malignancy were extracted from the National Surgical Quality Improvement Program (NSQIP) database (2005-2010). The data was analyzed to determine differences in perioperative mortality and morbidity between the two groups. A total of 1680 patients who underwent right or left hepatic lobectomy for malignant diagnoses were identified. Patients undergoing right hepatic lobectomy had a four-fold increase in perioperative mortality, compared to left lobectomy (p < 0.0001). Mortality in right lobectomy patients increased incrementally with age, with a 12-fold increase in patients > 81 years of age. Patients undergoing right lobectomy also experienced a statistically significant increase in morbidity involving several systems (infectious, pulmonary, cardiac and renal). The results of our study demonstrate that patients undergoing right hepatic lobectomy for malignancy experience a significantly higher incidence of mortality and multi-system morbidity when compared to left lobectomy. This information will be crucial for pre-operative risk-stratification of patients undergoing hepatic resection for malignancy.
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Affiliation(s)
- Jeffrey Douaiher
- Department of Surgery, University of Nebraska Medical Center, 984030 Nebraska Medical Center, Omaha, NE 68198-3280 USA
| | - Mashaal Dhir
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Lynette Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Chandrakanth Are
- Department of Surgery, University of Nebraska Medical Center, 984030 Nebraska Medical Center, Omaha, NE 68198-3280 USA
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25
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Amini N, Margonis GA, Buttner S, Besharati S, Kim Y, Gani F, Sobhani F, Kamel IR, Pawlik TM. Liver regeneration after major liver hepatectomy: Impact of body mass index. Surgery 2016; 160:81-91. [PMID: 27059638 DOI: 10.1016/j.surg.2016.02.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/11/2016] [Accepted: 02/05/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Obese patients may present with metabolic abnormalities that impact liver regeneration. We sought to assess the impact of body mass index (BMI) on liver volume regeneration index (RI) and kinetic growth rate (KGR) among patients undergoing liver resection. METHODS The study included 102 patients undergoing major hepatectomy (≥3 segments) between July 2004 and April 2015 and stratified the patients by preoperative BMI, number of segments resected, and postoperative remnant liver volume (RLVp) to total liver volume ratio. Resected volume at operation was subtracted from total liver volume to calculate postoperative RLVp. RI was defined as the relative increase in RLV within 2 months [(RLV2m-RLVp)/RLVp] and 7 months [(RLV7m-RLVp)/RLVp] postoperatively; KGR was calculated as RI divided by time postoperatively (weeks). RESULTS Median patient age was 59.6 years (interquartile range 48.1-68.7 years), and most patients were men (52.0%). Liver failure was associated with the KGR at 2 months (KGR2m) and was greater among patients with KGR2m <2.5% per week (KGR <2.5%, 18.5% vs KGR ≥ 2.5%, 4.6%; P = .04). Although RI and KGR within 2 and 7 months postoperatively were similar among all patients, after excluding patients with fibrosis, obese (0.42% per week) and overweight patients (0.29% per week) had lesser KGR2-7m compared with patients of normal BMI (0.82% per week; P < .05). Additionally, risk of a major complication was greatest among obese patients (normal weight, 8.1% vs overweight, 12.9% vs obese, 29.4%; P = .04). CONCLUSION BMI did not impact liver regeneration during the first 2 months. In contrast, KGR per week between 2 and 7 months postoperatively was less among overweight and obese patients.
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Affiliation(s)
- Neda Amini
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Georgios A Margonis
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stefan Buttner
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sepideh Besharati
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yuhree Kim
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Faiz Gani
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fatemeh Sobhani
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ihab R Kamel
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Timothy M Pawlik
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
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26
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Coelho FF, Kruger JAP, Fonseca GM, Araújo RLC, Jeismann VB, Perini MV, Lupinacci RM, Cecconello I, Herman P. Laparoscopic liver resection: Experience based guidelines. World J Gastrointest Surg 2016; 8:5-26. [PMID: 26843910 PMCID: PMC4724587 DOI: 10.4240/wjgs.v8.i1.5] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/07/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant (both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments (1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers’ practice. Continuous surgical training, as well as new technologies should augment the application of laparoscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation.
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27
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He J, Amini N, Spolverato G, Hirose K, Makary M, Wolfgang CL, Weiss MJ, Pawlik TM. National trends with a laparoscopic liver resection: results from a population-based analysis. HPB (Oxford) 2015; 17:919-26. [PMID: 26234323 PMCID: PMC4571760 DOI: 10.1111/hpb.12469] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/02/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Interest in laparoscopic liver resection (LLR) has grown since the International 'Louisville Statement' regarding laparoscopic liver surgery was published in 2009. However, limited population-based data on LLR utilization patterns and outcomes are available. METHODS LLR data from the Nationwide Inpatient Sample (NIS, 2000-2012) and the National Surgical Quality Improvement Project (NSQIP, 2005-2012) were compared before and after the Louisville Statement in 2009. RESULTS In total, 1131 and 642 LLR were identified from NIS and NSQIP, respectively. Three-quarters of patients underwent LLR for a malignant indication (NIS primary malignancy, 29.6% versus metastasis, 45.1%; NSQIP primary malignancy, 35.5% versus metastasis, 46.1%). The annual volume of LLR increased from 2000-2008 versus 2009-2012 (NIS: 63 versus 168, P < 0.001; NSQIP: 52 versus 127; both P = 0.001). The peri-operative mortality associated with LLR was 2.8% in NIS and 2.2% in NSQIP. The morbidity was 38.1% in NIS and 30.7% in NSQIP. Mortality and morbidity did not change over time (both P > 0.050). After 2009, LLR was associated with a shorter length of stay (LOS) (NIS: 5 versus 6 days, P = 0.007). CONCLUSION Since the Louisville Statement in 2009, utilization of LLR has increased. LLR is associated with a modest decrease in LOS and appears to be safe with mortality and morbidity similar to open surgery.
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Affiliation(s)
- Jin He
- Department of Surgery, The Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Neda Amini
- Department of Surgery, The Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Gaya Spolverato
- Department of Surgery, The Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Kenzo Hirose
- Department of Surgery, The Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Martin Makary
- Department of Surgery, The Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Christopher L Wolfgang
- Department of Surgery, The Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Matthew J Weiss
- Department of Surgery, The Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, The Johns Hopkins University School of MedicineBaltimore, MD, USA
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