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Peng Z, Zhu ZR, He CY, Huang H. A meta-analysis: laparoscopic versus open liver resection for large hepatocellular carcinoma. MINIM INVASIV THER 2025; 34:24-34. [PMID: 38634257 DOI: 10.1080/13645706.2024.2334762] [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: 10/15/2023] [Accepted: 02/18/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The indication of laparoscopic liver resection (LLR) for treating large hepatocellular carcinoma (HCC) is controversial. In this study, we compared the short-term and long-term outcomes of LLR and open liver resection (OLR) for large HCC. MATERIAL AND METHODS We searched eligible articles about LLR versus OLR for large HCC in PubMed, Cochrane Library, and EMBASE and performed a meta-analysis. RESULTS Eight publications involving 1,338 patients were included. Among them, 495 underwent LLR and 843 underwent OLR. The operation time was longer in the LLR group (MD: 22.23, 95% CI: 4.14-40.33, p = 0.02). but the postoperative hospital stay time was significantly shorter (MD : -4.88, CI: -5.55 to -4.23, p < 0.00001), and the incidence of total postoperative complications and major complications were significantly fewer (OR: 0.49, 95% CI:0.37-0.66, p < 0.00001; OR: 0.54, 95% CI:0.36 - 0.82, p = 0.003, respectively). Patients in the laparoscopic group had no significant difference in intraoperative blood loss, intraoperative transfusion rate, resection margin size, R0 resection rate, three-year overall survival (OS) and three-year disease-free survival (DFS). CONCLUSION LLR for large HCC is safe and feasible. This surgical strategy will not affect the long-term outcomes of patients.
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Affiliation(s)
- Zha Peng
- Guangxi Medical University, Nanning, China
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Wuming Hospital, Nanning, China
| | - Zhuang-Rong Zhu
- Guangxi Medical University, Nanning, China
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Wuming Hospital, Nanning, China
| | - Cheng-Yi He
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Wuming Hospital, Nanning, China
| | - Hai Huang
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Wuming Hospital, Nanning, China
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Yu YD, Halazun KJ, Chandwani R, Samstein B. Minimally invasive tools are necessary for the modern practice of liver surgery. J Minim Access Surg 2024:01413045-990000000-00059. [PMID: 38958005 DOI: 10.4103/jmas.jmas_377_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/15/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION Minimally invasive liver resection (MILR) is performed for other gastrointestinal applications. At our centre, all liver resections are systematically performed using a minimally invasive approach. This study aimed to describe our experience in minimising open surgery and emphasised the importance of minimally invasive surgery. PATIENTS AND METHODS We retrospectively reviewed 260 patients who underwent liver surgery and compared the surgical outcomes between the open and MILR groups. RESULTS A total of 154 patients (68%) underwent MILR. The proportion of patients who underwent prior abdominal surgery and resection was higher in the open surgery group. However, the proportion of patients with liver cirrhosis was similar between the two groups. The MILR group was superior in terms of operative time, blood loss, Pringle manoeuvre rate and mean hospital stay. In addition, major complication and bile leak rates were lower in the MILR group. No significant differences in the tumour size, number of lesions or underlying liver pathology were observed between the two groups. CONCLUSION Acceptable outcomes can be achieved even when the minimally invasive approach is considered the primary option for all patients who require liver resection. Minimally invasive tools are necessary for the modern practice of liver surgery; therefore, laparoscopic or robotic surgery should be included in the armamentarium of liver surgeons.
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Affiliation(s)
- Young-Dong Yu
- Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Weill Cornell Medical College, New York, NY, USA
- Department of Surgery, Division of HBP Surgery and Liver Transplantation, Korea University College of Medicine, Seoul, Korea
| | - Karim J Halazun
- Department of Surgery, Division Hepatobiliary and Pancreatic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Rohit Chandwani
- Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Benjamin Samstein
- Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Weill Cornell Medical College, New York, NY, USA
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Seo CH, Choi HJ, You YK. Long-term outcomes of single-port laparoscopic hepatectomy for hepatocellular carcinoma: a retrospective comparative analysis. Ann Surg Treat Res 2024; 106:354-360. [PMID: 38868585 PMCID: PMC11164656 DOI: 10.4174/astr.2024.106.6.354] [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: 02/20/2024] [Revised: 03/09/2024] [Accepted: 04/12/2024] [Indexed: 06/14/2024] Open
Abstract
Purpose Numerous efforts have been made to achieve minimally invasive surgery, such as single-port laparoscopic surgery. However, few studies have provided long-term follow-up information, and the number of patients with hepatocellular carcinoma (HCC) in previous studies has been small. The purpose in this study is to compare the long-term oncological outcomes of HCC patients who underwent single-port laparoscopic hepatectomy (SPLH) with those of patients who underwent multiport laparoscopic hepatectomy (MPLH). Methods We retrospectively reviewed the medical records of 135 patients with HCC who underwent laparoscopic liver between January 2008 and December 2018. Of the 135 patients, 53 underwent MPLH, and 82 underwent SPLH. Results From January 2008 to December 2018, 135 patients underwent laparoscopic hepatectomy for HCC. Among them, 82 patients underwent SPLH, and 53 patients underwent MPLH. Neither long-term overall survival (P = 0.849) nor recurrence-free survival (P = 0.057) differed significantly between the 2 groups, even though the recurrence rate was higher in the SPLH group. In the univariable analysis of risk factors for recurrence, multiple tumors, SPLH method, and portal vein invasion were statistically significant (P < 0.05). Multivariable analysis showed that the SPLH method and portal vein invasion were independent adverse prognostic factors for recurrence-free survival. Conclusion In terms of both short-term and long-term outcomes, the SPLH method seems to be a feasible approach for HCC in select patients. Because the potential risk of margin recurrence might produce poor oncological outcomes, strict patient selection is essential to ensure that an adequate safety margin can be secured.
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Affiliation(s)
- Chang Ho Seo
- Department of Surgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Joong Choi
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Kyoung You
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Li S, Yin Y, Wang P, Jiang L, Yan H, Cang J. Goal-directed fluid therapy during post-resection phase in low central venous pressure assisted laparoscopic hepatectomy: a randomized controlled superiority trial. J Anesth 2024; 38:77-85. [PMID: 38091035 DOI: 10.1007/s00540-023-03282-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/30/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE The purpose of this prospective single blinded randomized controlled trial was to find out whether goal-directed fluid therapy (GDFT) strategy in post-transection period in low central venous pressure (CVP) assisted laparoscopic hepatectomy (LH) has more benefit than traditional fluid strategy. METHODS Between April 2020 and Dec 2021, patients who were scheduled for laparoscopic liver resection surgery were eligible to participate in the study. Patients were randomly divided into two groups: control group that received traditional fluid strategy in post-transection period in low CVP assisted laparoscopic hepatectomy and GDFT strategy group that received GDFT strategy in post-transection period. The primary outcome parameter is the incidence of postoperative complications. Secondary outcome parameters include perioperative clinical outcomes, postoperative clinical outcomes, length of hospital stay after surgery, postoperative lactic acid, fluids and vasoactive medications during the operation. RESULTS A total of 159 patients in the control group and 160 patients in the GDFT were included. Two groups had no significant difference in the incidence of postoperative complications including pneumonia (P = 0.34), acute kidney injury (P = 0.72), hepatic insufficiency (P = 0.25), pleural effusion (P = 0.08) and seroperitoneum (P = 1.00), respectively. The amount of perioperative urine output is fewer in GDFT group than in the control group (P = 0.0354), while other perioperative variables and postoperative variables were comparable between two groups. CONCLUSIONS The results show the implementation of GDFT strategy is not associated with fewer postoperative complications. GDFT strategy did not result in improved outcomes in low CVP-assisted laparoscopic hepatectomy.
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Affiliation(s)
- Shichao Li
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yue Yin
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Pei Wang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Long Jiang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Huan Yan
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Jing Cang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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Tsukagoshi M, Harimoto N, Araki K, Ishii N, Hagiwara K, Hoshino K, Yanagisawa K, Ogawa Y, Handa H, Shirabe K. Laparoscopic hepatectomy for hepatocellular carcinoma in patients with hemophilia A and B: a report of two cases. Clin J Gastroenterol 2023; 16:884-890. [PMID: 37668948 DOI: 10.1007/s12328-023-01854-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is a life-threatening complication of hemophilia. Reports of patients with hemophilia undergoing hepatectomy for HCC are scarce. We report the cases of patients with hemophilia A and B who underwent laparoscopic hepatectomy for HCC. Perioperative hemophilia management was supervised by the hematology team. The patients received coagulation factor bolus injections immediately preoperatively, then continuous intravenous infusions intra- and postoperatively. A laparoscopic segment II partial hepatectomy was performed in case 1. Due to severe adhesions, intermittent pedicle clamping could not be used during parenchymal transection. The surgical duration was 235 min, and the estimated blood loss was 13 mL. The patient was discharged 11 days postoperatively without any complications. In case 2, laparoscopic partial hepatectomy for segments V/VI was performed. An intermittent pedicle clamp (Pringle method) was used during parenchymal transection. The surgical duration and estimated blood loss were 219 min and 18 mL, respectively. The patient was discharged 8 days postoperatively without complications. In both cases, intraoperative bleeding was minimal, and the patients were discharged without postoperative hemorrhage with appropriate perioperative coagulation factor management. Laparoscopic hepatectomy can be safely performed and appears to be a feasible treatment option for HCC in patients with hemophilia.
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Affiliation(s)
- Mariko Tsukagoshi
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Norifumi Harimoto
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kenichiro Araki
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Norihiro Ishii
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kei Hagiwara
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kouki Hoshino
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kunio Yanagisawa
- Infection Control and Prevention Center, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Yoshiyuki Ogawa
- Department of Hematology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroshi Handa
- Department of Hematology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ken Shirabe
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Zhao G, Shi X, Zhang L, Liang H. Comment on "Effect of vessels that encapsulate tumor clusters (VETC) and different stages of hepatocellular carcinoma after hepatectomy". Dig Liver Dis 2023; 55:1439-1440. [PMID: 37422410 DOI: 10.1016/j.dld.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Gang Zhao
- Department of Radiology, Shengjing Hospital of China Medical University, Liaoning, China
| | - Xiaobao Shi
- Department of Radiology, Shengjing Hospital of China Medical University, Liaoning, China
| | - Lingyun Zhang
- Department of Medical Oncology, the First Hospital of China Medical University, Liaoning, China
| | - Hongyuan Liang
- Department of Radiology, Shengjing Hospital of China Medical University, Liaoning, China.
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Yang SY, Feng JK, Yan ML, Guo L, Duan YF, Ye JZ, Liu ZH, Xiang YJ, Xu L, Xue J, Shi J, Lau WY, Cheng SQ, Guo WX. Laparoscopic and open liver resection for hepatocellular carcinoma with type 2 diabetes mellitus: multicenter propensity score-matched study. Hepatol Int 2023; 17:1251-1264. [PMID: 37060489 DOI: 10.1007/s12072-023-10492-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/20/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE This study aimed at analyzing and comparing the perioperative results and long-term oncological outcomes of hepatocellular carcinoma (HCC) patients with type 2 diabetes mellitus (T2DM) treated with laparoscopic (LLR) versus open liver resection (OLR). METHODS Clinicopathological data of HCC patients with T2DM who underwent LLR or OLR as initial treatment from four medical centers were retrospectively reviewed. The survival outcomes of patients who underwent laparoscopic liver resection (LLR) were compared with those of patients who underwent open liver resection (OLR). Using the Kaplan-Meier method, survival curves for the two groups of patients were generated, and the log-rank test was used to compare survival differences. Propensity score matching (PSM) analysis was used to match patients of the LLR and OLR groups in a 1:1 ratio. RESULTS 230 HCC patients with T2DM were enrolled, including 101 patients in the LLR group and 129 patients in the OLR group. After PSM, 90 patients were matched in each of the study group. Compared with the OLR group, the LLR group had less blood loss, a shorter hospitalization and fewer postoperative complications. The LLR group had a significantly better overall survival (OS) and recurrence-free survival (RFS) than the OLR group before and after PSM. Subgroup analysis demonstrated that HCC patients with T2DM had survival benefits from LLR regardless of the course of T2DM. CONCLUSIONS Laparoscopic liver resection for HCC patients with T2DM can be safely performed with favorable perioperative and long-term oncological outcomes at high-volume liver cancer centers, regardless of the course of T2DM.
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Affiliation(s)
- Shi-Ye Yang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Jin-Kai Feng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Mao-Lin Yan
- Department of Hepatobiliary and Pancreatic Surgery, Fujian Provincial Hospital, The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Lei Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Yun-Fei Duan
- Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Soochow University (Changzhou People's Hospital), Jiangsu, China
| | - Jia-Zhou Ye
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Guangxi, China
| | - Zong-Han Liu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Yan-Jun Xiang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Li Xu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Jie Xue
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Jie Shi
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Shu-Qun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China.
| | - Wei-Xing Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China.
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8
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Wang YY, Xing BC. Author's reply: Comment on ``Effect of vessels that encapsulate tumor clusters (VETC) and different stages of hepatocellular carcinoma after hepatectomy''. Dig Liver Dis 2023; 55:1441-1442. [PMID: 37666681 DOI: 10.1016/j.dld.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Yan-Yan Wang
- Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing 100142, China
| | - Bao-Cai Xing
- Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing 100142, China.
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Ding DY, Liu L, Lin KY, Gan XJ, Guo XG, Ding WB, Sun DP, Li W, Tao QF, Gu FM, Guo WX, Zeng YY, Zhou WP, Yuan SX. Perioperative and long-term survival outcomes of laparoscopic versus open hepatectomy for BCLC stage A large hepatocellular carcinoma patients in difficult segments: A two-centre, propensity score matching analysis. Front Oncol 2023; 13:1095357. [PMID: 36969010 PMCID: PMC10038276 DOI: 10.3389/fonc.2023.1095357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
BackgroundThe differences in short- and long-term outcome between laparoscopic liver resection (LLR) and open liver resection (OLR) for BCLC stage A large hepatocellular carcinoma (HCC) in difficult segments (I, IVa, VII, VIII) remain unclear. This PSM two-centre study aimed to compare perioperative and long-term survival outcomes of LLR with OLR for this HCC.MethodsHCC patients with BCLC stage A who underwent OLR or LLR in two medical centres were enrolled in the study. PSM analysis was performed to match patients between the LLR cohort and OLR cohort. Survival was analysed based on the Kaplan–Meier method. Independent risk factors were identified by Cox regression.ResultsAfter PSM, 35 patients remained in the LLR cohort, and 84 remained in the OLR cohort. Patients in the LLR cohort had more intraoperative blood loss (p=0.036) and shorter hospital stays after surgery (p<0.001). The LLR cohort and OLR cohort had no difference in intraoperative blood transfusion, surgical margin or postoperative short-term outcomes. The OS and RFS were not significantly different between the two cohorts. The OS and RFS of these two cohorts were not different in the subgroup analysis. Surgical margin was identified as an independent risk factor for tumour recurrence.ConclusionFor BCLC stage A large HCC patients with lesions in difficult segments, LLR was feasible and had shorter hospital stay than OLR. In addition, a surgical margin ≥1 cm could significantly decrease the recurrence probability for large HCC located in different segments without compromising short-term outcomes.
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Affiliation(s)
- Dong-yang Ding
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Lei Liu
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Kong-ying Lin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiao-jie Gan
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Xing-gang Guo
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Wen-bin Ding
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Da-peng Sun
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Wen Li
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Qi-fei Tao
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Fang-ming Gu
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Wei-xing Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Wei-ping Zhou, ; Sheng-xian Yuan, ; Yong-yi Zeng, ; Wei-xing Guo,
| | - Yong-yi Zeng
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- *Correspondence: Wei-ping Zhou, ; Sheng-xian Yuan, ; Yong-yi Zeng, ; Wei-xing Guo,
| | - Wei-ping Zhou
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Wei-ping Zhou, ; Sheng-xian Yuan, ; Yong-yi Zeng, ; Wei-xing Guo,
| | - Sheng-xian Yuan
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Wei-ping Zhou, ; Sheng-xian Yuan, ; Yong-yi Zeng, ; Wei-xing Guo,
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Hsieh PM, Hsiao P, Chen YS, Yeh JH, Hung CM, Lin HY, Ma CH, Tang T, Huang YW, Cheng PN, Hsieh KC, Hu KC, Bair MJ, Lin CW. Clinical prognosis of surgical resection versus transarterial chemoembolization for single large hepatocellular carcinoma (≥5 cm): A propensity score matching analysis. Kaohsiung J Med Sci 2023; 39:302-310. [PMID: 36625289 DOI: 10.1002/kjm2.12640] [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: 10/11/2022] [Revised: 12/04/2022] [Accepted: 12/11/2022] [Indexed: 01/11/2023] Open
Abstract
Favorable prognostic factors and therapeutic strategies are important for patients with single large hepatocellular carcinoma (HCC). This retrospective study aimed to investigate the prognostic factors in patients with single large (≥5 cm) HCC with Child-Pugh (CP) class A patients and to recommend therapeutic strategies. Overall, 298 HCC patients with single and large (≥5 cm) tumors with CP class A, but without distant metastasis and macrovascular invasion were included, and their clinicopathological data, overall survival (OS), and progression-free survival (PFS) were recorded. OS and PFS was analyzed by the Kaplan-Meier method and Cox regression analysis. Propensity score matching (PSM) analysis was performed. The 298 HCC patients were 79.2% male and median age of 64 years. For the initial treatment, surgical resection (SR) and transarterial chemoembolization (TACE) was 50.8% and 49.2%, respectively. The OS and PFS were significantly higher in patients receiving SR than those receiving TACE before and after PSM. Furthermore, in multivariate analysis, cirrhosis (Hazard ratio [HR]: 2.04; 95% confidence interval [CI]: 1.35-3.03, p < 0.001, CP class A5/6 [HR: 4.01; 95% CI: 2.43-6.66, p < 0.001], and initial treatment [SR vs. TACE HR = 3.23; 95% CI: 2.13-5.01, p < 0.001]) remained significantly associated with mortality. Moreover, in multivariate analysis, CP class A5/6 (HR: 3.23; 95% CI: 1.89-5.88, p < 0.001), and initial treatment (Resection vs. TACE; HR = 4.17; 95% CI: 1.64-8.33, p = 0.039) remained significantly associated with recurrence. In conclusion, SR was associated with significantly higher OS and PFS rates than TACE before and after PSM for single large HCC patients.
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Affiliation(s)
- Pei-Min Hsieh
- Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Pojen Hsiao
- Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yaw-Sen Chen
- Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Jen-Hao Yeh
- Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chao-Ming Hung
- Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Hung-Yu Lin
- Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ching-Hou Ma
- Department of Orthopedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - TaoQian Tang
- Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yu Wei Huang
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Emergency and Critical Care Center, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Nursing, Fooyin University, Pingtung, Taiwan
| | - Pin-Nan Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Kun-Chou Hsieh
- Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Kuang-Chun Hu
- Healthy Evaluation Center and Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing and Management, New Taipei, Taiwan
| | - Ming-Jong Bair
- Mackay Medical College, New Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taitung, Taiwan
| | - Chih-Wen Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Health Examination Center, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.,Research Center for Traditional Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
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11
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Outcomes and Patient Selection in Laparoscopic vs. Open Liver Resection for HCC and Colorectal Cancer Liver Metastasis. Cancers (Basel) 2023; 15:cancers15041179. [PMID: 36831521 PMCID: PMC9954110 DOI: 10.3390/cancers15041179] [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: 11/07/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM) are the two most common malignant tumors that require liver resection. While liver transplantation is the best treatment for HCC, organ shortages and high costs limit the availability of this option for many patients and make resection the mainstay of treatment. For patients with CRLM, surgical resection with negative margins is the only potentially curative option. Over the last two decades, laparoscopic liver resection (LLR) has been increasingly adopted for the resection of a variety of tumors and was found to have similar long-term outcomes compared to open liver resection (OLR) while offering the benefits of improved short-term outcomes. In this review, we discuss the current literature on the outcomes of LLR vs. OLR for patients with HCC and CRLM. Although the use of LLR for HCC and CRLM is increasing, it is not appropriate for all patients. We describe an approach to selecting patients best-suited for LLR. The four common difficulty-scoring systems for LLR are summarized. Additionally, we review the current evidence behind the emerging robotically assisted liver resection technology.
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12
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Jiang S, Yu D, He H, Sun H, Sun Y, Zhou L, Wu Z, Gu Q. Short- and Long-Term Outcomes in Laparoscopic Versus Open Hepatectomy for Hepatocellular Carcinoma in Elderly Patients: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2023; 33:321-334. [PMID: 36716177 DOI: 10.1089/lap.2022.0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background: Laparoscopic hepatectomy (LH) is considered a safe and feasible treatment for patients with hepatocellular carcinoma (HCC) in recent studies. However, in elderly patients, application of LH still remains controversial, and the outcomes of LH versus open hepatectomy (OH) have not been fully evaluated. Our objective is to compare the short- and long-term outcomes of LH with OH in elderly patients with HCC. Materials and Methods: All studies comparing LH and OH in elderly patients with HCC were systematically searched in the databases of PubMed, EmBase, and Web of Science. Statistical analysis was conducted using Review Manager 5.3 (Cochrane Collaboration, 2014). The last search was performed on March 20, 2022. Short-term outcomes include blood loss, operation time, blood transfusion, overall and major postoperative complications, mortality, hospital stay, tumor size, and surgical margin. Long-term outcomes include 1-, 3-, and 5-year overall survival (OS); 1-, 3-, and 5-year disease-free survival (DFS); and 1-, 3-, and 5-year recurrence-free survival (RFS). Results: Fourteen studies involving 1596 patients were included in this meta-analysis. The short-term outcomes of LH were a shorter postoperative hospital stay and fewer overall and major postoperative complications (all P < .00001). However, there were no significant differences in operation time, blood loss, blood transfusion rate, surgical margin, tumor size, and mortality. For the long-term outcomes, LH is comparable with OH in terms of 1-, 3-, and 5-year OS; 1-, 3-, and 5-year DFS; and 1-, 3-, and 5-year RFS. Conclusions: Compared with OH, LH is a safe and feasible treatment for elderly patients with HCC.
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Affiliation(s)
- Song Jiang
- Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Dong Yu
- Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Hongwei He
- Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Haijian Sun
- Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Yan Sun
- Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Longxiang Zhou
- Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Zhongxin Wu
- Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Qiyun Gu
- Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
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13
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Chua DW, Syn N, Koh YX, Teo JY, Cheow PC, Chung AYF, Chan CY, Goh BKP. Association of standardized liver volume and body mass index with outcomes of minimally invasive liver resections. Surg Endosc 2023; 37:456-465. [PMID: 35999310 DOI: 10.1007/s00464-022-09534-x] [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: 01/23/2022] [Accepted: 08/04/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION While minimally invasive liver resections (MILR) have demonstrated advantages in improved post-operative recovery, widespread adoption is hampered by inherent technical difficulties. Our study attempts to analyze the role of anthropometric measures in MILR-related outcomes. METHODS Between 2012 and 2020, 676 consecutive patients underwent MILR at the Singapore General Hospital of which 565 met study criteria and were included. Patients were stratified based on Body Mass Index (BMI) as well as Standardized Liver Volumes (SLV). Associations between BMI and SLV to selected peri-operative outcomes were analyzed using restricted cubic splines. RESULTS A BMI of ≥ 29 was associated with increase in blood loss [Mean difference (MD) 69 mls, 95% CI 2 to 137] as well as operative conversions [Relative Risk (RR) 1.63, 95% CI 1.02 to 2.62] among patients undergoing MILR while a SLV of 1600 cc or higher was associated with an increase in blood loss (MD 30 mls, 95% CI 10 to 49). In addition, a BMI of ≤ 20 was associated with an increased risk of major complications (RR 2.25, 95% 1.16 to 4.35). The magnitude of differences observed in these findings increased with each unit change in BMI and SLV. CONCLUSION Both BMI and SLV were useful anthropometric measures in predicting peri-operative outcomes in MILR and may be considered for incorporation in future difficulty scoring systems for MILR.
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Affiliation(s)
- Darren W Chua
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Nicholas Syn
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore
- Ministry of Health Holdings, Singapore, Singapore
| | - Ye-Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore, Singapore
| | - Jin-Yao Teo
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Peng-Chung Cheow
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore, Singapore
| | - Alexander Y F Chung
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore, Singapore
| | - Chung-Yip Chan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore.
- Duke-National University of Singapore Medical School, Singapore, Singapore.
- Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore, Singapore.
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14
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Laparoscopic versus Robotic Hepatectomy: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11195831. [PMID: 36233697 PMCID: PMC9571364 DOI: 10.3390/jcm11195831] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/28/2022] [Accepted: 09/24/2022] [Indexed: 12/02/2022] Open
Abstract
This study aimed to assess the surgical outcomes of robotic compared to laparoscopic hepatectomy, with a special focus on the meta-analysis method. Original studies were collected from three Chinese databases, PubMed, EMBASE, and Cochrane Library databases. Our systematic review was conducted on 682 patients with robotic liver resection, and 1101 patients were operated by laparoscopic platform. Robotic surgery has a long surgical duration (MD = 43.99, 95% CI: 23.45-64.53, p = 0.0001), while there is no significant difference in length of hospital stay (MD = 0.10, 95% CI: -0.38-0.58, p = 0.69), blood loss (MD = -20, 95% CI: -64.90-23.34, p = 0.36), the incidence of conversion (OR = 0.84, 95% CI: 0.41-1.69, p = 0.62), and tumor size (MD = 0.30, 95% CI: -0-0.60, p = 0.05); the subgroup analysis of major and minor hepatectomy on operation time is (MD = -7.08, 95% CI: -15.22-0.07, p = 0.09) and (MD = 39.87, 95% CI: -1.70-81.44, p = 0.06), respectively. However, despite the deficiencies of robotic hepatectomy in terms of extended operation time compared to laparoscopic hepatectomy, robotic hepatectomy is still effective and equivalent to laparoscopic hepatectomy in outcomes. Scientific evaluation and research on one portion of the liver may produce more efficacity and more precise results. Therefore, more clinical trials are needed to evaluate the clinical outcomes of robotic compared to laparoscopic hepatectomy.
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15
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Zhu QL, Li GL. Laparoscopic Right Hepatectomy is as Safe and Feasible as Open Procedure in the Treatment of Liver Tumors: Meta-analysis. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02824-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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Yang SY, Yan ML, Duan YF, Feng JK, Ye JZ, Xiang YJ, Liu ZH, Guo L, Xue J, Cheng SQ, Guo WX. Perioperative and long-term survival outcomes of laparoscopic versus laparotomic hepatectomy for BCLC stages 0-A hepatocellular carcinoma patients associated with or without microvascular invasion: a multicenter, propensity score matching analysis. Hepatol Int 2022; 16:892-905. [PMID: 35704267 DOI: 10.1007/s12072-022-10353-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/01/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To analyze the long-term oncological outcomes of Barcelona Clinic Liver Cancer (BCLC) stages 0-A hepatocellular carcinoma (HCC) patients associated with or without microvascular invasion (MVI) treated with laparoscopic versus laparotomic liver resection. METHODS Clinicopathological data of HCC patients with BCLC stages 0-A from four medical centers were retrospectively reviewed. The survival outcomes of patients who underwent laparoscopic hepatectomy were compared with those who underwent laparotomic hepatectomy. Subgroup analyses in terms of MVI were further performed to explore the effect of surgical approaches on the long-term survival outcomes. Propensity score matching (PSM) analysis was used to match patients between the laparoscopic and laparotomic resection groups in a 1:1 ratio. RESULTS 495 HCC patients at BCLC stages 0-A were enrolled, including 243 in the laparoscopic resection group and 252 in the laparotomic resection group. Laparoscopic resection group had a shorter operation time, less blood loss, a lower frequency of blood transfusion and postoperative complication rates. The laparoscopic resection group had a significantly better overall survival (OS) and recurrence-free survival (RFS) than the laparotomic resection group before and after PSM. Subgroup analysis demonstrated that OS and RFS of patients without MVI were remarkably better in the laparoscopic resection group compared with the laparotomic resection group. However, no significant differences in OS and RFS between the two groups were found in patients with MVI after PSM. CONCLUSIONS Pure laparoscopic hepatectomy for patients with BCLC stages 0-A HCC can be performed safely with favorable perioperative and long-term oncological outcomes at high-volume liver cancer centers, regardless of the presence of MVI.
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Affiliation(s)
- Shi-Ye Yang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Mao-Lin Yan
- Department of Hepatobiliary and Pancreatic Surgery, Fujian Provincial Hospital, The Shengli Clinical Medical College of Fujian Medical University, Fujian, China
| | - Yun-Fei Duan
- Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Soochow University (Changzhou People's Hospital), Jiangsu, China
| | - Jin-Kai Feng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Jia-Zhou Ye
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Guangxi, China
| | - Yan-Jun Xiang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Zong-Han Liu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Lei Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Jie Xue
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Shu-Qun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China.
| | - Wei-Xing Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China.
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17
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Naito S, Fujikawa T, Kouno N, Hasegawa S. Is laparoscopic liver resection safe for super-elderly patients (aged ≥80)? A propensity score-matched analysis. Asian J Endosc Surg 2022; 15:279-289. [PMID: 34612004 DOI: 10.1111/ases.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE The safety of laparoscopic liver resection in super-elderly patients with comorbidities is unknown. We used propensity score matching to evaluate the utility and safety of laparoscopic liver resection in super-elderly patients. METHODS Two-hundred and five patients who underwent laparoscopic liver resection were retrospectively reviewed. They were classified into two groups based on age: ≥80 years (elderly group, n = 49) and <80 years (control group, n = 156). Propensity score matching (PSM) was performed based on preoperative clinical parameters. The intraoperative and postoperative outcomes were compared. RESULTS After matching, 45 patients were included in each group. The intraoperative blood loss was identical between the control and elderly groups (60 vs 60 mL, respectively, P = .588); the frequency of serious postoperative complications (Clavien-Dindo class ≥3, 1/45 vs 1/45, P = 1.00) was also similar. There was no significant difference in terms of the exacerbation of malignancy (22.2% vs 11.1%, P = .258) or other diseases (8.9% vs 22.2%, P = .144). There was no difference in overall survival before and after PSM. However, 5-year overall survival excluding primary cancer-related death showed a difference after PSM (90.7% vs 70.4%; P = .048). CONCLUSIONS Laparoscopic liver resection is feasible and safe in super-elderly patients. The long-term prognosis was poor in patients affected by other illnesses compared to the younger population with similar risk profiles, but there was no difference in overall survival.
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Affiliation(s)
- Shigetoshi Naito
- Department of Surgery, Kokura Memorial Hospital, Fukuoka, Japan.,Department of Gastroenterological Surgery, Fukuoka University, Fukuoka, Japan
| | | | - Nobuji Kouno
- Department of Surgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Fukuoka University, Fukuoka, Japan
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18
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Tsuzaka S, Asahi Y, Kamiyama T, Kakisaka T, Orimo T, Nagatsu A, Aiyama T, Uebayashi T, Kamachi H, Matsuoka M, Wakabayashi K, Otsuka T, Matsuno Y, Taketomi A. Laparoscopic liver resection for liver metastasis of leiomyosarcoma of the thigh: a case report. Surg Case Rep 2022; 8:47. [PMID: 35307790 PMCID: PMC8934789 DOI: 10.1186/s40792-022-01400-1] [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: 02/10/2022] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although there is no established treatment strategy for liver metastasis of leiomyosarcoma, liver resection has been reported to be effective in some cases. However, almost all liver resections performed for liver metastasis of primary leiomyosarcoma are reported to be open resections, and there are few reports of liver resection performed by laparoscopy. Here, we report a case of laparoscopic liver resection for liver metastasis of a leiomyosarcoma in the right thigh.
Case presentation An 80-year-old man was diagnosed with leiomyosarcoma of the right thigh with liver metastasis. The primary tumor was first resected, and he was discharged on the 25th postoperative day. Four months after primary tumor resection, a laparoscopic right posterior sectionectomy was performed. There were no postoperative complications, and the patient was discharged on the 11th postoperative day with a histopathological diagnosis of liver metastasis of leiomyosarcoma and negative resection margins. Currently, 9 months have passed since the resection of the primary tumor, and 5 months have passed since the laparoscopic liver resection; there is no recurrence. Conclusions The liver metastasis of leiomyosarcoma was successfully removed, with good short-term outcomes after the laparoscopic liver resection. Laparoscopic liver resection seems to be effective for liver metastasis of leiomyosarcoma, which is characterized by a high recurrence rate after surgery. However, more case studies may be necessary to examine the effectiveness and long-term results of laparoscopic liver resection for the treatment of liver metastasis of leiomyosarcoma.
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Affiliation(s)
- Shoichi Tsuzaka
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Yoh Asahi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan.
| | - Toshiya Kamiyama
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Tatsuhiko Kakisaka
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Tatsuya Orimo
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Akihisa Nagatsu
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Takeshi Aiyama
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Takeyuki Uebayashi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Hirofumi Kamachi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Masatake Matsuoka
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Kento Wakabayashi
- Department of Surgical Pathology, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Takuya Otsuka
- Department of Surgical Pathology, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
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19
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Liao K, Yu F, Cao L, Wang B, Li X, Wang X, Li J, Fan Y, Chen J, Zheng S. Laparoscopic Glissonian pedicle versus hilar dissection approach hemihepatectomy: A prospective, randomized controlled trial. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:629-640. [PMID: 35224875 DOI: 10.1002/jhbp.1129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/14/2021] [Accepted: 01/19/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Ke‐Xi Liao
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Fan Yu
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
- The Third Hospital of Mianyang Sichuan Mental Health Center Mianyang 621000 Sichuan China
| | - Li Cao
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Bao‐Lin Wang
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Xue‐Song Li
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Xiao‐Jun Wang
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Jian‐Wei Li
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Yu‐Dong Fan
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Jian Chen
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Shu‐Guo Zheng
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
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20
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Monden K, Sadamori H, Hioki M, Ohno S, Takakura N. Short-term outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma in older patients: a propensity score matching analysis. BMC Surg 2022; 22:63. [PMID: 35197022 PMCID: PMC8864801 DOI: 10.1186/s12893-022-01518-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 02/08/2022] [Indexed: 12/15/2022] Open
Abstract
Background The incidence of hepatocellular carcinoma (HCC) requiring surgical treatment in older patients has been continuously increasing. This study aimed to examine the safety and feasibility of performing laparoscopic liver resection (LLR) versus open liver resection (OLR) for HCC in older patients at a Japanese institution. Methods Between January 2010 and June 2021, 133 and 145 older patients (aged ≥ 70 years) who were diagnosed with HCC underwent LLR and OLR, respectively. Propensity score matching (PSM) analysis with covariates of baseline characteristics was performed. The intraoperative and postoperative data were evaluated in both groups. Results After PSM, 75 patients each for LLR and OLR were selected and the data compared. No significant differences in demographic characteristics, clinical data, and operative times were observed between the groups, although less than 10% of cases in each group underwent a major resection. Blood loss (OLR: 370 mL, LLR: 50 mL; P < 0.001) was lower, and the length of postoperative hospital stay (OLR: 12 days, LLR: 7 days; P < 0.001) and time to start of oral intake (OLR: 2 days, LLR: 1 day; P < 0.001) were shorter in the LLR group than in the OLR group. The incidence of complications ≥ Clavien–Dindo class IIIa was similar between the two groups. Conclusions LLR, especially minor resections, is safely performed and feasible for selected older patients with HCC.
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Affiliation(s)
- Kazuteru Monden
- Department of Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, 721-8511, Japan.
| | - Hiroshi Sadamori
- Department of Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, 721-8511, Japan
| | - Masayoshi Hioki
- Department of Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, 721-8511, Japan
| | - Satoshi Ohno
- Department of Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, 721-8511, Japan
| | - Norihisa Takakura
- Department of Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, 721-8511, Japan
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Masetti M, Fallani G, Ratti F, Ferrero A, Giuliante F, Cillo U, Guglielmi A, Ettorre GM, Torzilli G, Vincenti L, Ercolani G, Cipressi C, Lombardi R, Aldrighetti L, Jovine E. Minimally invasive treatment of colorectal liver metastases: does robotic surgery provide any technical advantages over laparoscopy? A multicenter analysis from the IGoMILS (Italian Group of Minimally Invasive Liver Surgery) registry. Updates Surg 2022; 74:535-545. [DOI: 10.1007/s13304-022-01245-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/15/2022] [Indexed: 12/27/2022]
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Yeh CY, Chang WK, Wu HL, Chau GY, Tai YH, Chang KY. Associations of Multimodal Analgesia With Postoperative Pain Trajectories and Morphine Consumption After Hepatic Cancer Surgery. Front Med (Lausanne) 2022; 8:777369. [PMID: 35155466 PMCID: PMC8831718 DOI: 10.3389/fmed.2021.777369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background This study aimed to investigate the influential factors of postoperative pain trajectories and morphine consumption after hepatic cancer surgery with a particular interest in multimodal analgesia. Methods Patients receiving hepatic cancer surgery at a tertiary medical center were enrolled between 2011 and 2016. Postoperative pain scores and potentially influential factors like patient characteristics and the analgesic used were collected. Latent curve analysis was conducted to investigate predictors of postoperative pain trajectories and a linear regression model was used to explore factors associated with postoperative morphine consumption. Results 450 patients were collected, the daily pain scores during the first postoperative week ranged from 2.0 to 3.0 on average. Male and higher body weight were associated with more morphine consumption (both P < 0.001) but reduced morphine demand was noted in the elderly (P < 0.001) and standing acetaminophen users (P = 0.003). Longer anesthesia time was associated with higher baseline pain levels (P < 0.001). In contrast, male gender (P < 0.001) and standing non-steroidal anti-inflammatory drugs (NSAIDs) use (P = 0.012) were associated with faster pain resolution over time. Conclusions Multimodal analgesia with standing acetaminophen and NSAIDs had benefits of opioid-sparing and faster pain resolution, respectively, to patients receiving hepatic cancer surgery.
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Affiliation(s)
- Chia-Yi Yeh
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Kuei Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiang-Ling Wu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Gar-Yang Chau
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Hsuan Tai
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuang-Yi Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Kuang-Yi Chang
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Hendi M, Lv J, Cai XJ. Current status of laparoscopic hepatectomy for the treatment of hepatocellular carcinoma: A systematic literature review. Medicine (Baltimore) 2021; 100:e27826. [PMID: 34918631 PMCID: PMC8677975 DOI: 10.1097/md.0000000000027826] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/29/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Laparoscopic hepatectomy (LH) was first introduced in the 1990s and has now become widely accepted for the treatment of hepatocellular carcinoma (HCC). Laparoscopic liver resection (LLR) is considered a safe and effective approach for liver disease. However, the role of laparoscopic hepatectomy in HCC with cirrhosis remains controversial and needs to be further assessed, and the present literature review aimed to review the surgical and oncological outcomes of Laparoscopic hepatectomy (LH). According to Hong and colleagues laparoscopic resection for liver cirrhosis is a very safe and feasible procedure for both ideal cases and select patients with high risk factors [29]. The presence of only 1 of these factors does not represent an absolute contraindication for LH. METHODS AND RESULTS We selected 23 studies involving about 1363 HCC patients treated with LH. 364 (27%) patients experienced major resections. The mean operative time was 244.9 minutes, the mean blood loss was 308.1 mL and blood transfusions were required in only 4.9% of patients. There were only 2 (0.21%) postoperative deaths and overall morbidity was 9.9%. Tumor recurrence ranged from 6 to 25 months. The 1-year, 3-year, and 5-year disease free Survival (DFS) rates ranged from 71.9% to 99%, 50.3% to 91.2%, and 19% to 82% respectively. Overall survival rates ranged from 88% to 100%, 73.4% to 94.5%, and 52.6% to 94.5% respectively. CONCLUSIONS In our summery LH is lower risk and safer than conventional open liver surgery and is just as efficacious. Also, the LH approach decreased blood-loss, operation time, postoperative morbidity and had a lower conversion rate compared to other procedures whether open or robotic. Finally, LH may serve as a promising alternative to open procedures.
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Gaspar-Figueiredo S, Kefleyesus A, Sempoux C, Uldry E, Halkic N. Focal nodular hyperplasia associated with a giant hepatocellular adenoma: A case report and review of literature. World J Hepatol 2021; 13:1450-1458. [PMID: 34786179 PMCID: PMC8568569 DOI: 10.4254/wjh.v13.i10.1450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/15/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) are well-known benign liver lesions. Surgical treatment is usually chosen for symptomatic patients, lesions more than 5 cm, and uncertainty of diagnosis.
CASE SUMMARY We described the case of a large liver composite tumor in an asymptomatic 34-year-old female under oral contraceptive for 17-years. The imaging work-out described two components in this liver tumor; measuring 6 cm × 6 cm and 14 cm × 12 cm × 6 cm. The multidisciplinary team suggested surgery for this young woman with an unclear HCA diagnosis. She underwent a laparoscopic left liver lobectomy, with an uneventful postoperative course. Final pathological examination confirmed FNH associated with a large HCA. This manuscript aimed to make a literature review of the current management in this particular situation of large simultaneous benign liver tumors.
CONCLUSION The simultaneous presence of benign composite liver tumors is rare. This case highlights the management in a multidisciplinary team setting.
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Affiliation(s)
| | - Amaniel Kefleyesus
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne 1011, Switzerland
| | - Christine Sempoux
- Department of Pathology, Lausanne University Hospital, Lausanne 1011, Switzerland
| | - Emilie Uldry
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne 1011, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne 1011, Switzerland
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Kamarajah SK, Gujjuri RR, Hilal MA, Manas DM, White SA. Does minimally invasive liver resection improve long-term survival compared to open resection for hepatocellular carcinoma? A systematic review and meta-analysis. Scand J Surg 2021; 111:14574969211042455. [PMID: 34605328 DOI: 10.1177/14574969211042455] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Minimally invasive liver surgery for hepatocellular carcinoma has gained widespread interest as an alternative to conventional open liver surgery. However, long-term survival benefits of this approach seem unclear. This meta-analysis was conducted to investigate long-term survival following minimally invasive liver surgery. METHOD A systematic review was performed to identify studies comparing long-term survival after minimally invasive liver surgery and open liver surgery until January 2020. The I2 test was used to test for statistical heterogeneity and publication bias was assessed using Egger test. Random-effects meta-analysis was performed for all-cause 5-year (main outcome) and 3-year mortality, and disease-specific 5-year and 3-year mortality. Meta-regression was performed for the 5-year and 3-year survival outcomes with adjustment for study factors (region, design), annual center volume, patient factors (American Society of Anesthesiologists (ASA) grade, gender, age, body mass index, cirrhosis, tumor size, and number), and resection extent. Sensitivity analyses were performed on studies by study year, region, annual center volume, and resection type. RESULT The review identified 50 relevant studies including 13,731 patients undergoing liver resection for hepatocellular carcinoma of which 4071 (25.8%) underwent minimally invasive liver surgery. Pooled analysis revealed similar all-cause (odds ratio: 0.83, 95% confidence interval: 0.70-1.11, p = 0.3) and disease-specific (odds ratio: 0.93, 95% confidence interval: 0.80-1.09, p = 0.4) 5-year mortality after minimally invasive liver surgery compared with open liver surgery. Sensitivity analysis of published studies from 2010 to 2019 demonstrated a significantly lower disease-specific 3-year mortality (odds ratio: 0.75, 95% confidence interval: 0.59-0.96, p = 0.022) and all-cause 5-year mortality (odds ratio: 0.63, 95% confidence interval: 0.50-0.81, p = 0.002). Meta-regression identified no confounding factors in all analyses. CONCLUSIONS Improvement in minimally invasive liver surgery techniques over the past decade appears to demonstrate superior disease-specific mortality with minimally invasive liver surgery compared to open liver surgery. Therefore, minimally invasive liver surgery can be recommended as an alternative surgical approach for hepatocellular carcinoma.
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Affiliation(s)
- Sivesh K Kamarajah
- BMedSci, MBChB Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle University NHS Trust Hospitals, NE7 7DN, Newcastle upon Tyne, UK Institute of Cellular Medicine, Newcastle University, NE2 4HH, Newcastle upon Tyne, UK
| | - Rohan R Gujjuri
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Moh'd A Hilal
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Derek M Manas
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle University NHS Trust Hospitals, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Steven A White
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle University NHS Trust Hospitals, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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Cai JP, Chen W, Chen LH, Wan XY, Lai JM, Yin XY. Comparison between robotic-assisted and laparoscopic left hemi-hepatectomy. Asian J Surg 2021; 45:265-268. [PMID: 34120821 DOI: 10.1016/j.asjsur.2021.05.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To compare the safety and short-term outcomes between robotic-assisted and laparoscopic left hemi-hepatectomies in a single academic medical center. METHODS A cohort of 52 patients, who underwent robotic-assisted or laparoscopic left hemi-hepatectomies between April 2015 and January 2020 in Department of Pancreatobiliary Surgery, the First Affiliated Hospital of Sun Yat-Sen University was recruited into the study. Their clinicopathological features and short-term outcomes were analyzed retrospectively. RESULTS There were 25 robotic-assisted and 27 laparoscopic cases, with a median age of 55 years (34-77 years). There was one conversion to open in laparoscopic group. There were no significant differences in clinicopathological features between two groups, except robotic group had higher body mass index (23.9 vs. 22.0 kg/m2, p = 0.047). Robotic-assisted and laparoscopic groups had similar operative time (300 vs. 310 min, p = 0.515), length of hospital stay (8 vs. 8 days, p = 0.981) and complication rates (4.0% vs. 14.8%, p = 0.395), but the former had less blood loss (100 vs. 200 ml, p < 0.001) and lower incidence of blood transfusion (0% vs. 22.2%, p = 0.023) in comparison with laparoscopic group. R0 resection was achieved for all patients with malignancies. There was no perioperative mortality in both groups. The cost of robotic group was higher than laparoscopic group (105,870 vs. 64,191 RMB yuan, p = 0.02). CONCLUSION The robotic-assisted and laparoscopic approaches had similar safety and short-term outcomes in left hemi-hepatectomy, and the former can reduce operative blood loss and blood transfusion. However, the costs were higher in robotic group.
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Affiliation(s)
- Jian-Peng Cai
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wei Chen
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Liu-Hua Chen
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xi-Yu Wan
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jia-Ming Lai
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Yu Yin
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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Hong SK, Lee KW, Hong SY, Suh S, Hong K, Han ES, Lee JM, Choi Y, Yi NJ, Suh KS. Efficacy of Liver Resection for Single Large Hepatocellular Carcinoma in Child-Pugh A Cirrhosis: Analysis of a Nationwide Cancer Registry Database. Front Oncol 2021; 11:674603. [PMID: 33996606 PMCID: PMC8121000 DOI: 10.3389/fonc.2021.674603] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/12/2021] [Indexed: 01/27/2023] Open
Abstract
Background Therapeutic strategies and good prognostic factors are important for patients with single large hepatocellular carcinoma (HCC). This retrospective study aimed to identify the prognostic factors in patients with single large HCC with good performance status and Child-Pugh A cirrhosis using a large national cancer registry database and to recommend therapeutic strategies. Methods Among 12139 HCC patients registered at the Korean Primary Liver Cancer Registry between 2008 and 2015, single large (≥ 5 cm) HCC patients with Eastern Cooperative Oncology Group (ECOG) performance status 0 and Child-Pugh score A were selected. Results Overall, 466 patients were analyzed. The 1-,2-,3-, and 5-year survival rates after initial treatment were 84.9%, 71.0%, 60.1%, and 51.6%, respectively, and progression-free survival rates were 43.6%, 33.0%, 29.0%, and 26.8%, respectively. Platelet count < 100 × 109/L (P < 0.001), sodium level < 135 mmol/L (P = 0.002), maximum tumor diameter ≥ 10 cm (P = 0.001), and treatment other than resection (transarterial therapy vs. resection: P < 0.001, others vs. resection: P = 0.002) were significantly associated with poorer overall survival; sodium < 135 mmol/L (P = 0.015), maximum tumor diameter ≥ 10 cm (P < 0.001), and treatment other than resection (transarterial therapy vs. resection: P < 0.001, others vs. resection: P = 0.001) were independently associated with poorer progression-free survival. Conclusion Resection as an initial treatment should be considered when possible, even in patients with single large HCC with good performance status and mild cirrhosis. Caution should be exercised in patients with low platelet level (< 100 × 109/L), low serum sodium level (< 135 mmol/L), and maximum tumor diameter ≥ 10 cm.
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Affiliation(s)
- Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Su Young Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Sanggyun Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwangpyo Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Eui Soo Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong-Moo Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Wen N, Liu F, Zhang H, Lu J, Li B, Cheng N. Laparoscopic liver resection for hepatocellular carcinoma presents less respiratory complications compared with open procedure: A propensity score analysis in the elderly. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:2675-2681. [PMID: 34059378 DOI: 10.1016/j.ejso.2021.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 04/08/2021] [Accepted: 04/26/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Resection is still the most efficacious treatment to hepatocellular carcinoma (HCC), among which laparoscopic liver resection (LLR) have controversial effects against conventional open procedure (OLR). With a predictable aging tendency of population worldwide, conventional surgical procedures need to be modified to better accommodate elderly patients. Here, we designed a retrospective study based on propensity score analysis, aiming to compare the efficacy of OLR and LLR in patients over 65 years. METHODS We retrospectively analyzed patients with an age over 65 who underwent liver resection between January 2015 and September 2018. Patients were divided into the LLR group and OLR group. Short-term and long-term outcomes were compared before and after 1:1 propensity score matching. RESULTS Among 240 enrolled patients, 142 were matched with comparable baseline (71 each group). In the matched cohort, LLR group presented with shorter postoperative hospital stay (median 7 vs 6 days, p = 0.003) and fewer respiratory complications (19.7% vs. 7.0%, p = 0.049), especially pleural effusion (15.5% vs. 2.8%, p = 0.020). Meanwhile, LLR had comparable overall hospital cost (6142 vs. 6243 USD, p = 0.977) compared with OLR. The overall survival (OS) and disease-free survival (DFS) did not differ in the two groups. CONCLUSIONS Our study showed that laparoscopic liver resection for HCC in the older age groups is associated with shorter postoperative hospital stay and comparable hospital cost compared with open procedure, which could be attributable to less respiratory complications. We recommend that laparoscopy be taken as a priority option for elderly patients with resectable HCC.
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Affiliation(s)
- Ningyuan Wen
- Department of Biliary Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan Province, PR China
| | - Fei Liu
- Department of Liver Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan Province, PR China
| | - Haili Zhang
- Department of Liver Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan Province, PR China
| | - Jiong Lu
- Department of Biliary Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan Province, PR China
| | - Bei Li
- Department of Biliary Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan Province, PR China.
| | - Nansheng Cheng
- Department of Biliary Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan Province, PR China.
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Yan C, Li BH, Sun XT, Yu DC. Laparoscopic hepatectomy is superior to open procedures for hepatic hemangioma. Hepatobiliary Pancreat Dis Int 2021; 20:142-146. [PMID: 32980268 DOI: 10.1016/j.hbpd.2020.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/08/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Laparoscopic hepatectomy (LH) has become increasingly popular for liver neoplasms, but its safety and effectiveness remain controversial. Hepatic hemangiomas are the most common benign liver neoplasm; the main approaches to hepatic hemangiomas include open hepatectomy (OH) and LH. In this study, we compared early outcomes between patients undergoing OH and those with LH. METHODS Patients underwent OH or LH in our hospital for hepatic hemangiomas between December 2013 and December 2017 were enrolled. All patients underwent comprehensive preoperative evaluations. The clinicopathological index and risk factors of hemangioma resection were assessed. RESULTS In total, 41 patients underwent OH while 53 underwent LH. There was no significant difference in any preoperative clinical variables, including liver function, prothrombin time, or platelet count. Hepatic portal occlusion time and operative time were 39.74 vs. 38.35 minutes (P = 0.717) and 197.20 vs. 203.68 minutes (P = 0.652) in the OH and LH groups, respectively. No mortality nor significant perioperative complications were observed between the two groups. In LH group, two cases were converted to OH, one for an oversized tumor and the other for hemorrhage. Compared with OH patients, those with LH had less blood loss (361.69 vs. 437.81 mL, P = 0.024), shorter postoperative hospital stay (7.98 vs. 11.07 days, P = 0.001), and lower postoperative C-reactive protein (43.63 vs. 58.21 mg/L, P = 0.026). CONCLUSIONS LH is superior to OH in terms of postoperative recovery and blood loss for selected patients with hepatic hemangioma.
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Affiliation(s)
- Chen Yan
- Department of Hepatobiliary Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China; Department of General Surgery, Taikang Xianlin Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210046, China
| | - Bing-Hua Li
- Department of Hepatobiliary Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Xi-Tai Sun
- Department of Hepatobiliary Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - De-Cai Yu
- Department of Hepatobiliary Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
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Zeng Z, Dong J, Li Y, Dong Z, Liu Z, Huang J, Wang Y, Zhen Y, Lu Y. The expression level and diagnostic value of microRNA-22 in HCC patients. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2021; 48:683-686. [PMID: 32088997 DOI: 10.1080/21691401.2019.1703723] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Involvements of microRNA-22 (miR-22) in cancer have attracted much attention, but its role in diagnosis of hepatocellular carcinoma (HCC) is still largely unknown. Therefore, the aim of this study was to investigate the expression level and the prognostic value of miR-22 in HCC patients.Methods: Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to evaluate serum level of miR-22 in 108 HCC patients and 67 healthy controls. The relationship between miR-22 expression level and clinicopathologic characteristics was analysed via chi-square test. Receiver operating characteristic (ROC) curve was built to estimate the diagnostic value of serum miR-22 in HCC.Results: miR-22 expression was significantly down-regulated in HCC compared to that in healthy controls (p < .05). And the low miR-22 expression was significantly associated with vein invasion (p = .002), TNM stage (p = .013) and high serum levels of AFP (α-fetoprotein), ALT (alanine aminotransferase), AST (aspartate aminotransferase) and ALP (alkaline phosphatase. miR-22 had a high diagnostic value with area under the curve of 0.866 corresponding with a sensitivity of 89.3% and a specificity of 68.9%, respectively.Conclusion: miR-22 expression was down-regulated in HCC patients. Serum miR-22 might be a novel diagnostic marker in HCC.
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Affiliation(s)
- Zhen Zeng
- Comprehensive Liver Cancer Center, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jinghui Dong
- Radiology Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yinyin Li
- Comprehensive Liver Cancer Center, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zheng Dong
- Comprehensive Liver Cancer Center, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ze Liu
- Comprehensive Liver Cancer Center, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jiagan Huang
- Comprehensive Liver Cancer Center, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yonggang Wang
- The Institute of Intensive Care Unit, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yunhuan Zhen
- General Surgery Department, Guizhou Medical University, Guiyang, China
| | - Yinying Lu
- Comprehensive Liver Cancer Center, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
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Minimal-Invasive Versus Open Hepatectomy for Colorectal Liver Metastases: Bicentric Analysis of Postoperative Outcomes and Long-Term Survival Using Propensity Score Matching Analysis. J Clin Med 2020; 9:jcm9124027. [PMID: 33322087 PMCID: PMC7764401 DOI: 10.3390/jcm9124027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 12/14/2022] Open
Abstract
Minimal-invasive hepatectomy (MIH) has been increasingly performed for benign and malignant liver lesions with most promising short-term results. However, the oncological role of MIH in the treatment of patients with colorectal liver metastases (CRLM) needs further investigation. Clinicopathological data of patients who underwent liver resection for CRLM between 2012 and 2017 at the Department of Surgery, Charité-Universitätsmedizin Berlin, and the Inselspital Bern were assessed. Postoperative outcomes und long-term survivals of patients following MIH were compared with those after conventional open hepatectomy (OH) after 1:1 propensity score matching. During the study period, 229 and 91 patients underwent liver resection for CRLM at the Charité Berlin and the Inselspital Bern, respectively. Patients who underwent MIH in one of the two centers (n = 69) were compared with a matched cohort of patients who underwent OH. MIH was associated with lower complication rates (23% vs. 44%, p = 0.011), shorter length of intensive care unit stay (ICU, 1 vs. 2 days, p = 0.043), shorter length of hospital stay (7 vs. 11 days, p < 0.0001), and a reduced need for intraoperative transfusions (12% vs. 25%, p = 0.047) compared to OH. R0 status was achieved in 93% and 75% of patients after MIH and OH, respectively (p = 0.005). After a median follow-up of 31 months, MIH resulted in similar five-year overall survival (OS) rate (56% vs. 48%, p = 0.116) in comparison to OH. MIH for CRLM is associated with lower postoperative morbidity, shorter length of ICU and hospital stay, reduced need for transfusions, and comparable oncologic outcomes compared to the established OH. Our findings suggest that MIH should be considered as the preferred method for the treatment of curatively resectable CRLM.
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Laparoscopic Versus Open Left Lateral Segmentectomy for Large Hepatocellular Carcinoma: A Propensity Score-Matched Analysis. Surg Laparosc Endosc Percutan Tech 2020; 29:513-519. [PMID: 31568257 DOI: 10.1097/sle.0000000000000723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND With the advancement of endoscopic technology, laparoscopic liver resection has become the standard procedure for left lateral segmentectomy. The aim of this study was to compare perioperative and oncological outcomes between laparoscopic and open left lateral segmentectomy for hepatocellular carcinoma (HCC) >5 cm. PATIENTS AND METHODS A total of 66 patients underwent left lateral segmentectomy for HCC (>5 cm) during the period spanning between 2013 and 2015. To overcome selection bias, 1:3 match using propensity score-matched analysis was performed between laparoscopic and open liver resection. RESULTS Relatively smaller tumor size (6.0 vs. 7.0 cm; P=0.030) and more frequent incidence of complete tumor capsule (93.3% vs. 58.8%; P=0.013) were observed in the laparoscopic group compared with the open group before matching. Although the longer operation time (195 vs. 150 min; P=0.022) was consumed in the laparoscopic procedure after matching, the laparoscopic group had shorter postoperative hospital stay (6 vs. 7 d; P=0.002) and less blood loss volume (50 vs. 100 mL; P=0.022). The Pringle maneuver for hepatic inflow occlusion was more likely to be applied in patients who underwent open surgery. The incidence of postoperative complication seemed to be lower in the laparoscopic group (6.7%) compared with that in the open group (11.8%) before matching. On the basis of propensity score-matched analysis, the complication rates were comparable between the 2 groups (7.1% vs. 6.7%, P=0.953). No difference in the 1-year and 3-year overall and recurrence-free survival rates was found between the laparoscopic and open groups. CONCLUSION Laparoscopic left lateral segmentectomy for large HCC patients showed better perioperative outcomes and equivalent oncologic outcomes as the open procedure, providing evidence for considering as a standard laparoscopic practice through careful selection.
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Navarro JG, Kang I, Rho SY, Choi GH, Han DH, Kim KS, Choi JS. Major Laparoscopic Versus Open Resection for Hepatocellular Carcinoma: A Propensity Score-Matched Analysis Based on Surgeons' Learning Curve. Ann Surg Oncol 2020; 28:447-458. [PMID: 32602059 DOI: 10.1245/s10434-020-08764-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical complications for surgeons still in the learning phase of major laparoscopic liver resection (LLR) have been frequently observed. We aimed to compare perioperative and long-term outcomes of laparoscopic and open surgery based on the surgeons' learning curve for LLR after propensity score-matched (PSM) analysis. METHODS This was a retrospective study of all patients with a histologic diagnosis of hepatocellular carcinoma who underwent major hepatectomy between January 2013 and December 2018. A PSM analysis was used to compare the groups of patients who underwent LLR and open major liver resection (OLR) before and after the learning curve was maximized. RESULTS Among 405 patients, 106 underwent LLR and 299 underwent OLR. The learning curve was maximized after 42 cases. Compared with OLR, LLR had more liver-related injury and grade III or higher complications during the learning phase. The LLR group had less blood loss, fewer transfusion requirements, and fewer liver-related complications during the 'experienced' phase. Hospital stay was significantly shorter during and after maximization of the learning curve in LLR compared with OLR. Operative time was comparable in the two phases. Overall, LLR was associated with less blood loss, fewer complications, and shorter hospital stay compared with open surgery. There was no significant difference in long-term survival outcomes between the two groups. CONCLUSIONS LLR had a higher incidence of liver-related complications during the surgeon's learning phase compared with OLR. This association was significantly diminished with surgeon experience. Overall perioperative outcomes such as estimated blood loss, surgical complications, and hospital stay remained better for LLR compared with OLR.
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Affiliation(s)
- Jonathan Geograpo Navarro
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Division of Surgical Oncology, Department of Surgery, Vicente Sotto Memorial Medical Center, Cebu City, Cebu, Philippines
| | - Incheon Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seoung Yoon Rho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Gi Hong Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
| | - Dai Hoon Han
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Sik Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sub Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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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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Pan YX, Wang JC, Lu XY, Chen JB, He W, Chen JC, Wang XH, Fu YZ, Xu L, Zhang YJ, Chen MS, Lai RC, Zhou ZG. Intention to control low central venous pressure reduced blood loss during laparoscopic hepatectomy: A double-blind randomized clinical trial. Surgery 2020; 167:933-941. [DOI: 10.1016/j.surg.2020.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 02/07/2023]
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Fung AKY, Chong CCN, Lai PBS. ERAS in minimally invasive hepatectomy. Ann Hepatobiliary Pancreat Surg 2020; 24:119-126. [PMID: 32457255 PMCID: PMC7271107 DOI: 10.14701/ahbps.2020.24.2.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/23/2020] [Accepted: 01/29/2020] [Indexed: 02/07/2023] Open
Abstract
Open hepatectomy is associated with significant post-operative morbidity and mortality profile. The use of minimally invasive approach for hepatectomy can reduce the post-operative complication profile and total length of hospital stay. Enhanced recovery after surgery (ERAS) programs involve evidence-based multimodal care pathways designed to achieve early recovery for patients undergoing major surgery. This review will discuss the published evidence, challenges and future directions for ERAS in minimally invasive hepatectomy.
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Affiliation(s)
- Andrew K Y Fung
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Charing C N Chong
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Paul B S Lai
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Clinical outcome of open surgery versus laparoscopic surgery for cirrhotic hepatocellular carcinoma patients: a meta-analysis. Eur J Gastroenterol Hepatol 2020; 32:239-245. [PMID: 31567715 DOI: 10.1097/meg.0000000000001495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Open surgery remains the major approach to treat hepatocellular carcinoma, and laparoscopy-assisted liver resection has been recommended as a superior treatment. However, the efficacy of laparoscopic surgery versus open surgery for cirrhotic patients is under debate. Therefore, the aim of this meta-analysis was to compare the clinical outcomes of laparoscopic and open resection of hepatocellular carcinoma in patients with cirrhosis. METHODS Electronic databases were searched for eligible literature updated on November 2018. After rigorous review of quality, the data were extracted from eligible trials. All the data were pooled with the corresponding 95% confidence interval using RevMan software. Sensitivity analyses and heterogeneity were quantitatively evaluated. RESULTS Fourteen trials met the inclusion criteria. According to the pooled result of surgery duration, laparoscopic surgery was associated with significantly shorter hospital stay [STD mean difference (SMD) = -0.61, 95% confidence interval -0.89 to -0.32; P < 0.0001], lower intraoperative blood loss (SMD = -0.56, 95% confidence interval -0.99 to -0.12; P = 0.01), fewer complications (odds ratio = 0.38, 95% confidence interval 0.28 to 0.52; P < 0.00001) and lower transfusion rate (odds ratio = 0.58, 95% confidence interval 0.36-0.93; P = 0.02). Nevertheless, there was no remarkable difference in operative time (SMD = 0.17, 95% confidence interval -0.25 to -0.59; P = 0.42) between the two groups. The pooled analysis of overall survival showed that laparoscopic surgery did not achieve benefit compared with open surgery (P = 0.02). Moreover, the pooled results of three subgroups indicated that laparoscopic surgery was associated with significantly better disease-free survival (P < 0.05). CONCLUSION The current analysis indicates that laparoscopic liver resection for hepatocellular carcinoma improved intraoperative and disease-free survival, with similar overall survival compared to the open procedure. Laparoscopic surgery may serve as a safe and feasible alternative for selected hepatocellular carcinoma patients with cirrhosis.
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Long-term outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma: Retrospective case-matched study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hong Q, Wang J, Wang Y, Fu B, Fang Y, Tong Q, Liu T, Wu Z, Zhou J. Clinical outcomes of laparoscopic versus open right hepatectomy for liver tumors: A meta-analysis. Medicine (Baltimore) 2020; 99:e18667. [PMID: 31895832 PMCID: PMC6946504 DOI: 10.1097/md.0000000000018667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Laparoscopic right hepatectomy (LRH) is one of the most challenging procedures. Right liver resections have been always performed in open procedure and open right hepatectomy (ORH) was initially considered as routine way. Moreover, it is unclear how beneficial the minimally invasive technique is to patients; thus, we conducted a meta-analysis to acquire a more reliable conclusion about the feasibility and safety of LRH compared with ORH. METHODS We comprehensively searched the electronic databases of PubMed, Embase, and the Cochrane Library using the key words. Meta-analysis was performed using the Review Manager, with results expressed as odds ratio and weighted mean difference with 95% confidence intervals. The fixed-effect model was selected initially if high heterogeneity was not present between the studies; otherwise, the randomized-effect model was used. Subgroup analysis was performed based on different surgical methods of pure laparoscopic operation or hand-assisted operation. RESULTS Seven studies with 467 patients were included. In the overall analysis, less intraoperative blood loss (MD = -155.17; 95% CI, -238.89, -71.45; P = .0003) and a shorter length of stay (MD = -4.45; 95% CI, -5.84, -3.07; P < .00001) were observed in the LRH group compared to the ORH group. There were fewer overall complications (OR = 0.30; 95% CI, 0.10, 0.90; P = 0.03) and severe complications (OR = 0.24; 95% CI, 0.10, 0.58; P = .002;) in the LRH group than in the ORH group. The disadvantage of LRH was the longer operative time (MD = 49.39; 95% CI, 5.33, 93.45; P = .03). No significant difference was observed between the 2 groups in portal occlusion, rate of R0 resection, transfusion rate, mild complications, and postoperative mortality. In the subgroup analysis, intraoperative blood loss was significantly lower in the pure LRH group and hand-assist LRH group compared with ORH group. Length of stay was shorter by use of pure LRH and hand-assisted LRH manners than ORH. The incidence rate of complications was lower in the pure LRH group than in the ORH group. In contrast, there was no significant difference between hand-assisted LRH group and ORH group. CONCLUSION Compared to ORH, LRH has short-term surgical advantages and leads to a shorter recovery time in selected patients. We speculate that the operative time of LRH is closer with ORH. Overall, LRH can be considered a feasible choice in routine clinical practice with experienced surgeons, although more evidence is needed to make a definitive conclusion.
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Affiliation(s)
- Qiang Hong
- Department of Surgical Oncology, Jinhua GuangFu Oncology Hospital
| | - Jianjun Wang
- Department of Surgical Oncology, Jinhua GuangFu Oncology Hospital
| | - Yong Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou
- Key Laboratory of Laparoscopic Technology of Zhejiang Province, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Baojuan Fu
- Department of Surgical Oncology, Jinhua GuangFu Oncology Hospital
| | - Yuejun Fang
- Department of Surgical Oncology, Jinhua GuangFu Oncology Hospital
| | - Qin Tong
- Department of Surgical Oncology, Jinhua GuangFu Oncology Hospital
| | - Tao Liu
- Department of Surgical Oncology, Jinhua GuangFu Oncology Hospital
| | - Zhangqiang Wu
- Department of Surgical Oncology, Jinhua GuangFu Oncology Hospital
| | - Junchao Zhou
- Department of Surgical Oncology, Jinhua GuangFu Oncology Hospital
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Wang ZY, Chen QL, Sun LL, He SP, Luo XF, Huang LS, Huang JH, Xiong CM, Zhong C. Laparoscopic versus open major liver resection for hepatocellular carcinoma: systematic review and meta-analysis of comparative cohort studies. BMC Cancer 2019; 19:1047. [PMID: 31694596 PMCID: PMC6833163 DOI: 10.1186/s12885-019-6240-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/06/2019] [Indexed: 12/13/2022] Open
Abstract
Background The application of laparoscopic liver resection (LLR) has expanded rapidly in recent decades. Although multiple authors have reported LLR shows improved safety and efficacy in treating hepatocellular carcinoma (HCC) compared with open liver resection (OLR), laparoscopic (LMLR) and open (OMLR) major liver resections for HCC treatment remain inadequately evaluated. This work aimed to test the hypothesis that LMLR is safer and more effective than OMLR for HCC. Methods Comparative cohort and registry studies on LMLR and OMLR, searched in PubMed, the Science Citation Index, EMBASE, and the Cochrane Library, and published before March 31, 2018, were collected systematically and meta-analyzed. Fixed- and random-effects models were employed for generating pooled estimates. Heterogeneity was assessed by the Q-statistic. Results Nine studies (1173 patients) were included. Although the pooled data showed operation time was markedly increased for LMLR in comparison with OMLR (weighted mean difference [WMD] 74.1, 95% CI 35.1 to 113.1, P = 0.0002), blood loss was reduced (WMD = − 107.4, 95% CI − 179.0 to − 35.7, P = 0.003), postoperative morbidity was lower (odds ratio [OR] 0.47, 95% CI 0.35 to 0.63, P < 0.0001), and hospital stay was shorter (WMD = − 3.27, 95% CI − 4.72 to − 1.81, P < 0.0001) in the LMLR group. Although 1-year disease-free survival (DFS) was increased in patients administered LMLR (OR = 1.55, 95% CI 1.04 to 2.31, P = 0.03), other 1-, 3-, and 5-year survival outcomes (overall survival [OS] and/or DFS) were comparable in both groups. Conclusions Compared with OMLR, LMLR has short-term clinical advantages, including reduced blood loss, lower postsurgical morbidity, and shorter hospital stay in HCC, despite its longer operative time. Long-term oncological outcomes were comparable in both groups.
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Affiliation(s)
- Zi-Yu Wang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Airport Road, Guangzhou, 510405, China.,Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Qing-Lian Chen
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Airport Road, Guangzhou, 510405, China.,Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Ling-Ling Sun
- Department of Oncology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Shu-Ping He
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Airport Road, Guangzhou, 510405, China.,Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Xiao-Fen Luo
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Airport Road, Guangzhou, 510405, China.,Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Li-Shuang Huang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Jun-Hai Huang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Airport Road, Guangzhou, 510405, China.,Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Cheng-Ming Xiong
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Airport Road, Guangzhou, 510405, China.,Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Chong Zhong
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Airport Road, Guangzhou, 510405, China. .,Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
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Pan YX, Long Q, Yi MJ, Chen JB, Chen JC, Zhang YJ, Xu L, Chen MS, Zhou ZG. Radiofrequency ablation versus laparoscopic hepatectomy for hepatocellular carcinoma: A real world single center study. Eur J Surg Oncol 2019; 46:548-559. [PMID: 31677940 DOI: 10.1016/j.ejso.2019.10.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/18/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Both radiofrequency ablation (RFA) and laparoscopic hepatectomy (LH) are minimally invasive approach for hepatocellular carcinoma (HCC) at early stage. This study aimed to compare the efficacy of RFA and LH for treating HCC with a large cohort. METHODS From March 2014 to July 2016, 477 patients who underwent RFA (n = 314) or LH (n = 163) for HCC tumors meeting the criteria were included. Overall survival (OS) and recurrence-free survival (RFS) were compared. Propensity score matching (PSM) was performed to balance for the factors that may affect the choice of treatment. RESULTS Collectively, the 1-, 2- and 3-year OS rates were significantly greater after LH than RFA, as well the corresponding RFS rates, before and after PSM by 2:1. However, the RFA group had fewer major complications (P=0.004), shorter postoperative stays (P=0.023) and lower hospital charges (P<0.001) than the LH group. In the subgroup analysis, RFA demonstrated comparable RFS in treating less than 3 cm tumor (P=0.22) located in noncentral bisection (SII, SIII, SVI, SVII) and tumor between 3 cm and 5 cm (P=0.07) located in central bisections (SIV, SV, SVIII). The female, HBV infection, and RFA are factors of worse OS, and the latter two factors also indicated higher RFS. CONCLUSIONS Though, LH possessed superior intrahepatic control rate than RFA in most condition of tumor smaller than 5 cm, the RFA could be an optimal approach achieved comparable outcomes in patients with centrally located HCC, with fewer major complications, shorter postoperative stays and lower hospital charges.
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Affiliation(s)
- Yang-Xun Pan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, PR China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China.
| | - Qian Long
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, PR China; Department of Experimental Research, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China.
| | - Min-Jiang Yi
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, PR China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China.
| | - Jin-Bin Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, PR China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China.
| | - Jian-Cong Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, PR China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China.
| | - Yao-Jun Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, PR China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China.
| | - Li Xu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, PR China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China.
| | - Min-Shan Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, PR China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China.
| | - Zhong-Guo Zhou
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, PR China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China; Department of Molecular Medicine California Campus, The Scripps Research Institute, 10550, North Torrey Pines Road, La Jolla, CA, 92037, USA.
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Wilson GC, Geller DA. Evolving Surgical Options for Hepatocellular Carcinoma. Surg Oncol Clin N Am 2019; 28:645-661. [DOI: 10.1016/j.soc.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Zhu P, Liao W, Ding ZY, Chen L, Zhang WG, Zhang BX, Chen XP. Learning Curve in Robot-Assisted Laparoscopic Liver Resection. J Gastrointest Surg 2019; 23:1778-1787. [PMID: 30406576 DOI: 10.1007/s11605-018-3689-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/08/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the learning curve effect on the safety and feasibility of robot-assisted liver resection (RALR). METHODS In 140 consecutive cases, all data about demographic, surgical procedure, postoperative course were collected prospectively and analyzed. Risk-adjusted cumulative sum model was used for determining the learning curve based on the need for conversion. RESULTS Among all 140 patients, no patients suffered from any organ dysfunction postoperatively and the operative mortality was 0%. The CUSUM analysis showed that at the 30th consecutive patient, the open conversion rate reached to the average value, and it further improved thereafter. In the last 70 patients, only 3 patients (4.3%) required conversion and 7 patients (10%) needed blood transfusion. Only 1 patient (1.3%) out of 79 patients with HCC had a positive resection margin. Univariate analyses showed the following risk factors associated with significantly higher risks of conversion (P < 0.05): tumor number > 1, lesions in segments 1/4a/7/8, right posterior sectionectomy, and lesions which were beyond the indications of the Louisville statement. Multivariate logistic analysis revealed that both tumor number > 1 (OR: 2.10, P < 0.05) and right posterior sectionectomy (OR: 11.19, P < 0.01) were risk factors of conversion. CONCLUSIONS The robotic approach for hepatectomy is safe and feasible. A learning curve effect was demonstrated in this study after the 30th consecutive patient. The long-term oncological outcomes of robotic hepatectomy still need further investigation.
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Affiliation(s)
- Peng Zhu
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Liao
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ze-Yang Ding
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Chen
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wan-Guang Zhang
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bi-Xiang Zhang
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xiao-Ping Chen
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Slow Gait Speed Is a Risk Factor for Complications After Hepatic Resection. J Gastrointest Surg 2019; 23:1810-1816. [PMID: 30298420 DOI: 10.1007/s11605-018-3993-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 09/23/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE The aims of this study were to clarify the relationship of gait speed, hand grip strength, and skeletal muscle mass with complications after hepatic resection and to identify risk factors for complications in patients who underwent hepatic resection. METHODS We evaluated the risk factors for complications after hepatic resection in 154 consecutive patients. Preoperative factors included gait speed, hand grip strength, and skeletal muscle mass. The gait speed and hand grip strength of patients were measured by physical therapists, and skeletal muscle mass was measured by computed tomography. Multivariate logistic regression analyses using preoperative factors were performed to assess predictors of the development of complications after hepatic resection. RESULTS Thirty-three patients (21.4%) developed complications after hepatic resection. These patients had a significantly lower serum albumin level (p = 0.015), slower gait speed (p = 0.007), higher rate of hepatic resection ≥ 2 Couinaud segments (p = 0.014), and lower rate of laparoscopic hepatic resection (p = 0.017) than patients without complications. Multivariate analysis revealed that a gait speed ≤ 1.10 m/s and a serum albumin level of ≤ 4.0 g/dl were independent risk factors for complications after hepatic resection. CONCLUSIONS Slow gait speed and low serum albumin level are significant risk factors for complications after hepatic resection. These data will be helpful for perioperative patient management.
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Surgical and Oncological Outcomes of Laparoscopic Versus Open Pancreaticoduodenectomy in Patients With Pancreatic Duct Adenocarcinoma. Pancreas 2019; 48:861-867. [PMID: 31306305 DOI: 10.1097/mpa.0000000000001363] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
It is not clear which of the 2 principal treatments for patients with pancreatic duct adenocarcinoma (PDAC), laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD), has greater safety and efficacy. We performed the present meta-analysis to assess the efficacy of both treatments for PDAC patients undergoing LPD. Multiple electronic databases were systematically searched to identify studies (up to October 2018) comparing LPD with OPD for PDAC. Short- and long-term oncological outcomes were evaluated. Six studies were qualified for inclusion criteria in this meta-analysis with a total of 9144 PDAC participants. Regarding safety, there were fewer overall postoperative complications associated with LPD (P = 0.005), but the results were similar in terms of pancreatic fistula and mortality. Laparoscopic pancreaticoduodenectomy was associated with a better trend of performance both in R0 resection (relative risk, 1.03; 95% confidence interval [CI], 1.00-1.07; P = 0.07) and preserved lymph nodes (median, 2.14; 95% CI, -0.21 to 4.49; P = 0.07). Long-term overall survival was comparable between LPD and OPD (hazard ratio, 1.03; 95% CI, 0.95-1.13; P = 0.49). In conclusion, LPD was found to be a suitable alternative to OPD in selected PDAC patients with respect to both surgical and oncological outcomes.
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Qin L, Fei L, YongGang W, Bo L. Use of Transthoracic Transdiaphragmatic Approach Assisted with Radiofrequency Ablation for Thoracoscopic Hepatectomy of Hepatic Tumor Located in Segment VIII. J Gastrointest Surg 2019; 23:1547-1548. [PMID: 31152347 DOI: 10.1007/s11605-019-04172-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 02/20/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Resection of segment VIII remains challenging despite the widespread laparoscopic hepatectomies in past decades,1,2 especially for patients with cirrhosis. In this case, we combined radiofrequency ablation (RFA) with transthoracic approach, which was a novel approach for laparoscopic-guided hepatectomy of segment VIII in a cirrhotic patient. PATIENT A 42-year-old male patient with a body mass index of 22.0 kg/m2 suffered from HBV-related cirrhosis was admitted to our institution. The preoperative MRI showed a 1.3 cm liver mass located in segment VIII. The preoperative AFP is 192 ng/ml. The patient was considered to have hepatectomy using transthoracic transdiaphragmatic approach with the assist of RFA. TECHNIQUE The patient was placed in a left lateral position with artificial pneumothorax in the right lung and left side ventilation. Three trocars were placed into the right thoracic space. Transdiaphragmatic intraoperative ultrasonography (IOUS) was performed to confirm the size and location of the lesion. In order to decrease the blood loss during parenchymal dissection and to reach tumor-free margins, the RFA was performed around the tumor before hepatectomy. After that the resection was carried out along the ablative margin. After the specimen was removed, the diaphragm was sutured and a closed thoracic drainage tube was placed. The operative time was 210 min with an estimated blood loss of 50 mL. The postoperative course was uneventful. Antibiotics was used in the first 24 h post-operation to prevent thoracic infection. Drainage tube was pulled out on the fourth day post-operation when we observed the daily fluid volume was less than 100 ml for 2 days and X-ray showed no gases and effusion in chest cavity. The pathology confirmed the diagnosis of hepatocellular carcinoma and the surgical margin was negative. The patient was discharged on the 8th day after surgery. DISCUSSION Lesions in the postero-superior segments still be challenging as we know.3 Previous studies showed that the procedure's results, such as the blood loss and operative time, were similar between thoracoscopic hepatectomy and laparoscopic hepatectomy, even the former was better.2,4 Thus, for the superficial lesions in the postero-superior segments, and not more than 3 cm in diameter, thoracoscopic hepatectomy is recommended. Furthermore, a patient with a hostile abdomen who has a lesion in S7 or S8, transthoracic approach may be particularly helpful. However, functional lung is required due to the unilateral ventilation. Besides, anatomic resections are difficult to perform from the top.5 In this case, we used RFA before liver resection, and the tumor cells were destroyed to ensure the negative margin of the cut, and the bleeding blood vessels were also closed. This method can make a significant reduction of blood loss in the patients with cirrhosis compared with conventional hepatectomy (whether through thoracoscopic6 or laparoscopic7 approach). CONCLUSION The novel approach for transthoracic hepatectomy was safe and feasible for lesions of segment VIII in selected patients with cirrhosis,8 which was associated with reduced blood loss and a safe surgical margin.
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Affiliation(s)
- Li Qin
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Liu Fei
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Wei YongGang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, 610041, China.
| | - Li Bo
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, 610041, China
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Jang EJ, Kim KW. Early experience of laparoscopic liver resection: A single institution experience with 37 consecutive cases. Ann Hepatobiliary Pancreat Surg 2019; 23:115-121. [PMID: 31225411 PMCID: PMC6558135 DOI: 10.14701/ahbps.2019.23.2.115] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/14/2018] [Accepted: 12/20/2018] [Indexed: 01/03/2023] Open
Abstract
Backgrounds/Aims Laparoscopic liver resection (LLR) has evolved and broadened in scope. While open liver resections are currently being performed safely in our hospital, LLRs are being implemented in fewer cases. The aim of this study was to review our initial experience in LLR to assess early outcomes of the procedure. Methods A retrospective chart review was conducted for 37 patients who underwent laparoscopic liver resections for various indications between January 2014 and July 2017 by a single surgeon who had performed 161 open liver resections and 50 live donor hepatectomies during the same period. Results Of 37 laparoscopic liver resections performed, male to female ratio was 23 to 4. Their mean age was 61.4 years. There were 13 cases of wedge resections, 7 cases of left lateral sectionectomy, 9 cases of left hepatectomy, and 8 cases of right hepatectomy. Pathology included hepatocellular carcinoma (n=20), cholangiocarcinoma (n=3), intrahepatic duct stones (n=6), metastatic liver carcinoma (n=6), primary neuroendocrine tumor of liver (n=1), and huge hemangioma (n=1). The mean operation time was 174.7 minutes (range, 40–410 minutes). Mean blood loss was 200.5 ml (range, 10–2200 ml). There were no open-conversion cases. There were no intraoperative or postoperative complications except that a case of severe portal vein stenosis in the laparoscopic right hepatectomy occurred postoperatively. The patient underwent reoperation (portal vein resection and anastomosis, stenting). The mean hospital stay was 8.7 days (range, 2–44 days). Conclusions Even though our experience in laparoscopic liver resection is still developing, our results are comparable to those of other studies. Therefore, an experienced surgeon in performing open liver resection should be able to perform the laparoscopic liver resection safely.
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Affiliation(s)
- Eun Jeong Jang
- Department of Surgery, Dong-A University College of Medicine, Dong-A University Medical Center, Busan, Korea
| | - Kwan Woo Kim
- Department of Surgery, Dong-A University College of Medicine, Dong-A University Medical Center, Busan, Korea
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Peng L, Zhou Z, Cao Z, Wu W, Xiao W, Cao J. Long-Term Oncological Outcomes in Laparoscopic Versus Open Pancreaticoduodenectomy for Pancreatic Cancer: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2019; 29:759-769. [PMID: 30835156 DOI: 10.1089/lap.2018.0683] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Long Peng
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhiyong Zhou
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhongren Cao
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Weibo Wu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Weidong Xiao
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jiaqing Cao
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Scherber PR, Gäbelein G, Eisele RM, Igna D, Glanemann M. [Early stage liver cancer : Hepatocellular carcinoma]. Chirurg 2019; 89:281-288. [PMID: 29075797 DOI: 10.1007/s00104-017-0538-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hepatocellular carcinoma (HCC) ranks among the most common primary cancers of the liver. The major risk factor for the formation of HCC is liver cirrhosis. The grade of cirrhosis as well as the extent of the tumor itself, can play an important role in the treatment options and patient prognosis. An operation aimed at an R0 resection is the treatment of choice for patients in an early stage of the disease and is associated with favorable long-term and recurrence-free survival. Liver transplantation offers an even better long-term survival rate after 5 years for selected patients with HCC meeting the Milan criteria as the underlying cirrhosis, the major risk factor for HCC recurrence, is simultaneously treated. Local tumor ablation is the least invasive curative surgical treatment, however, it is associated with an increased local recurrence rate; therefore, the early detection of tumors is of essential importance. As tumor-associated symptoms tend to arise only in advanced tumor stages, it is indispensable to identify patients with typical risk factors and to provide closely monitored screening examinations.
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Affiliation(s)
- P R Scherber
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland
| | - G Gäbelein
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland
| | - R M Eisele
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland
| | - D Igna
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland
| | - M Glanemann
- Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland.
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Efficacy and safety of radiofrequency ablation versus minimally invasive liver surgery for small hepatocellular carcinoma: a systematic review and meta-analysis. Surg Endosc 2019; 33:2419-2429. [PMID: 30989373 DOI: 10.1007/s00464-019-06784-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/04/2019] [Indexed: 12/19/2022]
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