Laparoscopic Liver Surgery: What Are the Advantages in Patients with Cirrhosis and Portal Hypertension? Systematic Review and Meta-Analysis with Personal Experience

Coletta, Diego; Padua, Cristina De; Parrino, Chiara; Peppo, Valerio De; Oddi, Angelo; Frigieri, Claudia; Grazi, Gian Luca

doi:10.1089/lap.2020.0408

Cited by 17 publications

(10 citation statements)

References 78 publications

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“…Traditional laparotomy has the advantages of simple operation and clear vision, but its trauma, pain, postoperative complications, and slow recovery process [ 7 , 8 ]. In recent years, with the progress of medical technology and surgical instruments, especially the increasingly mature technology of laparoscopic surgery, the advantages of small trauma, rapid postoperative recovery, and low complications are increasingly prominent, which greatly improve the prognosis and postoperative quality of life of patients with liver cancer [ 9 , 10 ]. However, due to the laparoscopic surgical technology and the precision of the instruments are still in the development stage, whether it can replace the traditional open liver resection is still a certain controversy.…”

Section: Introductionmentioning

confidence: 99%

Clinical Study on the Efficacy of Laparoscopic Hepatectomy and Its Influence on the Expression of Serum VEGF, FGF, and Immune Function

Tang

Liu

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Liver cancer is one of the most common malignant tumors. Partial hepatectomy is the most basic and effective treatment for hepatocellular carcinoma because of its high operative effect and perioperative safety. Open surgery is the most traditional hepatectomy. Although it can completely remove tumor lesions and prolong patient survival, it has disadvantages such as large trauma and long postoperative recovery time. Meanwhile, long-term bed rest can increase the risk of complications such as venous thrombosis and infection. The advantages of laparoscopic partial hepatectomy, such as clear operative field, simple operation, little trauma, light surgical stress, quick postoperative recovery, and low complications, can avoid damage to vital organs, blood vessels, and nerves, which has been widely accepted and recognized in clinical practice.

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Section: Introductionmentioning

confidence: 99%

Clinical Study on the Efficacy of Laparoscopic Hepatectomy and Its Influence on the Expression of Serum VEGF, FGF, and Immune Function

Tang

Liu

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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“…These findings were consistent with those obtained in previous studies. 7,[12][13][14][15] Surgical indications for laparoscopic hepatectomy are still controversial. It is generally believed that beginners should start off with simple cases of tumors located in the superficial or anterolateral liver segments.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study Using Propensity Score Matching to Compare Long-term Survival Outcomes After Robotic-assisted, Laparoscopic, or Open Liver Resection for Patients With BCLC Stage 0-A Hepatocellular Carcinoma

et al. 2022

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Objective: To compare the short-and long-term outcomes of robotassisted (RALR), laparoscopic (LLR), or open liver resection (OLR) in the treatment of Barcelona Clinic Liver Cancer (BCLC) stage 0-A hepatocellular carcinoma (HCC). Summary Background Data: Following the Balliol IDEAL classification, long-term oncological outcomes can be used to evaluate the value of minimally invasive techniques in the treatment of HCC, and to assess whether they should become a standard practice. Methods: Data from prospective cohorts of patients with BCLC stage 0-A HCC who underwent curative liver resection using OLR, LLR, or RALR at Tongji Hospital were reviewed. The short-term and long-term oncological outcomes of these 3 different surgical approaches after adequate follow-up were compared using propensity score matching to reduce selection bias. Results: Of 369 patients included in this study (71, RALR; 141, LLR; and 157, OLR), 56 patients in each of the 3 groups were chosen for further comparison, after propensity score matching. In the minimally invasive group (RALR+LLR), both the operative time and duration of Pringle's maneuver were significantly longer than those in the OLR group; however, the length of hospital stay was significantly shorter. There were no significant differences in the other intraoperative parameters and the incidence of postoperative complications among the 3 groups. HCC recurrence in the minimally invasive group when compared with the OLR group was characterized by a significantly higher proportion of single lesion or early-stage HCC. However, there were no significant differences in the 5-year disease-free survival (63.8%, 54.4%, and 50.6%) or overall survival rates (80.8%, 78.6%, and 75.7%, respectively) among the 3 groups. Clinically significant portal hypertension was the only risk factor that negatively affected the 5-year disease-free survival rate. Multivariate Cox regression analysis showed that clinically significant portal hypertension, serum alpha-fetoprotein level (≥400 ng/ mL), and Edmondson-Steiner grading (III+IV) were independent risk factors for poor long-term survival. Conclusion: Both robotic and laparoscopic hepatectomies were safe and effective for patients with BCLC stage 0-A HCC when compared with open hepatectomy.

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“…However, in patients with cirrhosis, PTPE is thought to be effective in enlarging the remaining liver volume to avoid the risk of postoperative liver failure. Furthermore, laparoscopic hepatectomy in patients with PH is associated with a lower risk of liver failure and faster recovery than open hepatectomy [ 17 ]. Therefore, a laparoscopic hepatectomy was performed.…”

Section: Discussionmentioning

confidence: 99%

Safe perioperative management of major hepatectomy in a patient with portal hypertension after elimination of hepatitis C: a case report

et al. 2022

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Background The administration of direct-acting antiviral agents in patients with liver cirrhosis and hepatitis C has been shown to improve liver function and long-term prognosis after sustained virological response (SVR) is achieved. However, in patients with portal hypertension (PH) at the time of SVR, PH may persist despite improvement in liver function. Case presentation An 82-year-old woman with liver cirrhosis due to hepatitis C was treated with direct-acting antiviral agents and achieved SVR. During follow-up, computed tomography revealed a low-density tumor in the left lateral region of the liver with dilation of the left intrahepatic bile duct. Considering the patient’s advanced age and PH persistence with a mild decrease in liver reserve function after SVR, preoperative percutaneous transhepatic portal embolization (PTPE) and partial splenic embolization (PSE) were performed concomitantly. Laparoscopic left hemihepatectomy was performed 8 days after the PTPE and PSE. The patient was discharged 8 days after surgery without any postoperative complications. Conclusions Laparoscopic left hemihepatectomy after preoperative management of PH was performed safely in a patient after the elimination of hepatitis C.

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Laparoscopic Liver Surgery: What Are the Advantages in Patients with Cirrhosis and Portal Hypertension? Systematic Review and Meta-Analysis with Personal Experience

Cited by 17 publications

References 78 publications

Clinical Study on the Efficacy of Laparoscopic Hepatectomy and Its Influence on the Expression of Serum VEGF, FGF, and Immune Function

Clinical Study on the Efficacy of Laparoscopic Hepatectomy and Its Influence on the Expression of Serum VEGF, FGF, and Immune Function

A Prospective Study Using Propensity Score Matching to Compare Long-term Survival Outcomes After Robotic-assisted, Laparoscopic, or Open Liver Resection for Patients With BCLC Stage 0-A Hepatocellular Carcinoma

Safe perioperative management of major hepatectomy in a patient with portal hypertension after elimination of hepatitis C: a case report

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