Learning process of laparoscopic liver resection and postoperative outcomes: chronological analysis of single-center 15-years’ experience

Seo, Satoru; Ogiso, Satoshi; Morino, Kazuhide; Nishio, Toshikazu; Koyama, Yukinori; Fukumitsu, Ken; Ishii, Takamichi; Taura, Kojiro; Hatano, E

doi:10.1007/s00464-021-08660-2

Cited by 8 publications

(5 citation statements)

References 30 publications

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“…The indications for LR included a CP grade of A or B, and ICG‐Krem<0.03 is defined as a contraindication. Surgical procedures of LR were reported elsewhere [24, 25]. During the study period, postoperative hepatic arterial infusion therapy (HAIC) was administered for Vp3‐Vp4 cases if appropriate [11].…”

Section: Methodsmentioning

confidence: 99%

A Conceptual Classification of Resectability for Hepatocellular Carcinoma

et al. 2022

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Backgrounds In the era of multidisciplinary treatment strategy, resectability for hepatocellular carcinoma (HCC) should be defined. This study aimed to propose and validate a resectability classification of HCC. Methods We proposed following the three groups; resectable-(R), borderline resectable-(BR), and unresectable (UR)-HCCs. Resectable two groups were sub-divided according to the value of indocyanine green clearance of remnant liver (ICG-Krem) and presence of macrovascular invasion (MVI); BR-HCC was defined as resectable HCCs with MVI and/or ICG-Krem≥0.03–<0.05, and R-HCC was the remaining. Consecutive patients with HCC who underwent liver resection (LR) and non-surgical treatment(s) (i.e., UR-HCC) between 2011 and 2017 were retrospectively analyzed to validate the proposed classification. Results A total of 361 patients were enrolled in the study. Of these, R-, BR- and UR-HCC were found in 251, 46, and 64 patients, respectively. In patients with resected HCC, ICG-Krem≥0.05 was associated with decreased risk of clinically relevant posthepatectomy liver failure (p=0.013) and the presence of MVI was associated with worse overall survival (OS) (p<0.001). The 3–5-years OS rates according to the proposed classification were 80.3, and 68.3% versus 51.4, and 35.6%, in the R and BR groups, respectively (both p<0.001). Multivariate analysis showed BR-HCC was independently associated with poorer OS (p<0.001) after adjusting for known tumor prognostic factors. Meanwhile, BR-HCC was associated with benefit in terms of OS compared with UR-HCC (p<0.001). Conclusion Our proposal of resectability for HCC allows for stratifying survival outcomes of HCC and may help to determine treatment strategy.

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Section: Methodsmentioning

confidence: 99%

A Conceptual Classification of Resectability for Hepatocellular Carcinoma

et al. 2022

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“…The transthoracic approach is employed for optimum exposure during LALR-S7, however, the critical problems of this procedure are that most surgeons have not got used to perform anatomic resections from the top, and it has increased thoracic organ injuries and postoperative pneumothorax using intercostal trocars [ 12 ]. Some surgeons employed a hand-assisted technique to facilitate liver exposure, however, the biggest concern of the hand-assisted technique would be that a larger incision, air leakage and fatigue in the inserted hand, and some surgeons consider that this approach is not suitable for lesions in S7 and S8 [ 13 ]. The rotating or elevating device approach is safe and effective for laparoscopic exposure, however, this approach is technically challenging and requires special devices, such as bags, service pipes and pressure infusion systems, and some centers do not have these conditions [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

A safe and simple exposure and Pringle maneuver in laparoscopic anatomical liver resection of segment 7

Li,

Wu,

et al. 2023

BMC Gastroenterol

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Background Laparoscopic access to liver segment 7 (S7) is difficult for deep surgical situations and bleeding control. Herein, our proposed laparoscopic technique for S7 lesions using a self-designed tube method is introduced. Methods Clinical data of patients who underwent laparoscopic anatomical liver resection of S7 (LALR-S7) with the help of our self-designed tube to improve the exposure of S7 and bleeding control in the Second Affiliated Hospital, Third Military Medical University (Army Medical University) from April 2019 to December 2021 were retrospectively analyzed to evaluate feasibility and safety. Results Nineteen patients were retrospectively reviewed. The mean age was 51.3 ± 10.3 years; mean operation time, 194.5 ± 22.7 min; median blood loss, 160.0 ml (150.0–205.0 ml); and median length of hospital stay, 8.0 days (7.0–9.0 days). There was no case conversion to open surgery. Postoperative pathology revealed all cases of hepatocellular carcinoma (HCC). Free surgical margins were achieved in all patients. No major postoperative complications were observed. Patients with postoperative complications recovered after conservative treatment. During outpatient follow-up examination, no other abnormality was presented. All patients survived without tumor recurrence. Conclusions The preliminary clinical effect of our method was safe, reproducible and effective for LALR-S7. Further research is needed due to some limitations of this study.

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“…Secondly, there was a significant between-study heterogeneity in several outcomes, which might be derived from the differences in age ranges, liver function, number and location of lesions, general condition of the individual patient, surgeons’ experience, perioperative care protocols, pre- and postoperative chemotherapy, and other factors. Some studies included patients at wide study intervals, which may introduce biases due to advances in the mastery of surgical skills and improvements in surgical instruments ( 53 ). Noteworthy, the covariates for matching were different between the included studies, and some studies did not adjust for some important confounders such as age, sex, and liver function classification.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: A systematic review and meta-analysis of propensity score-matched studies

Wang

et al. 2022

Front. Oncol.

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PurposeLaparoscopic liver resection (LLR) is a widely practiced therapeutic method and holds several advantages over open liver resection (OLR) including less postoperative pain, lower morbidity, and faster recovery. However, the effect of LLR for the treatment of hepatocellular carcinoma (HCC) in elderly patients remains controversial. Therefore, we aimed to perform the first meta-analysis of propensity score-matched (PSM) studies to compare the short- and long-term outcomes of LLR versus OLR for elderly patients with HCC.MethodsDatabases including PubMed, Embase, Scopus, and Cochrane Library were systematically searched until April 2022 for eligible studies that compared LLR and OLR for the treatment of HCC in elderly patients. Short-term outcomes include postoperative complications, blood loss, surgical time, and length of hospital stay. Long-term outcomes include overall survival (OS) rate and disease-free survival (DFS) rate at 1, 3, and 5 years.ResultsA total of 12 trials involving 1,861 patients (907 in the LLR group, 954 in the OLR group) were included. Compared with OLR, LLR was associated with lower postoperative complications (OR 0.49, 95% CI 0.39 to 0.62, P < 0.00001, I2 = 0%), less blood loss (MD −285.69, 95% CI −481.72 to −89.65, P = 0.004, I2 = 96%), and shorter hospital stay (MD −7.88, 95% CI −11.38 to −4.37, P < 0.0001, I2 = 96%), whereas operation time (MD 17.33, 95% CI −6.17 to 40.83, P = 0.15, I2 = 92%) was insignificantly different. Furthermore, there were no significant differences for the OS and DFS rates at 1, 3, and 5 years.ConclusionsFor elderly patients with HCC, LLR offers better short-term outcomes including a lower incidence of postoperative complications and shorter hospital stays, with comparable long-term outcomes when compared with the open approach. Our results support the implementation of LLR for the treatment of HCC in elderly patients.Systematic review registrationhttps://inplasy.com/inplasy-2022-4-0156/, identifier INPLASY202240156.

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Learning process of laparoscopic liver resection and postoperative outcomes: chronological analysis of single-center 15-years’ experience

Cited by 8 publications

References 30 publications

A Conceptual Classification of Resectability for Hepatocellular Carcinoma

A Conceptual Classification of Resectability for Hepatocellular Carcinoma

A safe and simple exposure and Pringle maneuver in laparoscopic anatomical liver resection of segment 7

Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: A systematic review and meta-analysis of propensity score-matched studies

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