Multicentre propensity score-matched study of laparoscopic <i>versus</i> open repeat liver resection for colorectal liver metastases

Poel, Marcel J. van der; Barkhatov, Leonid; Fuks, David; Berardi, Giammauro; Cipriani, Federica; Aljaiuossi, Anas; Laïnas, Panagiotis; Dagher, Ibrahim; D’Hondt, Mathieu; Rotellar, Fernando; Besselink, Marc G.; Aldrighetti, Luca; Troisi, Roberto; Gayet, Brice; Edwin, Bjørn; Hilal, Mohammed Abu

doi:10.1002/bjs.11096

Cited by 65 publications

(43 citation statements)

References 43 publications

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“…This led to a distortion of our results. Other studies showed a shorter LOPS with a mean hospitalization stay of 3–5 days 7 , 33 , 35 . First, Rebibo et al presented a pilot study with minor laparoscopic liver resections as a day-case surgery without overnight hospitalization 36 .…”

Section: Discussionmentioning

confidence: 86%

A falciform ligament flap surface sealing technique for laparoscopic and robotic-assisted liver surgery

Rahimli

Perrakis

Schellerer

et al. 2020

Sci Rep

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Whether sealing the hepatic resection surface after liver surgery decreases morbidity is still unclear. Nevertheless, various methods and materials are currently in use for this procedure. Here, we describe our experience with a simple technique using a mobilized falciform ligament flap in minimally invasive liver surgery (MILS). We retrospectively analyzed the charts from 46 patients who received minor MILS between 2011 and 2019 from the same surgical team in a university hospital setting in Germany. Twenty-four patients underwent laparoscopic liver resection, and 22 patients received robotic-assisted liver resection. Sixteen patients in the laparoscopic group and fourteen in the robotic group received a falciform ligament flap (FLF) to cover the resection surface after liver surgery. Our cohort was thus divided into two groups: laparoscopic and robotic patients with (MILS + FLF) and without an FLF (MILS−FLF). Twenty-eight patients (60.9%) in our cohort were male. The overall mean age was 56.8 years (SD 16.8). The mean operating time was 249 min in the MILS + FLF group vs. 235 min in the MILS−FLF group (p = 0.682). The mean blood loss was 301 ml in the MILS + FLF group vs. 318 ml in the MILS−FLF group (p = 0.859). Overall morbidity was 3.3% in the MILS + FLF group vs. 18.8% in the MILS−FLF group (p = 0.114). One patient in the MILS−FLF group (overall 2.2%), who underwent robotic liver surgery, developed bile leakage, but this did not occur in the MILS + FLF group. Covering the resection surface of the liver after minor minimally invasive liver resection with an FLF is a simple and cost-effective technique that does not prolong surgical time or negatively affect other perioperative parameters. In fact, it is a safe add-on step during MILS that may reduce postoperative morbidity. Further studies with larger cohorts will be needed to substantiate our proof of concept and results.

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Section: Discussionmentioning

confidence: 86%

A falciform ligament flap surface sealing technique for laparoscopic and robotic-assisted liver surgery

Rahimli

Perrakis

Schellerer

et al. 2020

Sci Rep

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“…Neither the postoperative complication rate nor the hospital stay was affected by abdominal adhesions in those patients. The above also applies to repeated liver resections, as recently shown for both CRLM and HCC [ 46 , 47 ]. If repeated liver resection is considered possible laparoscopically, patients have common advantages over the open technique, e.g., less blood loss, a lower complication rate, and reduced hospital stay.…”

Section: Limitationsmentioning

confidence: 88%

Laparoscopic liver resection: indications, limitations, and economic aspects

Schmelzle

Krenzien

Schöning

et al. 2020

Langenbecks Arch Surg

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Background Minimally invasive techniques have increasingly found their way into liver surgery in recent years. A multitude of mostly retrospective analyses suggests several advantages of laparoscopic over open liver surgery. Due to the speed and variety of simultaneous technical and strategic developments, it is difficult to maintain an overview of the current status and perspectives in laparoscopic liver surgery. Purpose This review highlights up-to-date aspects in laparoscopic liver surgery. We discuss established indications with regard to their development over time as well as continuing limitations of applied techniques. We give an assessment based on the current literature and according to our own center experiences, not least with regard to a highly topical cost discussion. Conclusions While in the beginning mainly benign tumors were laparoscopically operated on, liver metastasis and hepatocellular carcinoma are now among the most frequent indications. Technical limitations remain and should be evaluated with the overall aim not to endanger quality standards in open surgery. Financial aspects cannot be neglected with the necessity of cost-covering reimbursement.

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“…Currently, there is no randomized-control trial for open and laparoscopic repeat resection and only four propensity-score matching studies [ Table 1] [31][32][33] . Besides our study, the studies include patients with other diseases than HCC with few data for long-term results.…”

Section: The Propensity Score Matching Study For Hcc Patientsmentioning

confidence: 99%

Current status of laparoscopic repeat liver resection for hepatocellular carcinoma

Morise¹

2020

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Although liver resection (LR) is often adopted to recurrent hepatocellular carcinomas, risks of complications and conversion reportedly increase in laparoscopic repeat LR (LRLR). The indication is not agreed upon even with the recent advances of laparoscopic LR. We conducted an international propensity score matching study of LRLR and open repeat LR for hepatocellular carcinoma with 1,582 patients from 42 world centers. Propensity-score matched LRLR patients have smaller blood loss and longer operation time than open repeat LR patients. Median overall survival time was 8.94 years in open and 12.55 years in LRLR; although the difference was not significant, the P-value was 0.0855 and the better curve of LRLR is clearly separated from that of open. In our institution, we experienced 34 LRLR and 12 cases of three times or more repeat LR until 2019. There are no significant differences in operation time, blood loss, hospital stay, conversion, and morbidity rates among first, second, and third or higher laparoscopic LR, which is different from the open situation. However, postoperative bile leakage and intraoperative bleeding causing conversion did happen in the cases with repeat extended exposure of Glissonian pedicle. LRLR is feasible for selected patients. However, the procedure is under developing stage and further accumulation of experiences and evaluation are needed.

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Multicentre propensity score-matched study of laparoscopic versus open repeat liver resection for colorectal liver metastases

Cited by 65 publications

References 43 publications

A falciform ligament flap surface sealing technique for laparoscopic and robotic-assisted liver surgery

A falciform ligament flap surface sealing technique for laparoscopic and robotic-assisted liver surgery

Laparoscopic liver resection: indications, limitations, and economic aspects

Current status of laparoscopic repeat liver resection for hepatocellular carcinoma

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