RCT of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study)

Wong-Lun-Hing, Edgar M.; Dam, Ronald M. van; Breukelen, Gerard J. P. van; Tanis, P.J.; Ratti, F.; Hillegersberg, Richard van; Slooter, Gerrit D.; Wilt, Johannes H. W. de; Liem, Mike S L; Boer, Marieke T. de; Klaase, J.M.; Neumann, UP; Aldrighetti, L.A.; Dejong, C. H. C.

doi:10.1016/j.hpb.2019.10.365

Cited by 11 publications

(25 citation statements)

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“…16 Outcomes The primary outcome of the study was the incidence of a validated, repeatedly used clinical composite endpoint (CEP) that consists of frequent complications after hepatic resection as published before. [17][18][19] The CEP includes following complications: Liver failure (bilirubin above 50 mmol/l AND international normalized ratio greater than 1.5 or hepatic encephalopathy grade 3 or 4 on or after postoperative day 3), ascites (loss of >500 ml per day of intra-abdominal clear fluid via drain or wound), bile leakage (via abdominal wound or drains), intraabdominal abscess (purulent fluid in the abdominal drain or presence of a walled-off collection in the abdominal cavity on radiological examination) and mortality. The CEP was met if one or more of the aforementioned complications occurred within 6 weeks after surgery.…”

Section: Interventionmentioning

confidence: 99%

Effectiveness of terlipressin for prevention of complications after major liver resection – A randomized placebo-controlled trial

Köhler

Perrodin

Gottardi

et al. 2020

HPB

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Background: Elevated portal pressure in response to major liver resection is associated with impaired liver regeneration and increased postoperative complications. Terlipressin, a splanchnic vasoconstrictor used for treatment of hepatorenal syndrome, was tested for reduction of complications and renal protection after liver resection. Methods: A randomized double-blinded placebo-controlled trial including patients undergoing elective major liver resection was performed. Terlipressin was administered to patients in the intervention group for five days. The primary outcome parameter was the incidence of a clinical composite endpoint of following liver specific complications 6 weeks after surgery: liver failure, ascites, bile leakage, intraabdominal abscess and operative mortality. Postoperative kidney function was assessed as a secondary endpoint. Results: 150 patients (mean age 63.4 years, 73.3% male) were included. No difference was found in the composite endpoint between the placebo and intervention group (32.8% versus 30.8%, relative risk 1.066, 95%CI 0.643 to 1.769, p = 0.85). Patients receiving terlipressin showed a significant lower decrease in postoperative estimated glomerular filtration rate compared to placebo (two way ANOVA, p = 0.005). Conclusion: Perioperative administration of terlipressin during major liver surgery did not affect a composite endpoint of liver specific complications, but significantly protected from postoperative deterioration of kidney function compared to placebo. Clinicaltrials.gov identifier: NCT01921985.

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Section: Interventionmentioning

confidence: 99%

Effectiveness of terlipressin for prevention of complications after major liver resection – A randomized placebo-controlled trial

Köhler

Perrodin

Gottardi

et al. 2020

HPB

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“…There was no significant difference between the 2 groups regarding the body image scale and the sensation scale. However, PLDLH donors had significantly higher [5][6][7]; P = 0.050) and gave a higher score to the scar (4 [IQR, 3-8] versus 9.5 [IQR, [8][9][10]; P = 0.050) compared with scores given by CDLH donors. Regarding the self-confidence scale, there was no difference in self-confidence before the operation, but PLDLH donors had higher self-confidence after the operation (5 [IQR, 3-8] versus 9.5 [IQR, [9][10]; P = 0.050).…”

Section: Resultsmentioning

confidence: 95%

“…Two published randomized controlled trials showed reduced morbidity in laparoscopic hepatectomy for tumors compared with open surgery. (9,10) Furthermore, several retrospective studies showed reduced blood loss, postoperative pain, and hospital stay in the laparoscopic hepatectomy Original article | 371 group. (11)(12)(13)(14) However, the outcome of pure laparoscopic major hepatectomy in donors should be regarded somewhat differently from that in patients with tumors.…”

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confidence: 99%

Pure Laparoscopic Versus Open Left Hepatectomy Including the Middle Hepatic Vein for Living Donor Liver Transplantation

et al. 2020

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Pure laparoscopic donor hepatectomy (PLDH) has become increasingly accepted in the era of minimally invasive surgeries. However, the outcomes of pure laparoscopic donor left hepatectomy (PLDLH) are relatively less known than for left lateral sectionectomy or right hepatectomy. This study aimed to report our experience with and the outcomes of PLDLH including the middle hepatic vein (MHV) and to compare these outcomes with conventional donor left hepatectomy (CDLH). The medical records of living liver donors between January 2010 and January 2018 at Seoul National University Hospital were retrospectively reviewed. Donors who underwent left hepatectomy including the MHV were included. To minimize selection bias, donors who underwent CDLH after the initiation of the PLDH program were excluded. Finally, there were 18 donors who underwent CDLH and 8 who underwent PLDLH. The median (interquartile range [IQR]) warm ischemia time (11 [10‐16] minutes versus 4 [2‐7] minutes; P = 0.001) was longer in the PLDLH group than the CDLH group. The total operation time (333 [281‐376] minutes versus 265 [255‐308] minutes; P = 0.09) and time to remove the liver (245 [196‐276] minutes versus 182 [172‐205] minutes; P = 0.08) were also longer in PLDLH although not statistically significant. The length of postoperative hospital stay was significantly shorter in the PLDLH group (7 [7‐8] days versus 9 [8‐10] days; P = 0.01). There were no postoperative complications in the PLDLH group. The rate of complications in recipients was similar in both groups. In conclusion, PLDLH including the MHV appears to be safe and feasible. Further analysis including longterm outcomes is needed.

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“…Az első prospektív multicentrikus RCT, az Orange II 2010 és 2014 között zajlott 10 európai intézményben, és a hagyományos és a laparoszkópos bal lateralis sectionectomia eredményeit vizsgálta. Sajnos a kevés és lassú beválasztás miatt a vizsgálat sikertelenül zárult, de az előzetes eredmények a vizsgált paraméterek tekintetében (teljes funkcionális felépülés, morbiditás, ápolási napok száma) nem talált eltérést a laparoszkópos és a nyitott műtéti csoport között [8].…”

Section: Megbeszélésunclassified

“…Ennek oka talán az lehet, hogy a 30 napon belül jelentkező komplikációk egy jelentős része -mint az epecsorgás, a tályogképződés vagy a hasüregi vérzés -a májreszekcióval és nem a feltárás módjával van összefüg-gésben. Szövődményeink aránya nem különbözik az áttekintett nemzetközi irodalomban közöltektől [8,9,11]. A kórházban töltött átlagos idő mégis indirekt módon jelzi a minimálinvazív megközelítés jótékony hatását.…”

Section: Megbeszélésunclassified

Malignus májdaganatok miatt végzett laparoszkópos minor reszekciók eredményei az első 50 eset kapcsán

et al. 2019

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Introduction: Laparoscopic resection of liver malignancies is gaining acceptance. Besides the advantages of minimally-invasive techniques, publications so far show no oncologic compromise of laparoscopy. Aim: Our aim was to compare the results of our first fifty laparoscopic minor liver resections with traditional open procedures. Method: We investigated laparoscopic and open minor liver resections performed in our institute between 01. 01. 2013 and 31. 03. 2017. Data were analysed retrospectively. Resection of maximum two segments was considered a minor resection. We compared the number of resected segments, intraoperative blood loss, operative time, 30 day morbidity and mortality, hospital stay, R1 resection ratio and resection margin width. Results: During the given period, 123 open and 55 laparoscopic minor liver resections of malignant liver tumours were performed. Open and laparoscopic groups were similar considering age, sex and health status. The ratio of bi-segmentectomies was significantly higher in the open group (p<0.001). Operation time (p = 0.91) and peri-operative transfusion ratio did not differ in the two groups (p = 0.102). 30 day morbidity and mortality were consistent (p = 0.50; p = 0.34), but patients in the laparoscopic group spent shorter time in hospital (p = 0.0001). The average width of resection margins and the ratio of R1 resections showed no difference between open and laparoscopic groups (p = 0.447; p = 0.263). Conclusion: Our investigation indicates that in malignant liver tumours, laparoscopic resection significantly shortens hospital stay without oncologic compromise, even though 30 day morbidity and mortality does not show difference. We conclude that laparoscopic minor resection of malignant liver tumours is safe and feasible. Orv Hetil. 2019; 160(3): 104–111.

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RCT of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study)

Cited by 11 publications

References 0 publications

Effectiveness of terlipressin for prevention of complications after major liver resection – A randomized placebo-controlled trial

Effectiveness of terlipressin for prevention of complications after major liver resection – A randomized placebo-controlled trial

Pure Laparoscopic Versus Open Left Hepatectomy Including the Middle Hepatic Vein for Living Donor Liver Transplantation

Malignus májdaganatok miatt végzett laparoszkópos minor reszekciók eredményei az első 50 eset kapcsán

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