Robotic versus open minor liver resections of the posterosuperior segments: a multinational, propensity score matched study

Abstract

several guidelines interdict surgery for tumor >5 cm despite its resectability or operability, probably due to lack of published series regarding HCC with large size nodule. Here, the prevalence and management of double extra-large HCC (larger than 15 cm) are reported. Methods: We performed a descriptive retrospective study on patients treated in Cipto Mangunkusumo Hospital from 2010 until 2017. Results: There were 70 cases of HCC, 51 (72.9%) of them are male and the mean age is 51.3 years. The cases are classified into four categories: (1) Double Extra-large (diameter >15 cm), (2) Extra-large (diameter 10-15 cm), (3) Large (diameter 5-< 10 cm), and (4) Small (diameter < 5 cm). There were 22.9%, 14.3%, 25.7% and 37.2% cases in each group, consecutively. Range of diameter was 3 to 25 cm, mostly singular and located on the left liver. Hepatitis B was detected on 90% cases and 9 cases of non-B and C. Mean blood lost was 2000 ml. Overall operative mortality was 18,6%. Each category's mortality was 5.7% (XXL), 10% (XL and L each). The XXL operative mortality were 23.1% compared to 76.9% in the XL and L HCC. Prolonged ascites, pneumonia and relaparotomies occurred as operative morbidity. Range of length of stay was 14 to 44 days. Conclusion: Double Extra-Large HCC were common and not contraindicated for resection.

Laparoscopic versus open liver resections of posterolateral liver segments - a systematic review and meta-analysis.

“…The PRISMA flowchart presented in Figure 1 summarises the screening process. Baseline information on included studies is presented in Table I [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. All studies eligible for evaluation with the Newcastle-Ottawa scale were ranked as high quality.…”

Robotic approach as a valid strategy to improve the access to posterosuperior hepatic segments—Case series and review of literature

“…The resection of lesions on these segments was an independent predictor for conversion, which represented a risk five times higher than for other hepatic segments, and, for this reason, it was advocated that it was necessary anatomical resections, with no parenchyma sparing. For these hepatic segments, the robotic approach is a viable alternative for a minimally invasive surgery due to its sophisticated systems …”

Parenchymal transection in robotic liver resection: results of 70 resections using the Vessel Sealer

“…We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement [8] . Eleven of the minor resections of the posterosuperior liver segments have been described previously within a multi-institutional cohort study [9] . The overall initial experience at our centre has been published previously, including surgical outcomes of the first eighteen procedures [3,10] .…”