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The Extrahepatic Glissonian Versus Hilar Dissection Approach for Laparoscopic Formal Right and Left Hepatectomies in Patients with Hepatocellular Carcinoma

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Few studies have been performed to evaluate the value of the Glissonian approach (GA) for laparoscopic formal hemihepatectomy. The purpose of this study was to compare the outcomes of extrahepatic GA with those of the conventional hilar dissection approach for laparoscopic formal right and left hepatectomies in patients with hepatocellular carcinoma (HCC).

Methods

Between January 2015 and October 2017, a total of 95 HCC patients who underwent pure laparoscopic formal hemihepatectomies, of whom 49 underwent the GA, were included in this study. After a 1:1 propensity score matching, 42 laparoscopic GA hepatectomies were compared to 42 conventional approach (CA) hepatectomies. We have analyzed perioperative and oncologic outcomes of the two different operative approaches for HCC treatments.

Results

The GA did not increase the postoperative overall complication rates (P = 0.415) or the mean comprehensive complication index (P = 0.414) when compared with the CA. However, the operative time was significantly shorter (P = 0.006), and intraoperative blood loss was significantly lower (P < 0.001) in the GA group than in the CA group. There were no significant differences between the GA and CA groups regarding 3-year overall survival rate (P = 0.765) or 3-year disease-free survival rate (P = 0.622).

Conclusions

Pure laparoscopic extrahepatic GA hemihepatectomy is safe and feasible, and it was associated with similar complication rates and equivalent 3-year survival outcomes compared to the conventional approach in selected patients with HCC.

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Acknowledgments

We thank LetPub (www.letpub.com) for its linguistic assistance during the preparation of this manuscript.

Funding

This work was supported by the National Natural Science Foundation of China (No. 81602910) and the Fundamental Research Fund for the Central Universities (No. 2017SCU11045).

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Authors and Affiliations

  1. Department of Liver Surgery&Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan Province, China

    Fei Liu, YongGang Wei, Kefei Chen, Wentao Wang, Hong Wu, Tianfu Wen & Bo Li

  2. Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China

    HongYu Li

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  1. Fei Liu
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  2. YongGang Wei
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  6. Hong Wu
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  7. Tianfu Wen
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  8. Bo Li
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Contributions

Fei Liu: designed research/study, performed research/study, collected data, analyzed data, wrote the paper, and edited the manuscript. Yonggang Wei and Kefei Chen: performed research/study, collected data, analyzed data, and reviewed/edited the manuscript. Hongyu Li: collected data, analyzed data, and reviewed/edited the manuscript. Wentao Wang and Hong Wu: designed research/study, acquired data, and reviewed the manuscript. Tianfu Wen and Bo Li: designed research/study, performed research/study, reviewed the manuscript, and revised the manuscript.

Corresponding authors

Correspondence to YongGang Wei or Bo Li.

Ethics declarations

The study was approved by the Ethics Committee of West China Hospital of Sichuan University.

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The authors declare that they have no conflict of interest.

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Figure S1

The right Glissonian pedicle was transected by a linear stapler while the tape was retracted toward the left side. (PNG 1314 kb)

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Liu, F., Wei, Y., Chen, K. et al. The Extrahepatic Glissonian Versus Hilar Dissection Approach for Laparoscopic Formal Right and Left Hepatectomies in Patients with Hepatocellular Carcinoma. J Gastrointest Surg 23, 2401–2410 (2019). https://doi.org/10.1007/s11605-019-04135-x

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  • DOI: https://doi.org/10.1007/s11605-019-04135-x

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