Skip to main content
SpringerLink
Log in

Laparoscopic Repeat Hepatic Resection for the Management of Liver Tumors

  • Multimedia Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Laparoscopic hepatic resection has been developed as a minimally invasive surgery; however, laparoscopic repeat minor hepatic resection (LRH) carries a higher risk of damage to other organs because of postoperative changes to and losses of anatomical landmarks. The current standard approach at many facilities has been to perform open repeat minor hepatic resection (ORH). This paper describes the surgical outcomes, procedure safety, and utility of ORH versus LRH, as well as the laparoscopic techniques used in LRH.

Methods

Between February 2010 and May 2018, the data of 142 patients who underwent LRH or ORH at a single institution were retrospectively reviewed. Surgical outcomes, procedure safety, and procedure utility data were analyzed.

Results

Forty-five patients underwent LHR and 97 patients underwent ORH. The conversion rate from LHR to OHR was 13.3%. After propensity score matching (PSM), the estimated blood loss was significantly lower in the LRH group than in the ORH group (50 mL vs. 350 mL; P < 0.001). The LRH group had an 8.1% complication rate, while the ORH group had a complication rate of 24.3% (P = 0.044). The postoperative length of stay was significantly shorter in the LHR group than in the OHR group (9 days vs. 11 days) (P = 0.024).

Conclusion

LRH can be performed safely using various surgical devices. More favorable results are achieved with LRH than with ORH in terms of surgical outcomes including intraoperative bleeding, postoperative complications, and postoperative lengths of stay.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Inoue Y, Suzuki Y, Fujii K, Kawaguchi N, Ishii M, Masubuchi S, Yamamoto M, Hirokawa F, Hayashi M, Uchiyama K. Laparoscopic Liver Resection Using the Lateral Approach from Intercostal Ports in Segments VI, VII, and VIII. J Gastrointest Surg 2017;21:2135–2143.

    Article  Google Scholar 

  2. Inoue Y, Suzuki Y, Ota M, Fujii K, Kawaguchi N, Hirokawa F, Hayashi M, Uchiyama K. Short- and Long-Term Results of Laparoscopic Parenchyma-Sparing Hepatectomy for Small-Sized Hepatocellular Carcinoma: A Comparative Study Using Propensity Score Matching Analysis. Am Surg 2018;84:230–237.

    PubMed  Google Scholar 

  3. Inoue Y, Hayashi M, Tanaka R, Komeda K, Hirokawa F, Uchiyama K. Short-term results of laparoscopic versus open liver resection for liver metastasis from colorectal cancer: a comparative study. Am Surg 2013;79:495–501.

    PubMed  Google Scholar 

  4. Nord HJ. Laparoscopy - a historical perspective: are gastroenterologists going to reclaim it? Gastrointest Endosc 2008;68:67–68.

    Article  Google Scholar 

  5. Ishizawa T, Gumbs AA, Kokudo N, Gayet B. Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 2012;256:959–964.

    Article  Google Scholar 

  6. Inoue Y, Suzuki Y, Ota M, Fujii K, Kawaguchi N, Hirokawa F, Hayashi M, Uchiyama K. Short and long-term results of laparoscopic versus open hepatic resection for small-sized hepatocellular carcinoma: a comparative study using propensity score matching analyses. Am Surg 2018;84:230–237.

    PubMed  Google Scholar 

  7. Inoue Y, Hayashi M, Komeda K, Masubuchi S, Yamamoto M, Yamana H, Kayano H, Shimizu T, Asakuma M, Hirokawa F, Miyamoto Y, Takeshita A, Shibayama Y, Uchiyama K. Resection margin with anatomic or nonanatomic hepatectomy for liver metastasis from colorectal cancer. J Gastrointest Surg 2012;16:1171–1180.

    Article  Google Scholar 

  8. Inoue Y, Tanaka R, Komeda K, Hirokawa F, Hayashi M, Uchiyama K. Fluorescence detection of malignant liver tumors using 5-aminolevulinic acid-mediated photodynamic diagnosis: principles, technique, and clinical experience. World J Surg 2014;38:1786–1794.

    Article  Google Scholar 

  9. Strasberg SM. Nomenclature of hepatic anatomy and resection: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 2005;12:351–355.

    Article  Google Scholar 

  10. International Union Against Cancer (UICC), Sobin LH, Gospodarowicz MK, Wittekind Ch. (2009) TNM classification of malignant tumours. 7th edition. Wiley-Blackwell, New York

  11. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–213.

    Article  Google Scholar 

  12. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;2250:187–196.

    Article  Google Scholar 

  13. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97–132.

  14. Shelat VG, Serin K, Samim M, Besselink MG, Al Saati H, Gioia PD, Pearce NW, Abu Hilal M. Outcomes of repeat laparoscopic liver resection compared to the primary resection. World J Surg 2014;38:3175–3180.

    Article  CAS  Google Scholar 

  15. Goh BKP, Teo JY, Chan CY, Lee SY, Cheow PC, Chung AYF. Laparoscopic repeat liver resection for recurrent hepatocellular carcinoma. ANZ J Surg 2017;87:E143-E146.

    Article  Google Scholar 

  16. Noda T, Eguchi H, Wada H, Iwagami Y, Yamada D, Asaoka T, Gotoh K, Kawamoto K, Takeda Y, Tanemura M, Umeshita K, Doki Y, Mori M. Short-term surgical outcomes of minimally invasive repeat hepatectomy for recurrent liver cancer. Surg Endosc 2018;32:46–52.

    Article  Google Scholar 

  17. Kolecki RV, Golub RM, Sigel B, Machi J, Kitamura H, Hosokawa T, Justin J, Schwartz J, Zaren HA. Accuracy of viscera slide detection of abdominal wall adhesions by ultrasound. Surg Endosc 1994;8:871–874.

    Article  CAS  Google Scholar 

  18. Terasawa M, Ishizawa T, Mise Y, Inoue Y, Ito H, Takahashi Y, Saiura A. Applications of fusion-fluorescence imaging using indocyanine green in laparoscopic hepatectomy. Surg Endosc 2017;31:5111–5118.

    Article  Google Scholar 

  19. Uchiyama K, Ueno M, Ozawa S, Hayami S, Kawai M, Tani M, Mizumoto K, Haba M, Hatano Y, Yamaue H. Half clamping of the infrahepatic inferior vena cava reduces bleeding during a hepatectomy by decreasing the central venous pressure. Langenbecks Arch Surg 2009;394:243–247.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan

    Yoshihiro Inoue, Kensuke Fujii, Masatsugu Ishii, Syuji Kagota, Atsushi Tomioka, Hiroki Hamamoto, Wataru Osumi, Shinsuke Masubuchi, Masashi Yamamoto, Koji Komeda, Fumitoshi Hirokawa, Keitaro Tanaka, Junji Okuda & Kazuhisa Uchiyama

  2. Second Department of Internal Medicine, Osaka Medical College Hospital, Osaka, Japan

    Yusuke Tsuchimoto, Tetsuji Terasawa, Takeshi Ogura, Akira Imoto, Akira Asai, Shinya Fukunishi, Masahiro Goto & Kazuhide Higuchi

Authors
  1. Yoshihiro Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kensuke Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masatsugu Ishii
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Syuji Kagota
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Atsushi Tomioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroki Hamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wataru Osumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yusuke Tsuchimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tetsuji Terasawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takeshi Ogura
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Shinsuke Masubuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Masashi Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Akira Imoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Akira Asai
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Koji Komeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Shinya Fukunishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Fumitoshi Hirokawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Masahiro Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Keitaro Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Junji Okuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Kazuhide Higuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Kazuhisa Uchiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YI conceived the study concept and design, was involved with patient care, and drafted the manuscript. KF, MI, SK, AT, HH, WO, YT, TT, TO, SM, MY, AI, AA, KK, SF, FH, MG, KT, JO, KH, and KU were involved with formation of the study concept and design, patient care, and drafting of the manuscript. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Yoshihiro Inoue.

Ethics declarations

All patients were fully informed of the study design according to the Ethics Committee on Clinical Investigation of Osaka Medical College Hospital (No. 1828 and 1997) and provided written informed consent.

Conflict of Interest

Drs. Y. Inoue, K. Fujii, M. Ishii, S. Kagota, A. Tomioka, H. Hamamoto, W. Osumi, Y. Tsuchimoto, T. Terasawa, T. Ogura, S. Masubuchi, M. Yamamoto, A Imoto, A Asai, K. Komeda, S. Fukunishi, F. Hirokawa, M. Goto, K. Higuchi, and K. Uchiyama declare no conflict of interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

(MPG 343 MB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Inoue, Y., Fujii, K., Ishii, M. et al. Laparoscopic Repeat Hepatic Resection for the Management of Liver Tumors. J Gastrointest Surg 23, 2314–2321 (2019). https://doi.org/10.1007/s11605-019-04276-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-019-04276-z

Keywords

Search

Navigation