Abstract
Diffusion of laparoscopic major hepatectomies is experiencing a steady increasing trend, although slower compared to minor resections. The aim of this single-center study is to discuss current trends and indications in the application of minimally invasive techniques to major hepatic resections. Preoperative patients and disease characteristics of 49 laparoscopic major hepatectomies (LPS group), performed between 2005 and 2015, were compared with 585 open hepatectomies (Open group) to analyze differences in patients recruitment. Factors which were found to be differently distributed between groups were used as covariates in a propensity score-based case-matched analysis with a 1:3 ratio between LPS group and 147 patients from the Open group (constituting Open-mat group). Short-term outcome was analyzed in matched groups. ASA score, previous abdominal surgery, previous interventional procedures, indication, lesion size and associated procedures were significantly different between the LPS and the Open group. Short-term outcome analysis revealed that blood loss (200 vs 350 mL, p = 0.044) and time for functional recovery (3 vs 4 days, p = 0.05) were reduced in the LPS compared to the Open-mat group, in spite of longer length of surgery (260 vs 170 min, p = 0.041) and comparable oncological adequacy. Even though data on technical feasibility of laparoscopic major resections and their benefits in terms of blood loss and functional recovery support the diffusion of minimally invasive approach, the limit of the technique is still represented by the reduced pool of suitable candidates.
Similar content being viewed by others
Abbreviations
- LMH:
-
Laparoscopic major hepatectomy
- MH:
-
Major hepatectomy
- OMH:
-
Open major hepatectomy
References
Pulitanò C, Aldrighetti L (2008) The current role of laparoscopic liver resection for the treatment of liver tumors. Nat Clin Pract Gastroenterol Hepatol 5(11):648–654
Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS; World Consensus conference on laparoscopic surgery (2009) The international position on laparoscopic liver surgery: the Louisville statement, 2008. Ann Surg 250(5):825–830
Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, OʼRourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schön MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in morioka. Ann Surg 261(4):619–29
Nguyen KT, Gambin TC, Geller DA (2009) World review of laparoscopic liver resection—2804 patients. Ann Surg 250:831–841
Aldrighetti L, Cipriani F, Ratti F, Casciola L, Calise F, on behalf of the Italian National Survey Study Group (2013) The italian experience in minimally invasive surgery of the liver: a national survey. In: Calise F, Casciola L (eds) minimally invasive surgery of the liver. Springer, Milano, pp 295–312
Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC et al (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250:856–860
Dagher I, Gayet B, Tzanis D, Tranchart H, Fuks D, Soubrane O, Han HS, Kim KH, Cherqui D, O’Rourke N, Troisi RI, Aldrighetti L, Bjorn E, Abu Hilal M, Belli G, Kaneko H, Jarnagin WR, Lin C, Pekolj J, Buell JF, Wakabayashi G (2014) International experience for laparoscopic major liver resection. J Hepatobiliary Pancreat Sci 21(10):732–736
Belli G, Gayet B, Han HS, Wakabayashi G, Kim KH, Cannon R, Kaneko H, Gamblin T, Koffron A, Dagher I, Buell JF, International Consensus Group for Laparoscopic Liver Surgery (2013) Laparoscopic left hemihepatectomy a consideration for acceptance as standard of care. Surg Endosc. doi:10.1007/s004-013-2840-8
Huscher CG, Lirici MM, Chiodini S (1998) Laparoscopic liver resections. Semin Laparosc Surg 5(3):204–210
Lin NC, Nitta H, Wakabayashi G (2013) Laparoscopic major hepatectomy. A systematic literature review and comparison of 3 techniques. Ann Surg 257:205–213
Pulitanò C, Catena M, Arru M, Guzzetti E, Comotti L, Ferla G, Aldrighetti L (2008) Laparoscopic liver resection without portal clamping: a prospective evaluation. Surg Endosc 22:2196–2200
Aldrighetti L, Pulitanò C, Arru M, Catena M, Guzzetti E, Casati M, Ferla G (2008) Ultrasonic-mediated laparoscopic liver transection. Am J Surg 195:270–272
Aldrighetti L, Guzzetti E, Pulitanò C, Cipriani F, Catena M, Paganelli M, Ferla G (2010) Case-matched analysis of totally laparoscopic versus open liver resection for HCC: short and middle term results. J Surg Oncol 102:82–86
Soubrane O, Schwarz L, Cauchy F, Perotto LO, Brustia R, Bernard D, Scatton O (2014) A conceptual technique for laparoscopic right hepatectomy based on facts and oncologic principles: the caudal approach. Ann Surg 261(6):1226–1231 (epub ahead of print)
Viganò L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D (2009) The learning curve in laparoscopic liver resection. Improved feasibility and reproducibility. Ann Surg 250:772–782
Kluger MD, Viganò L, Barroso R, Cherqui D (2013) The learning curve in laparoscopic major liver resection. J Hepatobiliary Pancreat Sci 20:131–136
Belghiti J, Clavien PA, Gadzijev (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2:333–339
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Ratti F, Cipriani F, Ferla F, Catena M, Paganelli M, Aldrighetti LA (2013) Hilar cholangiocarcinoma: preoperative liver optimization with multidisciplinary approach. Toward a better outcome. World J Surg 37(6):1388–1396
Ratti F, Soldati C, Catena M, Paganelli M, Ferla G, Aldrighetti L (2010) Role of portal vein embolization in liver surgery: single centre experience in sixty-two patients. Surgery 62(3–4):153–159
Torzilli G, Donadon M, Marconi M, Botea F, Palmisano A, Del Fabbro D, Procopio F, Montorsi M (2008) Systematic extended right posterior sectionectomy: a safe and effective alternative to right hepatectomy. Ann Surg 247(4):603–611
Fretland ÅA, Kazaryan AM, Bjørnbeth BA, Flatmark K, Andersen MH, Tønnessen TI, Bjørnelv GM, Fagerland MW, Kristiansen R, Øyri K, Edwin B (2015) Open versus laparoscopic liver resection for colorectal liver metastases (the Oslo-CoMet study): study protocol for a randomized controlled trial. Trials 16(1):73
de’Angelis N, Eshkenazy R, Brunetti F, Valente R, Costa M, Disabato M, Salloum C, Compagnon P, Laurent A, Azoulay D (2015) Laparoscopic versus open resection for colorectal liver metastases: a single-center study with propensity score analysis. J Laparoendosc Adv Surg Tech A 25(1):12–20
Cipriani F, Shelat VG, Rawashdeh M, Francone E, Aldrighetti L, Takhar A, Armstrong T, Pearce NW, Abu Hilal M (2015) Laparoscopic parenchymal-sparing resections for nonperipheral liver lesions, the diamond technique: technical aspects, clinical outcomes, and oncologic efficiency. J Am Coll Surg. doi:10.1016/j.jamcollsurg.2015.03.029
Zhou YM, Shao WY, Zhao YF, Xu DH, Li B (2011) Meta-analysis of laparoscopic versus open resection for hepatocellular carcinoma. Dig Dis Sci 56(7):1937–1943
Kluger MD, Cherqui D (2013) Laparoscopic resection of hepatocellular carcinoma. Recent Results Cancer Res 190:111–126
Panni RZ, Hall BL, Chapman WC, Strasberg SM (2014) Standardizing a control group for comparing open with laparoscopic major liver resection in observational studies: reducing the need for correction of clinical heterogeneity. J Am Coll Surg 219(6):1124–1133
Abu Hilal M, Di Fabio F, Teng MJ, Lykoudis P, Primrose JN, Pearce NW (2011) Single-centre comparative study of laparoscopic versus open right hepatectomy. J Gastrointest Surg 15(5):818–823
Dagher I, Caillard C, Proske JM, Carloni A, Lainas P, Franco D (2008) Laparoscopic right hepatectomy: original technique and results. J Am Coll Surg 206(4):756–760
Huang MT, Wei PL, Wang W, Li CJ, Lee YC, Wu CH (2009) A series of laparoscopic liver resections with and without HALS in patients with hepatic tumors. J Gastrointest Surg 13(5):896–906
Aldrighetti L, Ratti F, Catena M, Pulitanò C, Cipriani F, Ferla G (2012) Laparoendoscopic single site (LESS) surgery for left-lateral hepatic sectionectomy as an alternative to traditional laparoscopy: case-matched analysis from a single center. Surg Endosc 26(7):2016–2022
Casciola L, Patriti A, Ceccarelli G, Bartoli A, Ceribelli C, Spaziani A (2011) Robot-assisted parenchymal-sparing liver surgery including lesions located in the posterosuperior segments. Surg Endosc 25:3815–3824
Patriti A, Cipriani F, Ratti F, Bartoli A, Ceccarelli G, Casciola L, Aldrighetti L (2014) Robot-assisted versus open liver resection in the right posterior section. JSLS 18(3)
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The authors of this manuscript have no conflicts of interest to disclose and further disclose any commercial interest that they may have in the subject of study and the source of any financial or material support.
Ethical standard
The study was approved by the Ethics committee of the Department and conformed to the ethical guidelines of the Helsinki declaration (as revised in Tokyo 2004). No study advertising was made and no remuneration was offered.
Research involving human participants and/or animals
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
No informed consent is required.
Rights and permissions
About this article
Cite this article
Ratti, F., Cipriani, F., Ariotti, R. et al. Laparoscopic major hepatectomies: current trends and indications. A comparison with the open technique. Updates Surg 67, 157–167 (2015). https://doi.org/10.1007/s13304-015-0312-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13304-015-0312-5