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Laparoscopic Minor Liver Resections for Hepatocellular Carcinoma in the Posterosuperior Segments Using the Rubber Band Technique

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Abstract

Background

Although laparoscopic minor liver resections (LLR) of posterosuperior (PS) segments are technically challenging, several expert centers are increasingly performing this procedure. In the present study, we introduced novel techniques, including the rubber band traction method and positional changes, and compared surgical outcomes of LLR for hepatocellular carcinoma (HCC) located in PS segments with open minor liver resection (OLR).

Methods

From January 2008 to August 2019, 113 patients underwent laparoscopic (n = 55) or open (n = 58) minor liver resections for single small HCCs (<5 cm) located in PS segments. Propensity score matching in a 1:1 ratio was conducted to minimize preoperative selection bias, and surgical outcomes were compared between the two groups.

Results

There was no intraoperative mortality or reoperation in either group. One conversion to open surgery was necessary due to severe post-operative adhesions. The matched LLR group compared to OLR had significantly shorter operative time (215.16 vs. 251.41 min, P = 0.025), lesser blood loss (218.11 vs. 358.92 mL, P = 0.046), lower complication rate (8.1% vs. 29.7%, P = 0.018), and shorter hospital stay (7.03 vs. 11.78 days, P = 0.001). Intraoperative transfusion, R0 resection, resection margin, 5-year disease-free survival and 5-year overall survival were comparable.

Conclusion

Our standardized LLR provided improved short-term outcomes and similar long-term outcomes, when compared with OLR. With advanced techniques and accumulated surgical experience, LLR can be the first option for HCC in PS segments at expert centers.

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References

  1. Buell JF, Cherqui D, Geller DA et al (2009) The international position on laparoscopic liver surgery: the Louisville statement. Ann Surg 250(5):825–830

    Article  Google Scholar 

  2. Wakabayashi G, Cherqui D, Geller DA et al (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261(4):619–629

    PubMed  Google Scholar 

  3. Aikawa M, Miyazawa M, Okamoto K et al (2014) Thoracoscopic hepatectomy for malignant liver tumor. Surg Endosc 28(1):314

    Article  Google Scholar 

  4. Ichida H, Ishizawa T, Tanaka M et al (2017) Use of intercostal trocars for laparoscopic resection of subphrenic hepatic tumors. Surg Endosc 31(3):1280–1286

    Article  Google Scholar 

  5. Lee W, Han HS, Yoon YS, Cho JY, Choi Y, Shin HK (2014) Role of intercostal trocars on laparoscopic liver resection for tumors in segments 7 and 8. J Hepatobiliary Pancreat Sci 21(8):E65-68

    Article  Google Scholar 

  6. Choi SH, Choi GH, Han DH, Choi JS (2015) Laparoscopic liver resection using a rubber band retraction technique: usefulness and perioperative outcome in 100 consecutive cases. Surg Endosc 29(2):387–397

    Article  Google Scholar 

  7. Lee JW, Choi SH, Kim S, Kwon SW (2020) Laparoscopic liver resection for segment VII lesion using a combination of rubber band retraction method and flexible laparoscope. Surg Endosc 34(2):954–960

    Article  Google Scholar 

  8. Strasberg SM (2005) Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 12(5):351–355

    Article  Google Scholar 

  9. Ikeda T, Toshima T, Harimoto N et al (2014) Laparoscopic liver resection in the semiprone position for tumors in the anterosuperior and posterior segments, using a novel dual-handling technique and bipolar irrigation system. Surg Endosc 28(8):2484–2492

    Article  Google Scholar 

  10. Coles SR, Besselink MG, Serin KR et al (2015) Total laparoscopic management of lesions involving liver segment 7. Surg Endosc 29(11):3190–3195

    Article  CAS  Google Scholar 

  11. Chiow AK, Lewin J, Manoharan B, Cavallucci D, Bryant R, O’Rourke N (2015) Intercostal and transthoracic trocars enable easier laparoscopic resection of dome liver lesions. HPB (Oxford) 17(4):299–303

    Article  Google Scholar 

  12. Ogiso S, Conrad C, Araki K, Nomi T, Anil Z, Gayet B (2015) Laparoscopic transabdominal with transdiaphragmatic access improves resection of difficult posterosuperior liver lesions. Ann Surg 262(2):358–365

    Article  Google Scholar 

  13. Li H, Wei Y, Li B, Peng B (2016) Modified Thoracoscopic hepatectomy for segment VIII: a case report. Medicine (Baltimore) 95(22):e3801

    Article  Google Scholar 

  14. Inoue Y, Suzuki Y, Fujii K et al (2017) Laparoscopic liver resection using the lateral approach from intercostal ports in segments VI, VII, and VIII. J Gastrointest Surg 21(12):2135–2143

    Article  Google Scholar 

  15. Guro H, Cho JY, Han HS et al (2018) Laparoscopic liver resection of hepatocellular carcinoma located in segments 7 or 8. Surg Endosc 32(2):872–878

    Article  Google Scholar 

  16. Okuda Y, Honda G, Kobayashi S et al (2018) Intrahepatic glissonean pedicle approach to segment 7 from the dorsal side during laparoscopic anatomic hepatectomy of the cranial part of the right liver. J Am Coll Surg 226(2):e1–e6

    Article  Google Scholar 

  17. Martínez-Cecilia D, Fontana M, Siddiqi NN, Halls M, Barbaro S, Abu-Hilal M (2018) Laparoscopic parenchymal sparing resections in segment 8: techniques for a demanding and infrequent procedure. Surg Endosc 32(4):2012–2019

    Article  Google Scholar 

  18. Morikawa T, Ishida M, Takadate T et al (2019) Laparoscopic partial liver resection improves the short-term outcomes compared to open surgery for liver tumors in the posterosuperior segments. Surg Today 49(3):214–223

    Article  Google Scholar 

  19. Berardi G, Wakabayashi G, Igarashi K et al (2019) Full laparoscopic anatomical segment 8 resection for hepatocellular carcinoma using the glissonian approach with indocyanine green dye fluorescence. Ann Surg Oncol 26(8):2577–2578

    Article  Google Scholar 

  20. Agrusa A, Di Buono G, Buscemi S, Cucinella G, Romano G, Gulotta G (2018) 3D laparoscopic surgery: a prospective clinical trial. Oncotarget 9(25):17325–17333

    Article  Google Scholar 

  21. Navarro JG, Kang I, Rho SY et al (2020) Stepwise development of laparoscopic liver resection skill using rubber traction technique. HPB (Oxford) 22(8):1174–1184

    Article  Google Scholar 

  22. Aghayan DL, Fretland ÅA, Kazaryan AM et al (2019) Laparoscopic versus open liver resection in the posterosuperior segments: a sub-group analysis from the OSLO-COMET randomized controlled trial. HPB (Oxford) 21(11):1485–1490

    Article  Google Scholar 

  23. Scuderi V, Barkhatov L, Montalti R et al (2017) Outcome after laparoscopic and open resections of posterosuperior segments of the liver. Br J Surg 104(6):751–759

    Article  CAS  Google Scholar 

  24. Deng ZC, Jiang WZ, Tang XD, Liu SH, Qin L, Qian HX (2018) Laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma in 157 patients: a case controlled study with propensity score matching at two Chinese centres. Int J Surg 56:203–207

    Article  Google Scholar 

  25. Li J, Ren H, Du G, Jin B (2018) A systematic surgical procedure: The “7+3” approach to laparoscopic right partial hepatectomy [deep segment (S) VI, S VII or S VIII] in 52 patients with liver tumors. Oncol Lett 15(5):7846–7854

    PubMed  PubMed Central  Google Scholar 

  26. Xiao L, Xiang LJ, Li JW, Chen J, Fan YD, Zheng SG (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma in posterosuperior segments. Surg Endosc 29(10):2994–3001

    Article  Google Scholar 

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Funding

This research did not receive any specific grand from any funding agency in the public, commercial or not-for-profit sector.

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Author notes

  1. Theo Genesis Tagaytay and Dai Hoon Han has equally contributed to this work as the first author.

Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Theo Genesis Tagaytay, Dai Hoon Han, Gi Hong Choi & Kyung Sik Kim

  2. Department of General Surgery, Vicente Sotto Memorial Medical Center, B. Rodriguez Street, 6000, Cebu City, Philippines

    Theo Genesis Tagaytay

  3. Department of Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-Ro Ilsan-Donggu, Goyang-Si, 10444, Gyeonggi-Do, Korea

    Jae Uk Chong & Hyeo Seong Hwang

Authors
  1. Theo Genesis Tagaytay
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  2. Dai Hoon Han
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  3. Jae Uk Chong
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  4. Hyeo Seong Hwang
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  5. Gi Hong Choi
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  6. Kyung Sik Kim
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Corresponding author

Correspondence to Gi Hong Choi.

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There is no conflict of interest to be declared by any author.

Ethical approval

This study was approved by the Yonsei Institutional Board (IRB No.: 4–2020-0675) and has been performed in accordance with ethical standards.

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Tagaytay, T.G., Han, D.H., Chong, J.U. et al. Laparoscopic Minor Liver Resections for Hepatocellular Carcinoma in the Posterosuperior Segments Using the Rubber Band Technique. World J Surg 46, 1151–1160 (2022). https://doi.org/10.1007/s00268-022-06468-2

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  • DOI: https://doi.org/10.1007/s00268-022-06468-2

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