Laparoscopic versus open parenchymal preserving liver resections in the posterosuperior segments: a case-matched study
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Patients with lesions in the posterosuperior (PS) segments of the liver have been considered poor candidates for laparoscopic liver resection (LLR). This study aims to compare short-term outcomes of LLR and open liver resections (OLR) in the PS segments.
This multicenter study consisted of all patients who underwent LLR in the PS segments and all patients who underwent OLR in the PS segments between October 2011 and July 2016. Laparoscopic cases were case-matched with those who had an identical open procedure during the same period based on tumor location (same segment) and the Brisbane classification of the resection. Demographics, comorbid factors, perioperative outcomes, short-term outcomes, necessity of adjuvant chemotherapy, and the interval between surgery and initiation of adjuvant chemotherapy were compared between the two groups. Data were retrieved from a prospectively maintained electronic database.
Both groups were comparable for age, sex, ASA score, maximum tumor diameter, and number of patients with additional liver resections outside the posterior segments. Operative time was similar in both groups (median 140 min; p = 0.92). Blood loss was less in the LLR-group (median: 150 vs. 300 ml in OLR-group). Median hospital stay was 6 days in both groups. There was no significant difference in postoperative complications (OLR-group: 31.4% vs. LLR-group: 25.7%; p = 0.60). There was no significant difference in R0 resections (LLR: 97.2 vs. 100% in OLR; p = 1.00). Tumor-free margins were less in the LLR group (LLR: 5 vs. 9.5 mm in OLR; p = 0.012). Patients undergoing LLR were treated with chemotherapy sooner compared to those undergoing OLR (41 vs. 56 days, p = 0.02).
This study suggests that laparoscopic parenchymal preserving liver resections in the PS segments can be performed with comparable short-term outcomes as similar OLR. The shorter interval to chemotherapy might provide long-term oncologic benefits in patients who underwent LLR.
KeywordsHepatobiliary surgery Laparoscopy Posterosuperior segments
Compliance with ethical standards
Mathieu D’Hondt, Esther Tamby, Isabelle Boscart, Simon Turcotte, Isabelle Parmentier, Hans Pottel, Réal Lapointe, Sander Ovaere, Franky Vansteenkiste, and Franck Vandenbroucke-Menu have no conflicts of interest or financial ties to disclose.
- 1.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 C-G, 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 J-N, 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 (2009) The international position on laparoscopic liver surgery: the Louisville statement. Ann Surg 250:825–830CrossRefPubMedGoogle Scholar
- 9.Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke 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 261:619–629PubMedGoogle Scholar
- 12.D’Hondt M, Yoshihara E, Vansteenkiste F, Steelant PJ, Van Ooteghem B, Pottel H, Devriendt D, Van Rooy F (2016) Laparoscopic parenchymal preserving hepatic resections in semiprone position for tumors located in the posterosuperior segments. Langenbecks Arch Surg 401:255–262CrossRefPubMedGoogle Scholar
- 15.Gold JS, Are C, Kornprat P, Jarnagin WR, Gönen M, Fong Y, Dematteo RP, Blumgart LH, D’Angelica M (2008) Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Ann Surg 247:109–117CrossRefPubMedGoogle Scholar
- 24.Ikeda T, Yonemura Y, Ueda N, Kabashima A, Shirabe K, Taketomi A, Yoshizumi T, Uchiyama H, Harada N, Ijichi H, Kakeji Y, Morita M, Tsujitani S, Maehara Y (2011) Pure laparoscopic right hepatectomy in the semiprone position using the intrahepatic Glissonian approach and a modified hanging maneuver to minimize intraoperative bleeding. Surg Today 41:1592–1598CrossRefPubMedGoogle Scholar
- 38.Montalti R, Berardi G, Laurent S, Sebastiani S, Ferdinande L, Libbrecht LJ, Smeets P, Brescia A, Rogiers X, de Hemptinne B, Geboes K, Troisi RI (2014) Laparoscopic liver resection compared to open approach in patients with colorectal liver metastases improves further resectability: oncological outcomes of a case-control matched-pairs analysis. Eur J Surg Oncol 40:536–544CrossRefPubMedGoogle Scholar
- 39.Hammond JS, Muirhead W, Zaitoun AM, Cameron IC, Lobo DN (2012) Comparison of liver parenchymal ablation and tissue necrosis in a cadaveric bovine model using the Harmonic Scalpel, the LigaSure, the Cavitron Ultrasonic Surgical Aspirator and the Aquamantys devices. HPB 14:828–832CrossRefGoogle Scholar