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Laparoscopic versus open parenchymal preserving liver resections in the posterosuperior segments: a case-matched study

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

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Authors and Affiliations

  1. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium

    Mathieu D’Hondt, Isabelle Boscart, Sander Ovaere & Franky Vansteenkiste

  2. HPB Surgery and Liver Transplantation Unit, CHUM St-Luc, University of Montreal, 1058 Saint-Denis, Montreal, QC, H2X 3J4, Canada

    Esther Tamby, Simon Turcotte, Réal Lapointe & Franck Vandenbroucke-Menu

  3. Department of Oncology and Statistics, Groeninge Hospital, President Kennedylaan 4, 8500 Kortrijk, Belgium

    Isabelle Parmentier

  4. Interdisciplinary Research Center, Catholic University Leuven, Campus Kortrijk, Etienne Sabbelaan 53, 8500, Kortrijk, Belgium

    Hans Pottel

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  1. Mathieu D’Hondt
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Correspondence to Mathieu D’Hondt.

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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.

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D’Hondt, M., Tamby, E., Boscart, I. et al. Laparoscopic versus open parenchymal preserving liver resections in the posterosuperior segments: a case-matched study. Surg Endosc 32, 1478–1485 (2018). https://doi.org/10.1007/s00464-017-5835-z

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  • DOI: https://doi.org/10.1007/s00464-017-5835-z

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