Journal of Gastrointestinal Surgery

, Volume 20, Issue 5, pp 1065–1071 | Cite as

What is the Learning Curve for Laparoscopic Major Hepatectomy?

Evidence-Based Current Surgical Practice

Abstract

Background

Laparoscopic liver resection is rapidly expanding with more than 9500 cases performed worldwide. While initial series reported non-anatomic resection of benign peripheral hepatic lesions, approximately 50–65 % of laparoscopic liver resections are now being done for malignant tumors, primarily hepatocellular carcinoma (HCC) or colorectal cancer liver metastases (mCRC).

Methods

We performed a literature review of published studies evaluating outcomes of major laparoscopic liver resection, defined as three or more Couinaud segments.

Results

Initial fears of adverse oncologic outcomes or tumor seeding have not been demonstrated, and dozens of studies have reported comparable 5-year disease-free and overall survival between laparoscopic and open resection of HCC or mCRC in case-cohort and propensity score-matched analyses. Increased experience has led to laparoscopic anatomic liver resections including laparoscopic major hepatectomy. A steep learning curve of 45–60 cases is evident for laparoscopic hepatic resection.

Conclusion

Laparoscopic major hepatectomy is safe and effective in the treatment of benign and malignant liver tumors when performed in specialized centers with dedicated teams. Comparable to other complex laparoscopic surgeries, laparoscopic major hepatectomy has a learning curve of 45–60 cases.

Keywords

Laparoscopic liver resection Laparoscopic major hepatectomy Learning curve Hepatocellular carcinoma HCC Colorectal cancer 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

References

  1. 1.
    Nguyen, K.T., T.C. Gamblin, and D.A. Geller, World review of laparoscopic liver resection-2,804 patients. Ann Surg, 2009. 250(5): p. 831–41.CrossRefPubMedGoogle Scholar
  2. 2.
    Geller, D.A. and A. Tsung, Longterm outcomes and safety of laparoscopic liver resection surgery for hepatocellular carcinoma and metastatic colorectal cancer. J Hepatobiliary Pancreat Sci, 2015.Google Scholar
  3. 3.
    Nguyen, K.T., T.C. Gamblin, and D.A. Geller, Laparoscopic liver resection for cancer. Future Oncol, 2008. 4(5): p. 661–70.CrossRefPubMedGoogle Scholar
  4. 4.
    Nguyen, K.T. and D.A. Geller, Is laparoscopic liver resection safe and comparable to open liver resection for hepatocellular carcinoma? Ann Surg Oncol, 2009. 16(7): p. 1765–7.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Nguyen, K.T., et al., Minimally invasive liver resection for metastatic colorectal cancer: a multi-institutional, international report of safety, feasibility, and early outcomes. Ann Surg, 2009. 250(5): p. 842–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Nguyen, K.T. and D.A. Geller, Outcomes of laparoscopic hepatic resection for colorectal cancer metastases. J Surg Oncol, 2010. 102(8): p. 975–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Reddy, S.K., A. Tsung, and D.A. Geller, Laparoscopic liver resection. World J Surg, 2011. 35(7): p. 1478–86.CrossRefPubMedGoogle Scholar
  8. 8.
    Sasaki, A., et al., Ten-year experience of totally laparoscopic liver resection in a single institution. Br J Surg, 2009. 96(3): p. 274–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Vigano, L., et al., Laparoscopic liver resection: a systematic review. J Hepatobiliary Pancreat Surg, 2009. 16(4): p. 410–21.CrossRefPubMedGoogle Scholar
  10. 10.
    Buell, J.F., et al., The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg, 2009. 250(5): p. 825–30.CrossRefPubMedGoogle Scholar
  11. 11.
    Wakabayashi, G., et al., Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg, 2015. 261(4): p. 619–29.PubMedGoogle Scholar
  12. 12.
    Ciria, R., et al., Comparative short term benefits of laparoscopic liver resection: 9,000 cases and climbing. Ann Surg, 2015.Google Scholar
  13. 13.
    Nguyen, K.T., et al., Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch Surg, 2011. 146(3): p. 348–56.CrossRefPubMedGoogle Scholar
  14. 14.
    Castaing, D., et al., Oncologic results of laparoscopic versus open hepatectomy for colorectal liver metastases in two specialized centers. Ann Surg, 2009. 250(5): p. 849–55.CrossRefPubMedGoogle Scholar
  15. 15.
    Kazaryan, A.M., et al., Laparoscopic resection of colorectal liver metastases: surgical and long-term oncologic outcome. Ann Surg, 2010. 252(6): p. 1005–12.CrossRefPubMedGoogle Scholar
  16. 16.
    Kazaryan, A.M., B.I. Rosok, and B. Edwin, Laparoscopic and open liver resection for colorectal metastases: different indications? HPB (Oxford), 2010. 12(6): p. 434; author reply 435.CrossRefGoogle Scholar
  17. 17.
    Topal, H., et al., Outcome of laparoscopic major liver resection for colorectal metastases. Surg Endosc, 2012. 26(9): p. 2451–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Schiffman, S.C., et al., Laparoscopic versus open liver resection for metastatic colorectal cancer: a metaanalysis of 610 patients. Surgery, 2015. 157(2): p. 211–22.CrossRefPubMedGoogle Scholar
  19. 19.
    Beppu, T., et al., Long-term and perioperative outcomes of laparoscopic versus open liver resection for colorectal liver metastases with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci, 2015.Google Scholar
  20. 20.
    Takahara, T., et al., Minimally invasive donor hepatectomy: evolution from hybrid to pure laparoscopic techniques. Ann Surg, 2015. 261(1): p. e3-4.CrossRefPubMedGoogle Scholar
  21. 21.
    Hasegawa, Y., et al., Approaches to laparoscopic liver resection: a meta-analysis of the role of hand-assisted laparoscopic surgery and the hybrid technique. J Hepatobiliary Pancreat Sci, 2015. 22(5): p. 335–41.CrossRefPubMedGoogle Scholar
  22. 22.
    Cardinal, J.S., et al., Laparoscopic major hepatectomy: pure laparoscopic approach versus hand-assisted technique. J Hepatobiliary Pancreat Sci, 2013. 20(2): p. 114–9.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Koffron, A.J., et al., Laparoscopic liver surgery for everyone: the hybrid method. Surgery, 2007. 142(4): p. 463–8; discussion 468 e1-2.CrossRefGoogle Scholar
  24. 24.
    Nitta, H., et al., Laparoscopy-assisted major liver resections employing a hanging technique: the original procedure. Ann Surg, 2010. 251(3): p. 450–3.CrossRefPubMedGoogle Scholar
  25. 25.
    Tsung, A., et al., Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg, 2014. 259(3): p. 549–55.CrossRefPubMedGoogle Scholar
  26. 26.
    Nguyen, K.T. and D.A. Geller, Laparoscopic liver resection--current update. Surg Clin North Am, 2010. 90(4): p. 749–60.CrossRefPubMedGoogle Scholar
  27. 27.
    Cherqui, D., et al., Laparoscopic living donor hepatectomy for liver transplantation in children. Lancet, 2002. 359(9304): p. 392–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Soubrane, O., et al., Laparoscopic left lateral sectionectomy in living donors: safety and reproducibility of the technique in a single center. Ann Surg, 2006. 244(5): p. 815–20.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Ban, D., et al., A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci, 2014. 21(10): p. 745–53.CrossRefPubMedGoogle Scholar
  30. 30.
    Giuliante, F. and F. Ardito, Minimally invasive liver surgery in a hepato-biliary unit: learning curve and indications. Updates Surg, 2015. 67(2): p. 201–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Nomi, T., et al., Learning curve for laparoscopic major hepatectomy. Br J Surg, 2015. 102(7): p. 796–804.CrossRefPubMedGoogle Scholar
  32. 32.
    Hunter, J.G., J.M. Sackier, and G. Berci, Training in laparoscopic cholecystectomy. Quantifying the learning curve. Surg Endosc, 1994. 8(1): p. 28–31.CrossRefPubMedGoogle Scholar
  33. 33.
    Andrew, C.G., et al., Early results after laparoscopic Roux-en-Y gastric bypass: effect of the learning curve. Can J Surg, 2006. 49(6): p. 417–21.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Bencini, L. and L.J. Sanchez, Learning curve for laparoscopic ventral hernia repair. Am J Surg, 2004. 187(3): p. 378–82.CrossRefPubMedGoogle Scholar
  35. 35.
    Jaffer, U. and A.E. Cameron, Laparoscopic appendectomy: a junior trainee’s learning curve. JSLS, 2008. 12(3): p. 288–91.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Lal, P., et al., Laparoscopic total extraperitoneal (TEP) inguinal hernia repair: overcoming the learning curve. Surg Endosc, 2004. 18(4): p. 642–5.CrossRefPubMedGoogle Scholar
  37. 37.
    Schlachta, C.M., et al., Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum, 2001. 44(2): p. 217–22.CrossRefPubMedGoogle Scholar
  38. 38.
    Vigano, L., et al., The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg, 2009. 250(5): p. 772–82.CrossRefPubMedGoogle Scholar
  39. 39.
    Kluger, M.D., et al., The learning curve in laparoscopic major liver resection. J Hepatobiliary Pancreat Sci, 2013. 20(2): p. 131–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Abu Hilal, M., et al., Single-centre comparative study of laparoscopic versus open right hepatectomy. J Gastrointest Surg, 2011. 15(5): p. 818–23.CrossRefPubMedGoogle Scholar
  41. 41.
    Dagher, I., et al., Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg, 2009. 250(5): p. 856–60.CrossRefPubMedGoogle Scholar
  42. 42.
    Lin, N.C., H. Nitta, and G. Wakabayashi, Laparoscopic major hepatectomy: a systematic literature review and comparison of 3 techniques. Ann Surg, 2013. 257(2): p. 205–13.CrossRefPubMedGoogle Scholar
  43. 43.
    Tzanis, D., et al., European experience of laparoscopic major hepatectomy. J Hepatobiliary Pancreat Sci, 2013. 20(2): p. 120–4.CrossRefPubMedGoogle Scholar
  44. 44.
    Pearce, N.W., et al., Laparoscopic right hepatectomy: a challenging, but feasible, safe and efficient procedure. Am J Surg, 2011. 202(5): p. e52-8.CrossRefPubMedGoogle Scholar
  45. 45.
    Alrasheed, T., et al., Robotic microsurgery: validating an assessment tool and plotting the learning curve. Plast Reconstr Surg, 2014. 134(4): p. 794–803.CrossRefPubMedGoogle Scholar
  46. 46.
    Boone, B.A., et al., Assessment of quality outcomes for robotic pancreaticoduodenectomy: identification of the learning curve. JAMA Surg, 2015. 150(5): p. 416–22.CrossRefPubMedGoogle Scholar
  47. 47.
    Napoli, N., et al., The learning curve in robotic distal pancreatectomy. Updates Surg, 2015.Google Scholar
  48. 48.
    Park, E.J., et al., Is the learning curve of robotic low anterior resection shorter than laparoscopic low anterior resection for rectal cancer?: a comparative analysis of clinicopathologic outcomes between robotic and laparoscopic surgeries. Medicine (Baltimore), 2014. 93(25): p. e109.CrossRefGoogle Scholar
  49. 49.
    Shakir, M., et al., The learning curve for robotic distal pancreatectomy: an analysis of outcomes of the first 100 consecutive cases at a high-volume pancreatic centre. HPB (Oxford), 2015. 17(7): p. 580–6.CrossRefGoogle Scholar
  50. 50.
    Starnes, C.C., et al., The economy of motion of the totally robotic gastric bypass: technique, learning curve, and outcomes of a fellowship-trained, robotic bariatric surgeon. J Laparoendosc Adv Surg Tech A, 2015. 25(5): p. 411–8.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2016

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Texas Medical BranchGalvestonUSA
  2. 2.Liver Cancer CenterUniversity of PittsburghPittsburghUSA
  3. 3.UPMC Liver Cancer CenterUPMC MontefiorePittsburghUSA

Personalised recommendations