The Extrahepatic Glissonian Versus Hilar Dissection Approach for Laparoscopic Formal Right and Left Hepatectomies in Patients with Hepatocellular Carcinoma
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Few studies have been performed to evaluate the value of the Glissonian approach (GA) for laparoscopic formal hemihepatectomy. The purpose of this study was to compare the outcomes of extrahepatic GA with those of the conventional hilar dissection approach for laparoscopic formal right and left hepatectomies in patients with hepatocellular carcinoma (HCC).
Between January 2015 and October 2017, a total of 95 HCC patients who underwent pure laparoscopic formal hemihepatectomies, of whom 49 underwent the GA, were included in this study. After a 1:1 propensity score matching, 42 laparoscopic GA hepatectomies were compared to 42 conventional approach (CA) hepatectomies. We have analyzed perioperative and oncologic outcomes of the two different operative approaches for HCC treatments.
The GA did not increase the postoperative overall complication rates (P = 0.415) or the mean comprehensive complication index (P = 0.414) when compared with the CA. However, the operative time was significantly shorter (P = 0.006), and intraoperative blood loss was significantly lower (P < 0.001) in the GA group than in the CA group. There were no significant differences between the GA and CA groups regarding 3-year overall survival rate (P = 0.765) or 3-year disease-free survival rate (P = 0.622).
Pure laparoscopic extrahepatic GA hemihepatectomy is safe and feasible, and it was associated with similar complication rates and equivalent 3-year survival outcomes compared to the conventional approach in selected patients with HCC.
KeywordsLaparoscopic hepatectomy Extrahepatic Glissonian approach Hilar dissection approach Hepatocellular carcinoma
We thank LetPub (www.letpub.com) for its linguistic assistance during the preparation of this manuscript.
Fei Liu: designed research/study, performed research/study, collected data, analyzed data, wrote the paper, and edited the manuscript. Yonggang Wei and Kefei Chen: performed research/study, collected data, analyzed data, and reviewed/edited the manuscript. Hongyu Li: collected data, analyzed data, and reviewed/edited the manuscript. Wentao Wang and Hong Wu: designed research/study, acquired data, and reviewed the manuscript. Tianfu Wen and Bo Li: designed research/study, performed research/study, reviewed the manuscript, and revised the manuscript.
This work was supported by the National Natural Science Foundation of China (No. 81602910) and the Fundamental Research Fund for the Central Universities (No. 2017SCU11045).
Compliance with Ethical Standards
The study was approved by the Ethics Committee of West China Hospital of Sichuan University.
Conflict of Interest
The authors declare that they have no conflict of interest.
- 7.Lortat-Jacob JL, Robert HG, Henry C. [Case of right segmental hepatectomy]. Memoires Academie de chirurgie. 1952;78(8–9):244–51.Google Scholar
- 12.Takasaki K, Kobayashi S, Tanaka S. Newly developed systematized hepatectomy by Glissonean pedicle transection method. Shujutsu 1986;40:7–14.Google Scholar
- 27.Guo S, Fraser MW. Propensity Score Analysis: Statistical Methods and Applications. Advanced Quantitative Techniques in the Social Sciences Series. Los Angeles: SAGE Publications, Inc; 2010.Google Scholar
- 33.Liu F, Xu H, Li Q, et al. Outcomes of pure laparoscopic Glissonian pedicle approach hepatectomy for hepatocellular carcinoma: a propensity score matching analysis. Surg Endosc. 2018 Aug 17. doi: https://doi.org/10.1007/s00464-018-6380-0