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Laparoscopic Parenchymal-Sparing Hepatectomy: the New Maximally Minimal Invasive Surgery of the Liver—a Systematic Review and Meta-Analysis

  • Review Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Parenchymal-sparing hepatectomies (PSH) are liver resections with preservation of as much liver parenchyma as possible. PSH can be performed laparoscopically (LPSH), but access to the posterosuperior segments is difficult and they are challenging when there are multiple bilobar lesions; the procedure may require repositioning and may be long and cumbersome. The objective of this systematic review is to analyze the feasibility and limitations of laparoscopic PSH in the literature.

Methods

A systematic review of the literature was performed by searching Medline/PubMed, Scopus, and Cochrane databases. Resections were categorized by segment(s), and data regarding operative time, blood loss, length of hospital stay, complications, and R0 resection were analyzed.

Results

Of 351 studies screened for relevance, 48 studies were reviewed. Ten publications fulfilled inclusion criteria, reporting data from 579 patients undergoing LPSH. The most common indication was CRLM (58%) followed by hepatocellular carcinoma (16%). Only 92 patients were reported to have resections of more than one tumor; the maximum number of lesions resected was seven. Of resected lesions, 21.5% were located in the cranial segments. Mean operating time was 335.2 min, estimated blood loss was 462 cc, and hospital stay was 7.6 days. Conversion rate was 9.7%, and complications occurred in 19.4% of cases. No perioperative mortality was reported. R0 resections were achieved in 87.7% of cases.

Conclusion

Laparoscopic PSH is performed and reported, but the data quality is low so far. The main limitation of LPSH is the low number of lesions resected, especially for bilobar, metastatic disease. Prospective reports with tumor-specific oncological data are desirable.

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Acknowledgements

The authors thank Jennifer Westrick, reference librarian, in assisting with the search terms and search process.

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Authors and Affiliations

  1. Department of Surgery – Transplant Surgery, Rush University Medical Center, 1653 W. Congress Pkwy, Jelke Building 7th floor, Chicago, IL, 60612, USA

    Jennifer A. Kalil, Jennifer Poirier, Xavier Keutgen & Erik Schadde

  2. Department of Gastroenterology, Cantonal Hospital Winterthur, Brauerstr. 15, 8401, Winterthur, Switzerland

    Bjoern Becker

  3. Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands

    Robert Van Dam

  4. Department of Surgery, Cantonal Hospital Winterthur, Brauerstr. 15, 8401, Winterthur, Switzerland

    Erik Schadde

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  1. Jennifer A. Kalil
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Correspondence to Erik Schadde.

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Kalil, J.A., Poirier, J., Becker, B. et al. Laparoscopic Parenchymal-Sparing Hepatectomy: the New Maximally Minimal Invasive Surgery of the Liver—a Systematic Review and Meta-Analysis. J Gastrointest Surg 23, 860–869 (2019). https://doi.org/10.1007/s11605-019-04128-w

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  • DOI: https://doi.org/10.1007/s11605-019-04128-w

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