Feasibility of Laparoscopic Right Posterior Sectionectomy for Malignant Lesion Compared to Open Right Posterior Sectionectomy: Retrospective, Single Center Study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Purpose

We aimed to compare the operative outcomes of laparoscopic right posterior sectionectomy (RPS) and open RPS and evaluate the feasibility of laparoscopic RPS.

Methods

From January 2009 to December 2017, laparoscopic liver resections were performed in 235 patients at Chonnam National University Hwasun Hospital, South Korea. We retrospectively analyzed the clinical data of 16 patients who underwent laparoscopic RPS and compared the outcomes with those who underwent open RPS (n=17).

Results

The laparoscopic group had a mean tumor size of 3.82±1.73 cm (open group [OG]; 4.18±2.07 cm, p=0.596), mean tumor-free margin of 10.44±9.69 mm (OG; 10.06±10.62 mm, p=0.657), mean operation time of 412.2±102.2 min (OG; 275.0±60.5, p<0.001), mean estimated blood loss of 339.4±248.3 ml (OG; 236.4±102.7 ml, p=0.631), mean postoperative hospital stay of 11.63±2.58 days (OG; 14.71±4.69 days, p=0.027), and mean postoperative peaks of aspartate aminotransferase, alanine aminotransferase, total bilirubin, and prothrombin time of 545 mg/dl, 538 mg/dl, 1.39 mg/dl, 1.41 international normalized ratio (OG; 237 ( p<0.001), 216 ( p<0.001), 1.52 ( p=0.817), and 1.45 ( p=0.468)), respectively. There were no deaths or major complications in ether group. There were no cases of open conversion. Laparoscopic RPS was associated with a shorter hospital stay, prolonged operation time and lower complication rate. With long-term prognosis, no difference was found in overall survival rate and disease-free survival rate between the two groups.

Conclusion

Laparoscopic RPS can be performed, but the problems of long operative time and decrease in liver function should be resolved.

Related collections

Most cited references 16

Record: found
Abstract: found
Article: not found

The international position on laparoscopic liver surgery: The Louisville Statement, 2008.

Heidi D. Nelson, Robert Goldstein, C Pinson … (2009)

To summarize the current world position on laparoscopic liver surgery. Multiple series have reported on the safety and efficacy of laparoscopic liver surgery. Small and medium sized procedures have become commonplace in many centers, while major laparoscopic liver resections have been performed with efficacy and safety equaling open surgery in highly specialized centers. Although the field has begun to expand rapidly, no consensus meeting has been convened to discuss the evolving field of laparoscopic liver surgery. On November 7 to 8, 2008, 45 experts in hepatobiliary surgery were invited to participate in a consensus conference convened in Louisville, KY, US. In addition, over 300 attendees were present from 5 continents. The conference was divided into sessions, with 2 moderators assigned to each, so as to stimulate discussion and highlight controversies. The format of the meeting varied from formal presentation of experiential data to expert opinion debates. Written and video records of the presentations were produced. Specific areas of discussion included indications for surgery, patient selection, surgical techniques, complications, patient safety, and surgeon training. The consensus conference used the terms pure laparoscopy, hand-assisted laparoscopy, and the hybrid technique to define laparoscopic liver procedures. Currently acceptable indications for laparoscopic liver resection are patients with solitary lesions, 5 cm or less, located in liver segments 2 to 6. The laparoscopic approach to left lateral sectionectomy should be considered standard practice. Although all types of liver resection can be performed laparoscopically, major liver resections (eg, right or left hepatectomies) should be reserved for experienced surgeons facile with more advanced laparoscopic hepatic resections. Conversion should be performed for difficult resections requiring extended operating times, and for patient safety, and should be considered prudent surgical practice rather than failure. In emergent situations, efforts should be made to control bleeding before converting to a formal open approach. Utilization of a hand assist or hybrid technique may be faster, safer, and more efficacious. Indications for surgery for benign hepatic lesions should not be widened simply because the surgery can be done laparoscopically. Although data presented on colorectal metastases did not reveal an adverse effect of the laparoscopic approach on oncological outcomes in terms of margins or survival, adequacy of margins and ability to detect occult lesions are concerns. The pure laparoscopic technique of left lateral sectionectomy was used for adult to child donation while the hybrid approach has been the only one reported to date in the case of adult to adult right lobe donation. Laparoscopic liver surgery has not been tested by controlled trials for efficacy or safety. A prospective randomized trial appears to be logistically prohibitive; however, an international registry should be initiated to document the role and safety of laparoscopic liver resection. Laparoscopic liver surgery is a safe and effective approach to the management of surgical liver disease in the hands of trained surgeons with experience in hepatobiliary and laparoscopic surgery. National and international societies, as well as governing boards, should become involved in the goal of establishing training standards and credentialing, to ensure consistent standards and clinical outcomes.

0 comments Cited 96 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Laparoscopic versus open hepatic resections for benign and malignant neoplasms--a meta-analysis.

Ara Darzi, P P Tekkis, Richard Lovegrove … (2007)

Laparoscopic surgery for hepatic neoplasms aims to provide curative resection while minimizing complications. The present study compared laparoscopic versus open surgery for patients with hepatic neoplasms with regard to short-term outcomes. Comparative studies published between 1998 and 2005 were included. Evaluated endpoints were operative, functional, and adverse events. A random-effects model was used and sensitivity analysis performed to account for bias in patient selection. Eight nonrandomized studies were included, reporting on 409 resections of hepatic neoplasms, of which 165 (40.3%) were laparoscopic and 244 (59.7%) were open. Operative blood loss (weighted mean difference = -123 mL; confidence interval = -179, -67 mL) and duration of hospital stay (weighted mean difference = -2.6 days; confidence interval = -3.8, -1.4 days) were significantly reduced after laparoscopic surgery. These findings remained consistent when considering studies matched for the presence of malignancy and segment resection. There was no difference in postoperative adverse events and extent of oncologic clearance. Laparoscopic resection results in reduced operative blood loss and earlier recovery with oncologic clearance comparable with open surgery. When performed by experienced surgeons in selected patients it may be a safe and feasible option. Because of the potential of significant bias arising from the included studies, further randomized controlled trials should be undertaken to confirm this bias and to assess long-term survival rates.

0 comments Cited 60 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Laparoscopic liver resection of hepatocellular carcinoma.

Hironori Kaneko, Akira Tamura, S Takagi … (2005)

We have continued to develop laparoscopic hepatectomy as a means of surgical therapy for hepatocellular carcinoma (HCC). We evaluated the degree of invasiveness and analyzed the outcomes of laparoscopic hepatectomy compared with open hepatectomy for HCC. There were notable differences with respect to blood loss and operating time compared with open hepatectomy cases. Patients started walking and eating significantly earlier in the laparoscopic hepatectomy group, and these more rapid recoveries allowed shorter hospitalizations. On the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system, there was no difference in preoperative risk. However, a significant difference was seen in the surgical stress and comprehensive risk scores between the open hepatectomy and laparoscopic hepatectomy groups. Concerning the survival rate and disease-free survival rate, there were no significant differences between procedures. Laparoscopic hepatectomy avoids some of the disadvantages of open hepatectomy and is beneficial for patient quality of life (QOL) as a minimally invasive procedure if the operative indications are appropriately based on preoperative liver function and the location and size of HCC.

0 comments Cited 44 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): J Minim Invasive Surg

Journal ID (iso-abbrev): J Minim Invasive Surg

Journal ID (publisher-id): J Minim Invasive Surg

Title: Journal of Minimally Invasive Surgery

Publisher: The Korean Society of Endoscopic and Laparoscopic Surgeons

ISSN (Print): 2234-778X

ISSN (Electronic): 2234-5248

Publication date (Print): 15 June 2020

Publication date (Electronic): 15 June 2020

Volume: 23

Issue: 2

Pages: 74-79

Affiliations

[1 ]Department of Surgery, Chonnam National University Hospital, Gwangju, Korea

[2 ]Division of Hepatobiliary Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea

[3 ]Division of Hepatobiliary Surgery, Department of Surgery, Chonnam National University Hospital, Gwangju, Korea

Author notes

Corresponding author Yang Seok Koh Division of Hepatobiliary Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun 58128, Korea Tel: +82-62-220-6456 Fax: +82-62-220-6456 E-mail: bleocrj@ 123456hanmail.net ORCID: https://orcid.org/0000-0002-0368-5389

Author information

Eui Sung Jeong https://orcid.org/0000-0003-4020-9311

Yang Seok Koh https://orcid.org/0000-0002-0368-5389

Chol Kyoon Cho https://orcid.org/0000-0001-8457-7314

Hee Joon Kim https://orcid.org/0000-0002-8636-5726

Eun Kyu Park https://orcid.org/0000-0001-7242-4855

Article

Publisher ID: JMIS-23-2-074

DOI: 10.7602/jmis.2020.23.2.74

PMC ID: 8985648

SO-VID: 71098cf4-73f5-42b0-bc0e-d91935f7f9e8

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 04 September 2019

Date revision received : 17 October 2019

Date accepted : 04 November 2019

Feasibility of Laparoscopic Right Posterior Sectionectomy for Malignant Lesion Compared to Open Right Posterior Sectionectomy: Retrospective, Single Center Study

Read this article at

Abstract

Purpose

Methods

Results

Conclusion

Related collections

Nanopublications (single, attributable and machine-readable assertions in scientific literature)

Most cited references 16

The international position on laparoscopic liver surgery: The Louisville Statement, 2008.

Laparoscopic versus open hepatic resections for benign and malignant neoplasms--a meta-analysis.

Laparoscopic liver resection of hepatocellular carcinoma.

Author and article information

Journal

Affiliations

Author notes

Author information

Article

History

Categories

Comments

Comment on this article

Similar content 110

Most referenced authors 253