Mini-Invasive Approach Contributes to Expand the Indication for Liver Resection for Hepatocellular Carcinoma Without Increasing the Incidence of Posthepatectomy Liver Failure and Other Perioperative Complications: A Single-Center Analysis (original) (raw)
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Digestive Medicine Research, 2020
Background Liver resection in cirrhotic patients reported to have higher morbidity and mortality rates compared to non-cirrhotic patients. Recently, there is increased acceptance of laparoscopic approach in liver surgery. However, few reports evaluated laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) in cirrhotic patients. The aim of this study is to evaluate our experience of LLR for HCC and to compare perioperative and long-term outcomes between patients with and without liver cirrhosis (LC). Methods A retrospective analysis of 232 patients who underwent LLR for HCC between 2004 and 2013 was carried out. Patients were divided into two groups according to the pathological status of their liver parenchyma, in terms of presence or absence of LC. Results LC group had 141 patients, and non-LC group had 91 patients. There were no statistically significant differences between both groups regarding operation time, blood loss, transfusion requirements, intraoperative complications, hospital stay, and postoperative complications. Long-term oncologic outcomes were comparable between both groups regarding the recurrence rates (p = 0.067), overall survival (OS) rates (p = 0.908), and disease-free survival (DFS) rates (p = 0.197).
A narrative review of minimally invasive liver resections for hepatocellular carcinoma
2020
Development of laparoscopic liver resection (LLR) LLR was first reported in 1991 (1). Since then, sporadic reports of partial liver resections were published in mid-1990's, followed by reports of left lateral sectionectomies (2,3) in 1996. Due to advancements in surgical techniques and development of equipment for LLR, the procedure was expanded to include hemi-hepatectomies (4,5), followed by left medial, right anterior and posterior sectionectomies (6-8). During this period, two international consensus conferences on LLR (ICCLLR) were convened (9,10). In 2008, the first ICCLLR was held in Louisville (9). Standardized terminologies on LLR were defined and variable techniques for parenchymal transection were introduced, leading to a global spread of LLR. In 2014,
Comparative study and systematic review of laparoscopic liver resection for hepatocellular carcinoma
World journal of hepatology, 2015
To compare the surgical outcomes between laparoscopic liver resection (LLR) and open liver resection (OLR) as a curative treatment in patients with hepatocellular carcinoma (HCC). A PubMed database search was performed systematically to identify comparative studies of LLR vs OLR for HCC from 2000 to 2014. An extensive text word search was conducted, using combinations of search headings such as "laparoscopy", "hepatectomy", and "hepatocellular carcinoma". A comparative study was also performed in our institution where we analysed surgical outcomes of 152 patients who underwent liver resection between January 2005 to December 2012, of which 42 underwent laparoscopic or hand-assisted laparoscopic resection and 110 underwent open resection. Analysis of our own series and a review of 17 high-quality studies showed that LLR was superior to OLR in terms of short-term outcomes, as patients in the laparoscopic arm were found to have less intraoperative blood lo...
Hepatoma Research, 2024
Hepatocellular carcinoma (HCC) is a formidable global health challenge with rising incidence rates and significant morbidity and mortality. As medical technology evolves, laparoscopic liver resection has emerged as a promising alternative to traditional open surgery for HCC treatment. This manuscript provides a comprehensive review of the contemporary perspectives on laparoscopic liver resection for HCC, with a focus on elucidating its potential benefits and inherent limitations. Our review takes a close look at how laparoscopic liver resection is currently being used to treat HCC, considering its application in various stages of the disease, tumor sizes, and locations. Through a systematic analysis of existing studies and clinical trials, we highlight the main benefits of LLR, such as less blood loss, shorter hospital stays, quicker recovery times, and better cosmetic results. This review delves into the oncological safety and outcomes of laparoscopic HCC resection. Despite its promise, laparoscopic liver resection is not without limitations. The manuscript probes into the challenges associated with this approach, such as technical complexity, restricted access to certain tumor locations, and limited surgical field visualization. Furthermore, we address the critical issue of patient selection, as not all HCC patients are suitable candidates for laparoscopic resection, necessitating a personalized and multidisciplinary treatment approach.
Liver resection for hepatocellular carcinoma, are we going to dismiss the traditional approach?
Annals of Laparoscopic and Endoscopic Surgery, 2017
Background: Minimally invasive surgery has recently demonstrated results comparable to traditional surgery for recurrence-free or overall survival, even in cirrhotic patients. Laparoscopic liver resection (LLR) is gaining a central role for the treatment of hepatocellular carcinoma (HCC). The aim of our study is to analyze the evolution of traditional and minimally invasive liver resection for HCC in our Center since 2001. Methods: We divided the cohort into two groups: group 1, patients between 2001 and 2007 and group 2, patients between 2008 and 2015. Since 2001, 429 patients were resected in our department. Results: In group 1, we performed 42 major hepatectomies (25.3%) and 124 minor hepatectomies (74.7%). In group 2, we respectively performed 49 (18.6%) major hepatectomies and 214 (81.4%) minor hepatectomies. In group 1, 3% of patients and 44.5% in group 2 were treated by LLR. We observed an improvement of morbidity between the two groups (P<0.001), and of mortality with 3.6% in group 1 versus no mortality in group 2. Conclusions: The number of LLR has increased since 2001. However, the complexity of HCC resection on patients with cirrhosis seems to leave a place to the traditional approach. In our experience, the traditional surgical approach has still a place for the major resection in patients with HCC.
Minimally Invasive versus Open Liver Resection for Stage I/II Hepatocellular Carcinoma
Cancers
Minimally invasive liver resection (MILR) is increasingly used as a surgical treatment for patients with hepatocellular carcinoma (HCC). However, there is no large scale data to compare the effectiveness of MILR in comparison to open liver resection (OLR). We identified patients with stage I or II HCC from the National Cancer Database using propensity score matching techniques. Overall, 1931 (66%) and 995 (34%) patients underwent OLR or MILR between 2010 and 2015. After propensity matching, 5-year OS was similar in the MILR and OLR group (51.7% vs. 52.8%, p = 0.766). MILR was associated with lower 90-day mortality (5% vs. 7%, p = 0.041) and shorter length of stay (4 days vs. 5 days, p < 0.001), but higher rates of positive margins (6% vs. 4%, p = 0.001). An operation at an academic institution was identified as an independent preventive factor for a positive resection margin (OR 0.64: 95% CI 0.43–0.97) and 90-day mortality (OR 0.61; 95% CI 0.41–0.91). MILR for HCC is associated w...
Liver Surgery for Hepatocellular Carcinoma: Laparoscopic versus Open Approach
International journal of hepatology, 2011
In this study, we try to compare the benefit of laparoscopic versus open operative procedures. Patients and Methods. One hundred and sixteen patients underwent laparoscopic liver resection (LR) and another 208 patients went for open liver resection (OR) for hepatocellular carcinoma (HCC). Patients' selection for open or laparoscopic approach was not randomized. Results. The CLIP score for LR and OR was 0.59 ± 0.75 and 0.86 ± 1.04, respectively, (P = .016). The operation time was 156.3 ± 308.2 and 190.9 ± 79.2 min for LR and OR groups, respectively. The necessity for blood transfusion was found in 8 patients (6.9%) and 106 patients (50.9%) for LR and OR groups. Patients resumed full diet on the 2nd and 3rd postoperative day, and the average length of hospital stay was 6 days and 12 days for LR and OR groups. The complication rate and mortality rate were 0% and 6.0%, 2.9% and 30.2% for LR and OR groups, respectively. The 1-yr, 3-yr, and 5-yr survival rate was 87.0%, 70.4%, 62.2% a...
Liver cancer, 2018
Laparoscopic liver resection has been gaining momentum, and it has become an accepted practice after the two international consensus conferences where experts worked up guidelines to standardize this approach and improve its safety. However, most laparoscopic hepatectomies were performed in patients with liver metastases. The concurrent presence of liver cirrhosis with hepatocellular carcinoma (HCC) poses a great challenge to clinicians trying to establish a routine use of laparoscopic liver resection for HCC. The first Asia Pacific consensus meeting on laparoscopic liver resection for HCC was held in July 2016 in Hong Kong. A group of expert liver surgeons with experience in both open and laparoscopic hepatectomy for HCC convened to formulate recommendations on the role and perspective of laparoscopic liver resection for primary liver cancer. The recommendations consolidate the most recent evidence pertaining to laparoscopic hepatectomy together with the latest thinking of practici...