Joseph F Buell1, Brice Gayet2, Ho-Seong Han3, Go Wakabayashi4, Ki-Hun Kim5, Giulio Belli6, Robert Cannon7, Bob Saggi1, Hiro Keneko8, Alan Koffron9, Guy Brock10, Ibrahim Dagher11. 1. Tulane Transplant Institute, Tulane University, New Orleans, LA, USA. 2. Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France. 3. Department of Surgery, Seoul National University, Bundang Hospital, Seoul, South Korea. 4. Department of Surgery, Iwate Medical University, Morioka City, Japan. 5. Department of Surgery, Ulsan University and Asan Medical Center, Seoul, South Korea. 6. Department of Surgery, Loreto Nuovo Hospital, Naples, Italy. 7. Department of Surgery, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA. 8. Department of Surgery, Toho University School of Medicine, Tokyo, Japan. 9. Division of Transplantation, William Beaumont Hospital, Detroit, MI, USA. 10. Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA. 11. Department of General Surgery, Antoine Beclere Hospital, Paris-Sud School of Medicine, Clamart, France.
Abstract
METHODS: An international database of 1499 laparoscopic liver resections was analysed using multivariate and Kaplan-Meier analysis. RESULTS: In total, 764 stapler hepatectomies (SH) were compared with 735 electrosurgical resections (ER). SH was employed in larger tumours (4.5 versus 3.8 cm; P < 0.003) with decreased operative times (2.6 versus 3.1 h; P < 0.001), blood loss (100 versus 200 cc; P < 0.001) and length of stay (3.0 versus 7.0 days; P < 0.001). SH incurred a trend towards higher complications (16% versus 13%; P = 0.057) including bile leaks (26/764, 3.4% versus 16/735, 2.2%: P = 0.091). To address group homogeneity, a subset analysis of lobar resections confirmed the benefits of SH. Kaplan-Meier analysis in non-cirrhotic and cirrhotic patients confirmed equivalent patient (P = 0.290 and 0.118) and disease-free survival (P = 0.120 and 0.268). Multivariate analysis confirmed the parenchymal transection technique did not increase the risk of cancer recurrence, whereas tumour size, the presence of cirrhosis and concomitant operations did. CONCLUSIONS: A SH provides several advantages including: diminished blood loss, transfusion requirements and shorter operative times. In spite of the smaller surgical margins in the SH group, equivalent recurrence and survival rates were observed when matched for parenchyma and extent of resection.
METHODS: An international database of 1499 laparoscopic liver resections was analysed using multivariate and Kaplan-Meier analysis. RESULTS: In total, 764 stapler hepatectomies (SH) were compared with 735 electrosurgical resections (ER). SH was employed in larger tumours (4.5 versus 3.8 cm; P < 0.003) with decreased operative times (2.6 versus 3.1 h; P < 0.001), blood loss (100 versus 200 cc; P < 0.001) and length of stay (3.0 versus 7.0 days; P < 0.001). SH incurred a trend towards higher complications (16% versus 13%; P = 0.057) including bile leaks (26/764, 3.4% versus 16/735, 2.2%: P = 0.091). To address group homogeneity, a subset analysis of lobar resections confirmed the benefits of SH. Kaplan-Meier analysis in non-cirrhotic and cirrhotic patients confirmed equivalent patient (P = 0.290 and 0.118) and disease-free survival (P = 0.120 and 0.268). Multivariate analysis confirmed the parenchymal transection technique did not increase the risk of cancer recurrence, whereas tumour size, the presence of cirrhosis and concomitant operations did. CONCLUSIONS: A SH provides several advantages including: diminished blood loss, transfusion requirements and shorter operative times. In spite of the smaller surgical margins in the SH group, equivalent recurrence and survival rates were observed when matched for parenchyma and extent of resection.
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