Salvatore Gruttadauria1, Alessandro Tropea1, Duilio Pagano1, Aurelia Guarini2, Rosa Liotta3, Tian Ling4, Fabio Tuzzolino5, Angelo Luca6, Giovanni Vizzini7, Bruno Gridelli1. 1. 1 Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione) , Palermo, Italy . 2. 2 Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo , Palermo, Italy . 3. 3 Pathology Service, Department of Diagnostic and Therapeutic Services, fIRCCS-ISMETT , Palermo, Italy . 4. 4 School of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania. 5. 5 Office of Research, IRCCS-ISMETT , Palermo, Italy . 6. 6 Radiology Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT , Palermo, Italy . 7. 7 Hepatology Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT , Palermo, Italy .
Abstract
BACKGROUND: Liver resection (LR) for hepatocellular carcinoma (HCC) is the best alternative option for increasing the survival of many patients with intermediate or advanced stages of the Barcelona Clinic Liver Cancer staging classification. Mini-invasive approach may play a positive role in treating a tumor rising almost exclusively in a diseased liver. METHODS: A prospectively collected database was retrospectively reviewed for 167 consecutive patients who underwent LR between 1999 and 2015. RESULTS: A total of 38 LRs were performed from 1999 to 2009 (Period I), and 129 between 2010 and 2015 (Period II). Laparoscopic procedures increased from 5.3% to 38.1%. Not undergoing laparoscopic LR increased length of stay, and Clavien Grade II or worse complications. Ninety-day mortality decreased from 5.2% to 0%, and morbidity did not differ significantly, despite the fact that the most complex patients were in Period II. CONCLUSIONS: Mini-invasive approaches allow to safely expand limits of LR for HCC; in particular, laparoscopic approach favors surgical option even in more complex patients without increase the risk of posthepatic liver failure or other postsurgical complications.
BACKGROUND: Liver resection (LR) for hepatocellular carcinoma (HCC) is the best alternative option for increasing the survival of many patients with intermediate or advanced stages of the Barcelona Clinic Liver Cancer staging classification. Mini-invasive approach may play a positive role in treating a tumor rising almost exclusively in a diseased liver. METHODS: A prospectively collected database was retrospectively reviewed for 167 consecutive patients who underwent LR between 1999 and 2015. RESULTS: A total of 38 LRs were performed from 1999 to 2009 (Period I), and 129 between 2010 and 2015 (Period II). Laparoscopic procedures increased from 5.3% to 38.1%. Not undergoing laparoscopic LR increased length of stay, and Clavien Grade II or worse complications. Ninety-day mortality decreased from 5.2% to 0%, and morbidity did not differ significantly, despite the fact that the most complex patients were in Period II. CONCLUSIONS: Mini-invasive approaches allow to safely expand limits of LR for HCC; in particular, laparoscopic approach favors surgical option even in more complex patients without increase the risk of posthepatic liver failure or other postsurgical complications.
Authors: Giovanni Battista Levi Sandri; Giuseppe Maria Ettorre; Luca Aldrighetti; Umberto Cillo; Raffaele Dalla Valle; Alfredo Guglielmi; Vincenzo Mazzaferro; Alessandro Ferrero; Fabrizio Di Benedetto; Salvatore Gruttadauria; Luciano De Carlis; Giovanni Vennarecci Journal: Surg Endosc Date: 2018-09-10 Impact factor: 4.584
Authors: Mohammad Golriz; Omid Ghamarnejad; Elias Khajeh; Mohammadsadegh Sabagh; Markus Mieth; Katrin Hoffmann; Alexis Ulrich; Thilo Hackert; Karl Heinz Weiss; Peter Schirmacher; Markus W Büchler; Arianeb Mehrabi Journal: Can J Gastroenterol Hepatol Date: 2018-11-01