Giada Pattaro1,2,3, David Fuks4,5, Hadrien Tranchart1,3, Giuseppe Maria Ettorre2, Amal Suhool1, Christophe Bourdeaux1, Panagiotis Lainas1,3, Ibrahim Dagher1,3, Brice Gayet1,3. 1. Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France. 2. Department of General Surgery and Tansplantation, Polo Ospedaliero Interaziendale Trapianti "San Camillo-Forlanini" IRCSS-INMI "L. Spallanzani", Rome, Italy. 3. Department of Minimally Invasive Digestive Surgery, Hôpital Antoine Béclère, Université Paris Sud, Paris, France. 4. Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France. david.fuks@imm.fr. 5. Department of Minimally Invasive Digestive Surgery, Hôpital Antoine Béclère, Université Paris Sud, Paris, France. david.fuks@imm.fr.
Abstract
INTRODUCTION: The aim of this study was to analyse the outcomes of laparoscopic anatomic hepatectomies of the left liver segments. METHODS: This is a retrospective multicentre study including all patients operated on laparoscopically divided into unisegmentectomy of 2, 3 or 4 (Group 1), left lobectomy (or left lateral sectionectomy LLS) (Group 2), left hepatectomy (Group 3) and extended left hepatectomy (Group 4) between 2000 and 2016. These four groups were compared in terms of demographics, intraoperative data and postoperative outcomes. RESULTS: Among the 190 selected patients, the groups 1, 2, 3, 4 included 25 (13.2%), 116 (61.0%), 27 (14.2%) and 22 (11.6%) patients, respectively. The cohorts were comparable except for the number of lesions (p = 0.001) and tumour diameter (p = 0.004). The operative time, blood loss and the use of vascular clamping were more frequent in the Groups 3 and 4 (p = 0.0001), as is the rate of conversion to laparotomy (p = 0.001). Total morbidity was 23.3%, and major complications were more frequent in Group 4 (p = 0.0001). The prevalence of hepatic complications (11.6%), intra-abdominal collections (7.4%) and respiratory complications (3.7%) was proportionally correlated to the hepatectomy extension (p = 0.0001). CONCLUSION: All laparoscopic left liver resections seem safe and feasible even though extended hepatectomy is associated with a significant morbidity.
INTRODUCTION: The aim of this study was to analyse the outcomes of laparoscopic anatomic hepatectomies of the left liver segments. METHODS: This is a retrospective multicentre study including all patients operated on laparoscopically divided into unisegmentectomy of 2, 3 or 4 (Group 1), left lobectomy (or left lateral sectionectomy LLS) (Group 2), left hepatectomy (Group 3) and extended left hepatectomy (Group 4) between 2000 and 2016. These four groups were compared in terms of demographics, intraoperative data and postoperative outcomes. RESULTS: Among the 190 selected patients, the groups 1, 2, 3, 4 included 25 (13.2%), 116 (61.0%), 27 (14.2%) and 22 (11.6%) patients, respectively. The cohorts were comparable except for the number of lesions (p = 0.001) and tumour diameter (p = 0.004). The operative time, blood loss and the use of vascular clamping were more frequent in the Groups 3 and 4 (p = 0.0001), as is the rate of conversion to laparotomy (p = 0.001). Total morbidity was 23.3%, and major complications were more frequent in Group 4 (p = 0.0001). The prevalence of hepatic complications (11.6%), intra-abdominal collections (7.4%) and respiratory complications (3.7%) was proportionally correlated to the hepatectomy extension (p = 0.0001). CONCLUSION: All laparoscopic left liver resections seem safe and feasible even though extended hepatectomy is associated with a significant morbidity.
Entities:
Keywords:
Laparoscopic liver resection; Left hepatectomy; Postoperative outcomes
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