Fei Liu1, YongGang Wei2, HongYu Li3, WenTao Wang1, TianFu Wen1, Hong Wu1, JiaYin Yang1, MingQing Xu1, Bo Li4. 1. Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan, China. 2. Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan, China. wyonggang688@163.com. 3. Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China. 4. Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan, China. cdlibo688@163.com.
Abstract
BACKGROUND: LigaSure has been reported as a safe and effective approach for parenchymal transection in open hepatectomy; however, its roles in laparoscopic hepatectomy (LH) with liver cirrhosis have not been evaluated. The aim of this study was to compare the outcomes of LigaSure vs. Cavitron Ultrasonic Surgical Aspirator (CUSA) for LH in hepatocellular carcinoma (HCC) patients with cirrhosis. METHODS: We retrospectively reviewed the medical records of 135 HCC patients with background cirrhosis who underwent pure LH using CUSA (n = 55) or LigaSure (n = 80) for parenchymal transection between January 2015 and May 2017 at West China Hospital of Sichuan University. We performed 1:1 propensity score matching between the LigaSure and CUSA groups. Subsequently, 48 patients were included in each group. RESULTS: The mean parenchymal transection time (74.3 ± 23.6 vs. 86.3 ± 25.8 min, P = 0.019) in the LigaSure group was obviously shorter than that in the CUSA group. The LigaSure did not increase the intraoperative blood loss or blood transfusion requirement when compared with CUSA. Moreover, the degree of postoperative reperfusion injury and complications were not significantly different between the two groups. Furthermore, there were no significant differences between the two groups regarding 2-year overall survival rate or disease-free survival rate. In addition, the total hospitalization costs (P = 0.032) and intraoperative costs (P = 0.006) per case were significantly lower in the LigaSure group than those in the CUSA group. CONCLUSION: The two devices were safe and effective for LH in patients with cirrhosis. The LigaSure method may be a simple, feasible, and cost-effective surgical technique for LH in selected HCC patients with cirrhosis.
BACKGROUND: LigaSure has been reported as a safe and effective approach for parenchymal transection in open hepatectomy; however, its roles in laparoscopic hepatectomy (LH) with liver cirrhosis have not been evaluated. The aim of this study was to compare the outcomes of LigaSure vs. Cavitron Ultrasonic Surgical Aspirator (CUSA) for LH in hepatocellular carcinoma (HCC) patients with cirrhosis. METHODS: We retrospectively reviewed the medical records of 135 HCC patients with background cirrhosis who underwent pure LH using CUSA (n = 55) or LigaSure (n = 80) for parenchymal transection between January 2015 and May 2017 at West China Hospital of Sichuan University. We performed 1:1 propensity score matching between the LigaSure and CUSA groups. Subsequently, 48 patients were included in each group. RESULTS: The mean parenchymal transection time (74.3 ± 23.6 vs. 86.3 ± 25.8 min, P = 0.019) in the LigaSure group was obviously shorter than that in the CUSA group. The LigaSure did not increase the intraoperative blood loss or blood transfusion requirement when compared with CUSA. Moreover, the degree of postoperative reperfusion injury and complications were not significantly different between the two groups. Furthermore, there were no significant differences between the two groups regarding 2-year overall survival rate or disease-free survival rate. In addition, the total hospitalization costs (P = 0.032) and intraoperative costs (P = 0.006) per case were significantly lower in the LigaSure group than those in the CUSA group. CONCLUSION: The two devices were safe and effective for LH in patients with cirrhosis. The LigaSure method may be a simple, feasible, and cost-effective surgical technique for LH in selected HCC patients with cirrhosis.
Authors: Tan To Cheung; Wing Chiu Dai; Simon H Y Tsang; Albert C Y Chan; Kenneth S H Chok; See Ching Chan; Chung Mau Lo Journal: Ann Surg Date: 2016-10 Impact factor: 12.969
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