Daniel Pietrasz1, David Fuks2, Daren Subar2,3, Gianfranco Donatelli2, Carlotta Ferretti2, Christian Lamer4, Luca Portigliotti2, Marc Ward2, Jane Cowan2, Takeo Nomi2, Marc Beaussier5, Brice Gayet2. 1. Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France. daniel.pietrasz@aphp.fr. 2. Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France. 3. Department of General and HPB Surgery, Royal Blackburn Hospital, Haslingden Road, Lancashire, BB2 3HH, UK. 4. Department of Intensive Care Unit - Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France. 5. Department of Anesthesiology - Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France.
Abstract
BACKGROUND: Although laparoscopic major hepatectomy (LMH) is becoming increasingly common in specialized centers, data regarding laparoscopic extended major hepatectomies (LEMH) and their outcomes are limited. The aim of this study was to compare the perioperative characteristics and postoperative outcomes of LEMH to standard LMH. METHODS: All patients who underwent purely laparoscopic anatomical right or left hepatectomy and right or left trisectionectomy between February 1998 and January 2016 are enrolled. Demographic, clinicopathological, and perioperative factors were collected prospectively and analyzed retrospectively. Perioperative characteristics and postoperative outcomes in LEMH were compared to those of standard LMH. RESULTS: Among 195 patients with LMH, 47 (24.1%) underwent LEMH, colorectal liver metastases representing 66.7% of all indications. Preoperative portal vein embolization was undertaken in 31 (15.9%) patients. Despite more frequent vascular clamping, blood loss was higher in LEMH group (400 vs. 214 ml; p = 0.006). However, there was no difference in intraoperative transfusion requirements. Thirty-one patients experienced liver failure with no differences between LMH and LEMH groups. Postoperative mortality was comparable in the two groups [3 (2.5%) LMH patients vs. 2 (5%) LEMH patients (p = 0.388)]. Overall morbidity was higher in the LEMH group [49 LMH patients (41.5%) vs. 24 LEMH patients (60%) (p = 0.052)]. Patients treated with left LEMH experienced more biliary leakage (p = 0.011) and more major pulmonary complications (p = 0.015) than left LMH. CONCLUSION: LEMH is feasible at the price of important morbidity, with manageable and acceptable outcomes. These exigent procedures require high-volume centers with experienced surgeons.
BACKGROUND: Although laparoscopic major hepatectomy (LMH) is becoming increasingly common in specialized centers, data regarding laparoscopic extended major hepatectomies (LEMH) and their outcomes are limited. The aim of this study was to compare the perioperative characteristics and postoperative outcomes of LEMH to standard LMH. METHODS: All patients who underwent purely laparoscopic anatomical right or left hepatectomy and right or left trisectionectomy between February 1998 and January 2016 are enrolled. Demographic, clinicopathological, and perioperative factors were collected prospectively and analyzed retrospectively. Perioperative characteristics and postoperative outcomes in LEMH were compared to those of standard LMH. RESULTS: Among 195 patients with LMH, 47 (24.1%) underwent LEMH, colorectal liver metastases representing 66.7% of all indications. Preoperative portal vein embolization was undertaken in 31 (15.9%) patients. Despite more frequent vascular clamping, blood loss was higher in LEMH group (400 vs. 214 ml; p = 0.006). However, there was no difference in intraoperative transfusion requirements. Thirty-one patients experienced liver failure with no differences between LMH and LEMH groups. Postoperative mortality was comparable in the two groups [3 (2.5%) LMHpatients vs. 2 (5%) LEMHpatients (p = 0.388)]. Overall morbidity was higher in the LEMH group [49 LMHpatients (41.5%) vs. 24 LEMHpatients (60%) (p = 0.052)]. Patients treated with left LEMH experienced more biliary leakage (p = 0.011) and more major pulmonary complications (p = 0.015) than left LMH. CONCLUSION:LEMH is feasible at the price of important morbidity, with manageable and acceptable outcomes. These exigent procedures require high-volume centers with experienced surgeons.
Authors: Ibrahim Dagher; Brice Gayet; Dimitrios Tzanis; Hadrien Tranchart; David Fuks; Olivier Soubrane; Ho-Seong Han; Ki-Hun Kim; Daniel Cherqui; Nicholas O'Rourke; Roberto I Troisi; Luca Aldrighetti; Edwin Bjorn; Mohammed Abu Hilal; Giulio Belli; Hironori Kaneko; William R Jarnagin; Charles Lin; Juan Pekolj; Joseph F Buell; Go Wakabayashi Journal: J Hepatobiliary Pancreat Sci Date: 2014-08-06 Impact factor: 7.027
Authors: Hauke Lang; Georgios C Sotiropoulos; Eirini I Brokalaki; Arnold Radtke; Andrea Frilling; Ernesto P Molmenti; Massimo Malagó; Christoph E Broelsch Journal: J Am Coll Surg Date: 2006-07-13 Impact factor: 6.113
Authors: Hideki Nishio; Ernest Hidalgo; Zaed Z R Hamady; Kadiyala V Ravindra; Anil Kotru; Dowmitra Dasgupta; Ahmed Al-Mukhtar; K Rajendra Prasad; Giles J Toogood; J Peter A Lodge Journal: Ann Surg Date: 2005-08 Impact factor: 12.969
Authors: Mohammad Abu Hilal; Luca Aldrighetti; Ibrahim Dagher; Bjorn Edwin; Roberto Ivan Troisi; Ruslan Alikhanov; Somaiah Aroori; Giulio Belli; Marc Besselink; Javier Briceno; Brice Gayet; Mathieu D'Hondt; Mickael Lesurtel; Krishna Menon; Peter Lodge; Fernando Rotellar; Julio Santoyo; Olivier Scatton; Olivier Soubrane; Robert Sutcliffe; Ronald Van Dam; Steve White; Mark Christopher Halls; Federica Cipriani; Marcel Van der Poel; Ruben Ciria; Leonid Barkhatov; Yrene Gomez-Luque; Sira Ocana-Garcia; Andrew Cook; Joseph Buell; Pierre-Alain Clavien; Christos Dervenis; Giuseppe Fusai; David Geller; Hauke Lang; John Primrose; Mark Taylor; Thomas Van Gulik; Go Wakabayashi; Horacio Asbun; Daniel Cherqui Journal: Ann Surg Date: 2018-07 Impact factor: 12.969
Authors: Joseph F Buell; Daniel Cherqui; David A Geller; Nicholas O'Rourke; David Iannitti; Ibrahim Dagher; Alan J Koffron; Mark Thomas; Brice Gayet; Ho Seong Han; Go Wakabayashi; Giulio Belli; Hironori Kaneko; Chen-Guo Ker; Olivier Scatton; Alexis Laurent; Eddie K Abdalla; Prosanto Chaudhury; Erik Dutson; Clark Gamblin; Michael D'Angelica; David Nagorney; Giuliano Testa; Daniel Labow; Derrik Manas; Ronnie T Poon; Heidi Nelson; Robert Martin; Bryan Clary; Wright C Pinson; John Martinie; Jean-Nicolas Vauthey; Robert Goldstein; Sasan Roayaie; David Barlet; Joseph Espat; Michael Abecassis; Myrddin Rees; Yuman Fong; Kelly M McMasters; Christoph Broelsch; Ron Busuttil; Jacques Belghiti; Steven Strasberg; Ravi S Chari Journal: Ann Surg Date: 2009-11 Impact factor: 12.969
Authors: Daniel Heise; Jan Bednarsch; Andreas Kroh; Sandra Schipper; Roman Eickhoff; Marielle Coolsen; Ronald Van Dam; Sven Lang; Ulf Neumann; Florian Ulmer Journal: World J Gastrointest Surg Date: 2021-01-27
Authors: Daniel Heise; Jan Bednarsch; Andreas Kroh; Sandra Schipper; Roman Eickhoff; Sven Lang; Ulf Neumann; Florian Ulmer Journal: Surg Innov Date: 2021-02-10 Impact factor: 2.058