Burak Görgec1, Amal Suhool2, Ra'ed Al-Jarrah2, Martina Fontana3, Nadeem A Tehami4, Sachin Modi5, Mohammad Abu Hilal6. 1. Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, SO16 2YD, Southampton, UK; Department of Surgery, Fondazione Poliambulanza, Istituto Ospedaliero, Via Bissolati 57, Brescia, Italy. 2. Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, SO16 2YD, Southampton, UK. 3. Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, SO16 2YD, Southampton, UK; Department of Surgery, University Hospital of Verona, Piazzale Aristide Stefani 1, Verona, Italy. 4. Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Tremona Road, SO16 2YD, Southampton, UK. 5. Department of Radiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, SO16 2YD, Southampton, UK. 6. Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, SO16 2YD, Southampton, UK; Department of Surgery, Fondazione Poliambulanza, Istituto Ospedaliero, Via Bissolati 57, Brescia, Italy. Electronic address: abuhilal9@gmail.com.
Abstract
BACKGROUND: The use of the laparoscopic approach in one-stage or second-step of two-stage right hemihepatectomy (RHH) after portal vein embolization (PVE) in patients with initially unresectable colorectal liver metastases (CRLMs) is technically demanding. Currently, there is limited published data regarding the technique and results required to better understand its safety and feasibility. This paper reports our experience, results, techniques and variety of tips and tricks (highlighted in the attached video), to facilitate this resection. METHODS: A prospectively maintained database of laparoscopic liver surgery within our unit at a tertiary referral centre between August 2003 and March 2019 was reviewed. Patients with initially unresectable CRLMs who underwent laparoscopic RHH or extended RHH after PVE in the context of a one or two-stage procedure were included. RESULTS: Between August 2003 and March 2019, 19 patients with initially unresectable CRLMs underwent laparoscopic RHH after PVE. Twelve patients (63.2%) had RHH in the context of a two-stage hepatectomy and 7 as a one-stage procedure. Median time interval between PVE and surgery was 42.5 days (IQR, 34.5-60.0 days). Mean operating time was 351.8 ± 80.5 minutes. Median blood loss was 850 mL (IQR, 475-1350 mL). Conversion to open surgery occurred in 2 of 19 cases (10.5%). Severe postoperative morbidity occurred in 2 patients. The mortality rate was 5.3%. Median postoperative hospital stay was 5 days (IQR, 4-7 days). Radical resection was obtained in eighteen patients (94.7%). CONCLUSION: Laparoscopic RHH after PVE in the context of a one- or two-stage resection in patients with initially unresectable CRLMs is a safe and feasible procedure with favourable oncological outcomes.
BACKGROUND: The use of the laparoscopic approach in one-stage or second-step of two-stage right hemihepatectomy (RHH) after portal vein embolization (PVE) in patients with initially unresectable colorectal liver metastases (CRLMs) is technically demanding. Currently, there is limited published data regarding the technique and results required to better understand its safety and feasibility. This paper reports our experience, results, techniques and variety of tips and tricks (highlighted in the attached video), to facilitate this resection. METHODS: A prospectively maintained database of laparoscopic liver surgery within our unit at a tertiary referral centre between August 2003 and March 2019 was reviewed. Patients with initially unresectable CRLMs who underwent laparoscopic RHH or extended RHH after PVE in the context of a one or two-stage procedure were included. RESULTS: Between August 2003 and March 2019, 19patients with initially unresectable CRLMs underwent laparoscopic RHH after PVE. Twelve patients (63.2%) had RHH in the context of a two-stage hepatectomy and 7 as a one-stage procedure. Median time interval between PVE and surgery was 42.5 days (IQR, 34.5-60.0 days). Mean operating time was 351.8 ± 80.5 minutes. Median blood loss was 850 mL (IQR, 475-1350 mL). Conversion to open surgery occurred in 2 of 19 cases (10.5%). Severe postoperative morbidity occurred in 2 patients. The mortality rate was 5.3%. Median postoperative hospital stay was 5 days (IQR, 4-7 days). Radical resection was obtained in eighteen patients (94.7%). CONCLUSION: Laparoscopic RHH after PVE in the context of a one- or two-stage resection in patients with initially unresectable CRLMs is a safe and feasible procedure with favourable oncological outcomes.