Davit L Aghayan1,2, Gabriella d'Albenzio3,4, Åsmund A Fretland3,5,6, Egidijus Pelanis3,5, Bård I Røsok6, Sheraz Yaqub5,6, Rafael Palomar3,7, Bjørn Edwin3,5,6. 1. The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway. dr.aghayan@gmail.com. 2. Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia. dr.aghayan@gmail.com. 3. The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway. 4. Department of Informatics, University of Oslo, Oslo, Norway. 5. Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. 6. Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway. 7. Department of Computer Science, Norwegian University of Science and Technology, Gjøvik, Norway.
Abstract
BACKGROUND: Traditionally, patients with large liver tumors (≥ 50 mm) have been considered for anatomic major hepatectomy. Laparoscopic resection of large liver lesions is technically challenging and often performed by surgeons with extensive experience. The current study aimed to evaluate the surgical and oncologic safety of laparoscopic parenchyma-sparing liver resection in patients with large colorectal metastases. METHODS: Patients who primarily underwent laparoscopic parenchyma-sparing liver resection (less than 3 consecutive liver segments) for colorectal liver metastases between 1999 and 2019 at Oslo University Hospital were analyzed. In some recent cases, a computer-assisted surgical planning system was used to better visualize and understand the patients' liver anatomy, as well as a tool to further improve the resection strategy. The surgical and oncologic outcomes of patients with large (≥ 50 mm) and small (< 50 mm) tumors were compared. Multivariable Cox-regression analysis was performed to identify risk factors for survival. RESULTS: In total 587 patients met the inclusion criteria (large tumor group, n = 59; and small tumor group, n = 528). Median tumor size was 60 mm (range, 50-110) in the large tumor group and 21 mm (3-48) in the small tumor group (p < 0.001). Patient age and CEA level were higher in the large tumor group (8.4 μg/L vs. 4.6 μg/L, p < 0.001). Operation time and conversion rate were similar, while median blood loss was higher in the large tumor group (500 ml vs. 200 ml, p < 0.001). Patients in the large tumor group had shorter 5 year overall survival (34% vs 49%, p = 0.027). However, in the multivariable Cox-regression analysis tumor size did not impact survival, unlike parameters such as age, ASA score, CEA level, extrahepatic disease at liver surgery, and positive lymph nodes in the primary tumor. CONCLUSION: Laparoscopic parenchyma-sparing resections for large colorectal liver metastases provide satisfactory short and long-term outcomes.
BACKGROUND: Traditionally, patients with large liver tumors (≥ 50 mm) have been considered for anatomic major hepatectomy. Laparoscopic resection of large liver lesions is technically challenging and often performed by surgeons with extensive experience. The current study aimed to evaluate the surgical and oncologic safety of laparoscopic parenchyma-sparing liver resection in patients with large colorectal metastases. METHODS: Patients who primarily underwent laparoscopic parenchyma-sparing liver resection (less than 3 consecutive liver segments) for colorectal liver metastases between 1999 and 2019 at Oslo University Hospital were analyzed. In some recent cases, a computer-assisted surgical planning system was used to better visualize and understand the patients' liver anatomy, as well as a tool to further improve the resection strategy. The surgical and oncologic outcomes of patients with large (≥ 50 mm) and small (< 50 mm) tumors were compared. Multivariable Cox-regression analysis was performed to identify risk factors for survival. RESULTS: In total 587 patients met the inclusion criteria (large tumor group, n = 59; and small tumor group, n = 528). Median tumor size was 60 mm (range, 50-110) in the large tumor group and 21 mm (3-48) in the small tumor group (p < 0.001). Patient age and CEA level were higher in the large tumor group (8.4 μg/L vs. 4.6 μg/L, p < 0.001). Operation time and conversion rate were similar, while median blood loss was higher in the large tumor group (500 ml vs. 200 ml, p < 0.001). Patients in the large tumor group had shorter 5 year overall survival (34% vs 49%, p = 0.027). However, in the multivariable Cox-regression analysis tumor size did not impact survival, unlike parameters such as age, ASA score, CEA level, extrahepatic disease at liver surgery, and positive lymph nodes in the primary tumor. CONCLUSION: Laparoscopic parenchyma-sparing resections for large colorectal liver metastases provide satisfactory short and long-term outcomes.
Authors: Leonid Barkhatov; Davit L Aghayan; Vincenzo Scuderi; Federica Cipriani; Åsmund A Fretland; Airazat M Kazaryan; Francesca Ratti; Thomas Armstrong; Andrea Belli; Ibrahim Dagher; Giulio Belli; Luca Aldrighetti; Mohammad Abu Hilal; Roberto I Troisi; Bjørn Edwin Journal: Surg Endosc Date: 2021-08-30 Impact factor: 4.584
Authors: Thijs de Rooij; Jony van Hilst; Olivier R Busch; Marcel G Dijkgraaf; David A Kooby; Mohammed Abu Hilal; Marc G Besselink Journal: Ann Surg Date: 2017-12 Impact factor: 12.969
Authors: Giammauro Berardi; Stijn Van Cleven; Åsmund Avdem Fretland; Leonid Barkhatov; Mark Halls; Federica Cipriani; Luca Aldrighetti; Mohammed Abu Hilal; Bjørn Edwin; Roberto I Troisi Journal: J Am Coll Surg Date: 2017-08-31 Impact factor: 6.113