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1
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Vogel A, Chan SL, Dawson LA, Kelley RK, Llovet JM, Meyer T, Ricke J, Rimassa L, Sapisochin G, Vilgrain V, Zucman-Rossi J, Ducreux M. Hepatocellular carcinoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2025; 36:491-506. [PMID: 39986353 DOI: 10.1016/j.annonc.2025.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 02/10/2025] [Accepted: 02/11/2025] [Indexed: 02/24/2025] Open
Affiliation(s)
- A Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Division of Hepatology, Toronto General Hospital, Toronto, Canada; Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - S L Chan
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - L A Dawson
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - R K Kelley
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
| | - J M Llovet
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, USA; Liver Cancer Translational Research Group, Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - T Meyer
- Department of Oncology, Royal Free Hospital, London, UK; UCL Cancer Institute, University College London, London, UK
| | - J Ricke
- Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität München, Munich, Germany
| | - L Rimassa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - G Sapisochin
- Department of Surgery, University of Toronto, Toronto, Canada
| | - V Vilgrain
- Centre de Recherche sur l'Inflammation U 1149, Université Paris Cité, Paris, France; Department of Radiology, Beaujon Hospital, APHP Nord, Clichy, France
| | - J Zucman-Rossi
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
| | - M Ducreux
- INSERM U1279, Université Paris-Saclay, Villejuif, France; Department of Cancer Medicine, Gustave Roussy, Villejuif, France
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Choi WJ, Ivanics T, Rajendran L, Li Z, Gavira F, Jones O, Gravely A, Claasen M, Yoon PD, Ladak F, Rana M, Gotlieb N, Dini Y, Naccarato K, McCluskey S, Ferreira R, Msallak H, Chow J, Abreu P, Rabindranath M, Selvanathan C, Muaddi H, Magyar CTJ, Englesakis M, Beecroft R, Vogel A, O'Kane G, Hansen B, Sapisochin G. Comparative analysis of treatment modalities for solitary, small (≤3 cm) hepatocellular carcinoma: A systematic review and network meta-analysis of oncologic outcomes. Surgery 2025; 180:108917. [PMID: 39609218 DOI: 10.1016/j.surg.2024.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 10/15/2024] [Accepted: 10/17/2024] [Indexed: 11/30/2024]
Abstract
BACKGROUND Solitary hepatocellular carcinoma measuring ≤3 cm represents approximately 30% of hepatocellular carcinoma cases, yet treatment guidelines lack robust evidence. This study compares oncologic outcomes after ablation, liver resection, and liver transplantation for solitary, small hepatocellular carcinoma. METHODS We systematically searched databases up to 7 February 2022, for studies including adults with solitary hepatocellular carcinoma ≤3 cm treated by any ablation, liver resection, or liver transplantation. We excluded non-hepatocellular carcinoma cancers, recurrent/metastatic diseases, and alternative therapies. A frequentist network meta-analysis assessed 5-year overall survival and recurrence-free survival using only adjusted effect estimates while accounting for bias risk. RESULTS We identified 80 studies (4 randomized controlled trials, 72 retrospectives, and 4 prospective cohorts) with 28,211 patients. In the network meta-analysis for 5-year overall survival (26 studies), liver transplantation was associated with the lowest mortality hazard (hazard ratio, 0.47; 95% confidence interval, 0.31-0.73, referenced to liver resection), followed by liver resection (reference), whereas ablation had the greatest mortality hazard (hazard ratio, 1.32; 95% confidence interval, 1.16-1.49, referenced to liver resection). For 5-year recurrence-free survival (19 studies), liver transplantation had the best outcome (hazard ratio, 0.36; 95% confidence interval, 0.20-0.63, referenced to liver transplantation), followed by liver resection (reference), with ablation showing the least favorable outcome (hazard ratio, 1.67; 95% confidence interval, 1.45-1.93, referenced to liver resection). CONCLUSIONS This network meta-analysis provides the evidence for comparing treatment modality outcomes for solitary, small (≤3 cm) hepatocellular carcinoma. LT emerges as the superior choice for achieving a better 5-year OS, followed by liver resection, then ablation. When feasible to preserve liver function, liver resection can be prioritized. Ablation with close surveillance should be reserved for individuals unfit for surgery.
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Affiliation(s)
- Woo Jin Choi
- Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; University Health Network, HPB Oncology Research, Toronto, ON, Canada. https://twitter.com/WJChoiMD
| | - Tommy Ivanics
- University Health Network, HPB Oncology Research, Toronto, ON, Canada; Department of Surgery, Henry Ford Hospital, Detroit, MI; Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden. https://twitter.com/invanics_t
| | - Luckshi Rajendran
- Department of Surgery, University of Toronto, Toronto, ON, Canada; University Health Network, HPB Oncology Research, Toronto, ON, Canada
| | - Zhihao Li
- University Health Network, HPB Oncology Research, Toronto, ON, Canada
| | - Felipe Gavira
- University Health Network, HPB Oncology Research, Toronto, ON, Canada
| | - Owen Jones
- University Health Network, HPB Oncology Research, Toronto, ON, Canada
| | - Annabel Gravely
- University Health Network, HPB Oncology Research, Toronto, ON, Canada
| | - Marco Claasen
- University Health Network, HPB Oncology Research, Toronto, ON, Canada; Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Farah Ladak
- University Health Network, HPB Oncology Research, Toronto, ON, Canada
| | - Mehwish Rana
- University Health Network, HPB Oncology Research, Toronto, ON, Canada
| | - Neta Gotlieb
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Yasmin Dini
- University Health Network, HPB Oncology Research, Toronto, ON, Canada
| | - Katia Naccarato
- University Health Network, HPB Oncology Research, Toronto, ON, Canada
| | - Sydney McCluskey
- University Health Network, HPB Oncology Research, Toronto, ON, Canada
| | | | - Haythem Msallak
- Department of Surgery, University of Toronto, Toronto, ON, Canada; University Health Network, HPB Oncology Research, Toronto, ON, Canada
| | - James Chow
- University Health Network, HPB Oncology Research, Toronto, ON, Canada
| | - Phillipe Abreu
- University Health Network, HPB Oncology Research, Toronto, ON, Canada
| | | | | | - Hala Muaddi
- Department of Surgery, University of Toronto, Toronto, ON, Canada; University Health Network, HPB Oncology Research, Toronto, ON, Canada; Department of Surgery, Mayo Clinic Rochester, Rochester, MN
| | - Christian T J Magyar
- University Health Network, HPB Oncology Research, Toronto, ON, Canada; Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Rob Beecroft
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Arndt Vogel
- Division of Gastroenterology and Hepatology, Toronto General Hospital, Toronto, ON, Canada
| | - Grainne O'Kane
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada; Department of Medical Oncology, Trinity St. James's Cancer Institute, Trinity College Dublin, Dublin, Ireland
| | - Bettina Hansen
- Department of Epidemiology & Biostatistics, Erasmus MC, Rotterdam, the Netherlands
| | - Gonzalo Sapisochin
- Department of Surgery, University of Toronto, Toronto, ON, Canada; University Health Network, HPB Oncology Research, Toronto, ON, Canada.
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3
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Khan MMM, Woldesenbet S, Munir MM, Khalil M, Endo Y, Katayama E, Tsilimigras D, Rashid Z, Altaf A, Pawlik TM. Open versus minimally invasive hepatic and pancreatic surgery: 1-year costs, healthcare utilization and days of work lost. HPB (Oxford) 2025; 27:111-122. [PMID: 39547904 DOI: 10.1016/j.hpb.2024.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 07/16/2024] [Accepted: 10/29/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND Utilization of minimally invasive surgery (MIS) has become increasingly popular due to its potential benefits such as earlier recovery and reduced morbidity. We sought to characterize differences in 1-year healthcare costs and missed workdays among patients undergoing MIS and open surgery for a hepatic or pancreatic indication. METHODS Data on patients who underwent hepatic and pancreatic resection were obtained from the IBM Marketscan database. Generalized linear models were utilized to compare healthcare costs and missed workdays among patients undergoing MIS versus open surgery. RESULTS Among 8705 patients, 85.0 % (n = 7399) and 15.0 % (n = 1306) of patients underwent an open or MIS HP procedure, respectively. In the unmatched cohort, patients who underwent MIS were more likely to be female (62.7 % vs. 54.6 %) and were less likely to have a Charlson Comorbidity Index score >2 (34.5 % vs. 49.6 %) (both p < 0.05). After entropy balancing, multivariable analysis demonstrated that MIS was associated with lower 1-year post discharge expenditures (mean difference -$9,739, 95%CI-$12,893, -$6585) and fewer missed workdays at 1-year post-discharge (IRR 0.84, 95%CI 0.81-0.87) (all p < 0.001). CONCLUSION At index hospitalization and 1-year post-discharge, an HP MIS approach was associated with lower healthcare expenditures versus open surgery for hepatic and pancreatic resection, as well as fewer missed workdays.
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Affiliation(s)
- Muhammad M M Khan
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad M Munir
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Mujtaba Khalil
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Erryk Katayama
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Diamantis Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Zayed Rashid
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Abdullah Altaf
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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Gundavda KK, Patkar S, Varty GP, Shah N, Velmurugan K, Goel M. Liver Resection for Hepatocellular Carcinoma: Recent Advances. J Clin Exp Hepatol 2025; 15:102401. [PMID: 39286759 PMCID: PMC11402310 DOI: 10.1016/j.jceh.2024.102401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/06/2024] [Indexed: 09/19/2024] Open
Abstract
Hepatocellular carcinoma (HCC) represents a significant global health burden. Surgery remains a cornerstone in the curative treatment of HCC, and recent years have witnessed notable advancements aimed at refining surgical techniques and improving patient outcomes. This review presents a detailed examination of the recent innovations in HCC surgery, highlighting key developments in both surgical approaches and adjunctive therapies. Advanced imaging technologies have revolutionized preoperative assessment, enabling precise tumour localization and delineation of vascular anatomy. The use of three-dimensional rendering has significantly augmented surgical planning, facilitating more accurate and margin-free resections. The advent of laparoscopic and robotic-assisted surgical techniques has ushered in an era of minimal access surgery, offering patients the benefits of shorter hospital stays and faster recovery times, while enabling equivalent oncological outcomes. Intraoperative innovations such as intraoperative ultrasound (IOUS) and fluorescence-guided surgery have emerged as valuable adjuncts, allowing real-time assessment of tumour extent and aiding in parenchyma preservation. The integration of multimodal therapies, including neoadjuvant and adjuvant strategies, has allowed for 'bio-selection' and shown the potential to optimize patient outcomes. With the advent of augmented reality and artificial intelligence (AI), the future holds immense potential and may represent significant strides towards optimizing patient outcomes and refining the standard of care.
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Affiliation(s)
- Kaival K Gundavda
- Department of Gastrointestinal and Hepatobiliary Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Shraddha Patkar
- Department of Gastrointestinal and Hepatobiliary Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Gurudutt P Varty
- Department of Gastrointestinal and Hepatobiliary Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Niket Shah
- Department of Gastrointestinal and Hepatobiliary Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Karthik Velmurugan
- Department of Gastrointestinal and Hepatobiliary Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Mahesh Goel
- Department of Gastrointestinal and Hepatobiliary Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
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5
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Semash KO. Laparoscopic and robotic hepatectomy in living liver donors. Current state and prospects. RUSSIAN JOURNAL OF TRANSPLANTOLOGY AND ARTIFICIAL ORGANS 2024; 27:145-159. [DOI: 10.15825/1995-1191-2025-1-145-159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2025]
Abstract
Minimally invasive living-donor hepatectomy is a relatively new surgical technique that can improve donor safety and expedite donor rehabilitation. Following an early stage of research where donor safety was not adequately established, the minimally invasive approach nowadays yields better outcomes when carried out by experienced surgeons. Important factors include donor selection criteria, hospital equipment, and surgeon’s learning curve. This review describes the current status of laparoscopic and robotic living-donor hepatectomy, along with the challenges facing the advancement of these surgical techniques.
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6
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Nigam A, Hawksworth JS, Winslow ER. Minimally Invasive Robotic Techniques for Hepatocellular Carcinoma Resection: How I Do It. Surg Oncol Clin N Am 2024; 33:111-132. [PMID: 37945137 DOI: 10.1016/j.soc.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
The adoption of minimally invasive techniques for hepatocellular resection has progressively increased in North America. Cumulative evidence has demonstrated improved surgical outcomes in patients who undergo minimally invasive hepatectomy. In this review, the authors' approach and methodology to minimally invasive robotic liver resection for hepatocellular carcinoma is discussed.
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Affiliation(s)
- Aradhya Nigam
- Department of Surgery, Medstar Georgetown University Hospital, 3800 Reservoir Road, NW, 4PHC, Washington, DC 20007, USA
| | - Jason S Hawksworth
- Division of Abdominal Organ Transplantation, Columbia University Irving Medical Center, 622 West 168th Street, PH14-105, New York, NY 20032, USA.
| | - Emily R Winslow
- Department of Transplant Surgery, Medstar Georgetown University Hospital, 3800 Reservoir Road, NW, 2PHC, Washington, DC 20007, USA
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7
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Wu X, Lokken RP, Mehta N. Optimal treatment for small HCC (<3 cm): Resection, liver transplantation, or locoregional therapy? JHEP Rep 2023; 5:100781. [PMID: 37456674 PMCID: PMC10339255 DOI: 10.1016/j.jhepr.2023.100781] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/30/2023] [Indexed: 07/18/2023] Open
Abstract
Hepatocellular carcinoma (HCC) remains the most common form of liver cancer, accounting for 90% of all primary liver cancers. Up to 30% of HCC cases could be small (2-3 cm in diameter) at the time of diagnosis with advances in imaging techniques and surveillance programmes. Treating patients with early-stage HCC can be complex and often requires interdisciplinary care, owing to the wide and increasing variety of treatment options, which include liver resection, liver transplantation, and various locoregional therapies offered by interventional radiology and radiation oncology. Decisions regarding the optimal management strategy for a patient involve many considerations, including patient- and tumour-specific characteristics, as well as socioeconomic factors. In this review, we aim to comprehensively summarise the commonly used therapies for single, small HCC (<3 cm), with a focus on the impact of tumour size (<2 cm vs. 2-3 cm), as well as a brief discussion on the cost-effectiveness of the different treatment options.
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Affiliation(s)
- Xiao Wu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Ryan Peter Lokken
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Neil Mehta
- Department of General Hepatology and Liver Transplantation, University of California, San Francisco, CA, USA
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8
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Kakos CD, Papanikolaou A, Ziogas IA, Tsoulfas G. Global dissemination of minimally invasive living donor hepatectomy: What are the barriers? World J Gastrointest Surg 2023; 15:776-787. [PMID: 37342850 PMCID: PMC10277954 DOI: 10.4240/wjgs.v15.i5.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/16/2023] [Accepted: 03/16/2023] [Indexed: 05/26/2023] Open
Abstract
Minimally invasive donor hepatectomy (MIDH) is a relatively novel procedure that can potentially increase donor safety and contribute to faster rehabilitation of donors. After an initial period in which donor safety was not effectively validated, MIDH currently seems to provide improved results, provided that it is conducted by experienced surgeons. Appropriate selection criteria are crucial to achieve better outcomes in terms of complications, blood loss, operative time, and hospital stay. Beyond a pure laparoscopic technique, various approaches have been recommended such as hand-assisted, laparoscopic-assisted, and robotic donation. The latter has shown equal outcomes compared to open and laparoscopic approaches. A steep learning curve seems to exist in MIDH, mainly due to the fragility of the liver parenchyma and the experience needed for adequate control of bleeding. This review investigated the challenges and the opportunities of MIDH and the barriers to its global dissemination. Surgeons need expertise in liver transplantation, hepatobiliary surgery, and minimally invasive techniques to perform MIDH. Barriers can be categorized into surgeon-related, institutional-related, and accessibility. More robust data and the creation of international registries are needed for further evaluation of the technique and the acceptance from more centers worldwide.
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Affiliation(s)
- Christos Dimitrios Kakos
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54622, Greece
| | - Angelos Papanikolaou
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Ioannis A Ziogas
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Georgios Tsoulfas
- Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54622, Greece
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9
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Outcomes and Patient Selection in Laparoscopic vs. Open Liver Resection for HCC and Colorectal Cancer Liver Metastasis. Cancers (Basel) 2023; 15:cancers15041179. [PMID: 36831521 PMCID: PMC9954110 DOI: 10.3390/cancers15041179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM) are the two most common malignant tumors that require liver resection. While liver transplantation is the best treatment for HCC, organ shortages and high costs limit the availability of this option for many patients and make resection the mainstay of treatment. For patients with CRLM, surgical resection with negative margins is the only potentially curative option. Over the last two decades, laparoscopic liver resection (LLR) has been increasingly adopted for the resection of a variety of tumors and was found to have similar long-term outcomes compared to open liver resection (OLR) while offering the benefits of improved short-term outcomes. In this review, we discuss the current literature on the outcomes of LLR vs. OLR for patients with HCC and CRLM. Although the use of LLR for HCC and CRLM is increasing, it is not appropriate for all patients. We describe an approach to selecting patients best-suited for LLR. The four common difficulty-scoring systems for LLR are summarized. Additionally, we review the current evidence behind the emerging robotically assisted liver resection technology.
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10
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Cisneros-Garza LE, González-Huezo MS, Moctezuma-Velázquez C, Ladrón de Guevara-Cetina L, Vilatobá M, García-Juárez I, Alvarado-Reyes R, Álvarez-Treviño GA, Allende-Pérez S, Bornstein-Quevedo L, Calderillo-Ruiz G, Carrillo-Martínez MA, Castillo-Barradas M, Cerda-Reyes E, Félix-Leyva JA, Gabutti-Thomas JA, Guerrero-Ixtlahuac J, Higuera-de la Tijera F, Huitzil-Melendez D, Kimura-Hayama E, López-Hernández PA, Malé-Velázquez R, Méndez-Sánchez N, Morales-Ruiz MA, Ruíz-García E, Sánchez-Ávila JF, Torrecillas-Torres L. The second Mexican consensus on hepatocellular carcinoma. Part II: Treatment. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2022; 87:362-379. [PMID: 35778341 DOI: 10.1016/j.rgmx.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/20/2022] [Indexed: 01/03/2025]
Abstract
Hepatocellular carcinoma (HCC) is more frequently manifesting as one of the main complications of cirrhosis of the liver, its principal risk factor. There have been modifications in its incidence over the past decade, related to an epidemiologic transition in the etiology of cirrhosis, with a decrease in the prevalence of hepatitis C and an increase in nonalcoholic fatty liver disease (NAFLD) as a cause, as well as the development of HCC in the non-cirrhotic liver due to NAFLD. Genetic markers associated with the disease have been identified, and surveillance and diagnosis have improved. Regarding treatment, surgical techniques, in both resection and transplantation, have advanced and radiologic techniques, at the curative stage of the disease, have enhanced survival in those patients. And finally, there have been radical changes in the systemic approach, with much more optimistic expectations, when compared with the options available a decade ago. Therefore, the Asociación Mexicana de Hepatología decided to carry out the Second Mexican Consensus on Hepatocellular Carcinoma, which is an updated review of the available national and international evidence on the epidemiology, risk factors, surveillance, diagnosis, and treatment of the disease, to offer the Mexican physician current information on the different topics regarding hepatocellular carcinoma. In this second part of the document, the topics related to the treatment of HCC are presented.
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Affiliation(s)
- L E Cisneros-Garza
- Hospital Christus Muguerza Alta Especialidad, Monterrey, Nuevo León, Mexico.
| | | | | | | | - M Vilatobá
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, Mexico
| | - I García-Juárez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, Mexico
| | | | | | | | - L Bornstein-Quevedo
- InmunoQ, Laboratorio de Patología, Inmunohistoquímica y Biología Molecular, CDMX, Mexico
| | | | | | | | | | | | - J A Gabutti-Thomas
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, Mexico
| | | | | | - D Huitzil-Melendez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, Mexico
| | | | | | - R Malé-Velázquez
- Instituto de Salud Digestiva y Hepática SA de CV, Guadalajara, Jalisco, Mexico
| | | | - M A Morales-Ruiz
- Centro Oncológico Estatal Issemym, Toluca, Estado de México, Mexico
| | | | - J F Sánchez-Ávila
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico
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Cisneros-Garza L, González-Huezo M, Moctezuma-Velázquez C, Ladrón de Guevara-Cetina L, Vilatobá M, García-Juárez I, Alvarado-Reyes R, Álvarez-Treviño G, Allende-Pérez S, Bornstein-Quevedo L, Calderillo-Ruiz G, Carrillo-Martínez M, Castillo-Barradas M, Cerda-Reyes E, Félix-Leyva J, Gabutti-Thomas J, Guerrero-Ixtlahuac J, Higuera-de la Tijera F, Huitzil-Melendez D, Kimura-Hayama E, López-Hernández P, Malé-Velázquez R, Méndez-Sánchez N, Morales-Ruiz M, Ruíz-García E, Sánchez-Ávila J, Torrecillas-Torres L. The second Mexican consensus on hepatocellular carcinoma. Part II: Treatment. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2022; 87:362-379. [DOI: 10.1016/j.rgmxen.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/20/2022] [Indexed: 10/25/2022] Open
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Carissimi F, Scotti MA, Ciulli C, Fogliati A, Uggeri F, Chiarelli M, Braga M, Romano F, Garancini M. COVID-19 and Liver Surgery: How the Pandemic Affected an Italian Medium-Volume HBP Center. Front Surg 2022; 9:918348. [PMID: 35836608 PMCID: PMC9275712 DOI: 10.3389/fsurg.2022.918348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/02/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION While the COVID-19 pandemic is still ongoing, it is even more evident that victims of the pandemic are not only those who contract the virus, but also the countless patients suffering from other serious diseases (i.e., tumor) who have undergone delayed potentially life-saving surgery due to a lack of beds. Like many hospitals, ours also initially blocked all elective oncologic surgery, but these operations were "recovered" and reintegrated in a relatively short time, thanks to the establishment of COVID-free wards and operating rooms with staff dedicated to oncological surgery. In tis context, our aim is to assess whether and how the severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) pandemic has impacted our hepatobiliary surgery unit. METHODS From our prospective database, we retrospectively took data from patients undergoing liver surgery in 2018-2019 (pre-COVID) and 2020-2021 (COVID period). Patients admitted to COVID-free wards must necessarily have a negative nasal swab from the previous 24 h. RESULTS Between January 1, 2018, and December 31, 2019 (Group 1), 101 patients were treated; during the pandemic [January 1, 2020, and December 31, 2021 (Group 2)], 126 patients were treated. There was no statistical difference between the groups. The median postoperative hospital stay was 7 days for both groups; 7 patients had major complications (Clavien-Dindo > 3) in Group 1 and 11 in Group 2 (p = 0.795). A total of 4 patients died in Group 1 and 6 during the pandemic (p = 0.754). Tumor burden was significantly greater in Group 2 where nodule size, lymphadenectomy, and extrahepatic disease were significantly greater (p = 0.011, p = 0.004, and p = 0.026, respectively). CONCLUSION During the COVID pandemic, our HPB unit managed to offer a volume of tertiary-center hepatobiliary surgery without a significant impact in terms of length of stay, morbidity, or mortality despite the increase in tumor burden during the pandemic years.
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Affiliation(s)
- Francesca Carissimi
- Department of Surgery, HPB and Gastroenterological Surgery Unit, San Gerardo Hospital, Monza, Italy
- Department of Surgery, School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Mauro Alessandro Scotti
- Department of Surgery, HPB and Gastroenterological Surgery Unit, San Gerardo Hospital, Monza, Italy
| | - Cristina Ciulli
- Department of Surgery, HPB and Gastroenterological Surgery Unit, San Gerardo Hospital, Monza, Italy
- Department of Surgery, School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Alessandro Fogliati
- Department of Surgery, HPB and Gastroenterological Surgery Unit, San Gerardo Hospital, Monza, Italy
- Department of Surgery, School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Fabio Uggeri
- Department of Surgery, HPB and Gastroenterological Surgery Unit, San Gerardo Hospital, Monza, Italy
- Department of Surgery, School of Medicine, University of Milano-Bicocca, Milan, Italy
| | | | - Marco Braga
- Department of Surgery, HPB and Gastroenterological Surgery Unit, San Gerardo Hospital, Monza, Italy
- Department of Surgery, School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Fabrizio Romano
- Department of Surgery, HPB and Gastroenterological Surgery Unit, San Gerardo Hospital, Monza, Italy
- Department of Surgery, School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Mattia Garancini
- Department of Surgery, HPB and Gastroenterological Surgery Unit, San Gerardo Hospital, Monza, Italy
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Pusceddu C, Mascia L, Ninniri C, Ballicu N, Zedda S, Melis L, Deiana G, Porcu A, Fancellu A. The Increasing Role of CT-Guided Cryoablation for the Treatment of Liver Cancer: A Single-Center Report. Cancers (Basel) 2022; 14:3018. [PMID: 35740682 PMCID: PMC9221264 DOI: 10.3390/cancers14123018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 02/06/2023] Open
Abstract
Purpose: Cryoablation (CrA) is a minimally invasive treatment that can be used in primary and metastatic liver cancer. The purpose of this study was to assess the effectiveness of CrA in patients with hepatocellular carcinoma (HCC) and liver metastases. Methods: We retrospectively evaluated the patients who had CrA for HCC or liver metastases between 2015 and 2020. Technical success, complete ablation, CrA-related complications, local tumor progression, local recurrences, and distant metastases were evaluated in the study population. In patients with HCC, the median survival was also estimated. Results: Sixty-four liver tumors in 49 patients were treated with CrA (50 metastases and 14 HCC). The mean tumor diameter was 2.15 cm. The mean follow-up was 19.8 months. Technical success was achieved in the whole study population. Complete tumor ablation was observed after one month in 92% of lesions treated with CrA (79% and 96% in the HCC Group and metastases Group, respectively, p < 0.001). Local tumor progression occurred in 12.5 of lesions, with no difference between the study groups (p = 0.105). Sixteen patients (33%) developed local recurrence (45% and 29% in the HCC Group and metastases Group, respectively, p = 0.477). Seven patients (14%) developed distant metastases in the follow-up period. Ten patients (20.8%) underwent redo CrA for local recurrence or incomplete tumor ablation. Minor complications were observed in 14% of patients. In patients with HCC, the median survival was 22 months. Conclusions: CrA can be safely used for treatment of HCC and liver metastases not amenable of surgical resection. Further studies are necessary to better define the role of CrA in the multidisciplinary treatment of liver malignancies.
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Affiliation(s)
- Claudio Pusceddu
- Department of Oncological and Interventional Radiology, Oncological Hospital A, Businco, I-09121 Cagliari, Italy; (C.P.); (N.B.); (S.Z.); (L.M.)
| | - Luigi Mascia
- Department of Medical Oncology, Oncological Hospital A, Businco, I-09121 Cagliari, Italy;
| | - Chiara Ninniri
- Unit of General Surgery 2, Clinica Chirurgica, Department of Medical, Surgical, and Experimental Sciences, University of Sassari, I-07100 Sassari, Italy; (C.N.); (G.D.); (A.P.)
| | - Nicola Ballicu
- Department of Oncological and Interventional Radiology, Oncological Hospital A, Businco, I-09121 Cagliari, Italy; (C.P.); (N.B.); (S.Z.); (L.M.)
| | - Stefano Zedda
- Department of Oncological and Interventional Radiology, Oncological Hospital A, Businco, I-09121 Cagliari, Italy; (C.P.); (N.B.); (S.Z.); (L.M.)
| | - Luca Melis
- Department of Oncological and Interventional Radiology, Oncological Hospital A, Businco, I-09121 Cagliari, Italy; (C.P.); (N.B.); (S.Z.); (L.M.)
| | - Giulia Deiana
- Unit of General Surgery 2, Clinica Chirurgica, Department of Medical, Surgical, and Experimental Sciences, University of Sassari, I-07100 Sassari, Italy; (C.N.); (G.D.); (A.P.)
| | - Alberto Porcu
- Unit of General Surgery 2, Clinica Chirurgica, Department of Medical, Surgical, and Experimental Sciences, University of Sassari, I-07100 Sassari, Italy; (C.N.); (G.D.); (A.P.)
| | - Alessandro Fancellu
- Unit of General Surgery 2, Clinica Chirurgica, Department of Medical, Surgical, and Experimental Sciences, University of Sassari, I-07100 Sassari, Italy; (C.N.); (G.D.); (A.P.)
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Kapuller V, Kammar H, Zugayyar D, Luques L, Michael S, Arbell D. Bowel Resection Through a Single Umbilical Incision: A Case Series. J Laparoendosc Adv Surg Tech A 2022; 32:448-451. [PMID: 34990296 DOI: 10.1089/lap.2021.0610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The advent of laparoscopy has revolutionized surgery. The surgeon strives to minimize incisions and their adverse consequences. Although laparoscopy has gained widespread popularity, several advantages in open surgery are thereby lost. Tactile sensation of the tissue, hand-sewn anastomosis, and nonthermic vascular control are most prominent. To combine both approaches, single incision laparoscopic-assisted surgery (SILS) was advanced, trying to combine the best in both worlds. This approach is widely used in appendectomies. After having gained experience in this approach, we expanded the indications and hereby present our experience with bowel resections utilizing SILS. Patients and Methods: Data were collected retrospectively from operations performed during the past 3 years. We found 11 cases of SILS bowel resections: 3 sigmoidectomies, 3 small bowel atresia repairs, 1 subtotal colectomy, 1 Meckel's diverticulectomy, and 3 resections of bowel duplications. The age of the patients ranged from 2 days to 17 years. In all cases, a working 10 mm scope was inserted through the umbilicus, the bowel was extracted outside the abdomen through the umbilicus, dissection and resection with anastomosis were performed outside the abdomen in the classic open approach, and the bowel was returned to the abdomen. Results and Conclusions: All patients recovered promptly with no need for further intervention. There were no cases of wound infection, leak, or intra-abdominal abscess formation. Cosmesis was excellent with a small umbilical scar. We conclude that this approach is feasible and safe in a select population.
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Affiliation(s)
- Vadim Kapuller
- The Department of Pediatric Surgery, Hadassah University Hospital, Hebrew University, Jerusalem, Israel
| | - Haguy Kammar
- The Department of Pediatric Surgery, Hadassah University Hospital, Hebrew University, Jerusalem, Israel
| | - Diaa Zugayyar
- The Department of Pediatric Surgery, Hadassah University Hospital, Hebrew University, Jerusalem, Israel
| | - Lisandro Luques
- The Department of Pediatric Surgery, Hadassah University Hospital, Hebrew University, Jerusalem, Israel
| | - Samer Michael
- The Department of Pediatric Surgery, Hadassah University Hospital, Hebrew University, Jerusalem, Israel
| | - Dan Arbell
- The Department of Pediatric Surgery, Hadassah University Hospital, Hebrew University, Jerusalem, Israel
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Fancellu A, Sanna V, Scognamillo F, Feo CF, Vidili G, Nigri G, Porcu A. Surgical treatment of hepatocellular carcinoma in the era of COVID-19 pandemic: A comprehensive review of current recommendations. World J Clin Cases 2021; 9:3517-3530. [PMID: 34046452 PMCID: PMC8130078 DOI: 10.12998/wjcc.v9.i15.3517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
The new coronavirus disease 2019 (COVID-19) pandemic has resulted in a global health emergency that has also caused profound changes in the treatment of cancer. The management of hepatocellular carcinoma (HCC) across the world has been modified according to the scarcity of care resources that have been diverted mostly to face the surge of hospitalized COVID-19 patients. Oncological and hepatobiliary societies have drafted recommendations regarding the adaptation of guidelines for the management of HCC to the current healthcare situation. This review focuses on specific recommendations for the surgical treatment of HCC (i.e., hepatic resection and liver transplantation), which still represents the best chance of cure for patients with very early and early HCC. While surgery should be pursued for very selected patients in institutions where standards of care are maintained, alternative or bridging methods, mostly thermoablation and transarterial therapies, can be used until surgery can be performed. The prognosis of patients with HCC largely depends on both the characteristics of the tumour and the stage of underlying liver disease. Risk stratification plays a pivotal role in determining the most appropriate treatment for each case and needs to balance the chance of cure and the risk of COVID-19 infection during hospitalization. Current recommendations have been critically reviewed to provide a reference for best practices in the clinical setting, with adaptation based on pandemic trends and categorization according to COVID-19 prevalence.
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Affiliation(s)
- Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Valeria Sanna
- Unit of Medical Oncology, AOU Sassari, Sassari 07100, Italy
| | - Fabrizio Scognamillo
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 1 - Patologia Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Claudio F Feo
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, Unit of Internal Medicine, University of Sassari, Sassari 07100, Italy
| | - Giuseppe Nigri
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, St. Andrea University Hospital, Rome 00189, Italy
| | - Alberto Porcu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
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Fancellu A, Perra T, Vergari D, Vargiu I, Feo CF, Cossu ML, Deiana G, Porcu A. Management of complex liver cystic hydatidosis: challenging benign diseases for the hepatic surgeon: A case series report from an endemic area. Medicine (Baltimore) 2020; 99:e23435. [PMID: 33235127 PMCID: PMC7710265 DOI: 10.1097/md.0000000000023435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/03/2020] [Accepted: 10/25/2020] [Indexed: 02/05/2023] Open
Abstract
Hydatid cysts of the liver are benign lesions which require a wide range of surgical strategies for their treatment. We hypothesized that cysts larger than 15 cm, or compressing main vascular structures, or located in both hemilivers should be considered, as well as complicated cysts, in the category of complex hydatid cysts.In a retrospective study including 55 patients, we evaluated the characteristics of complex hydatid cysts, and compared surgical outcomes between patients operated on for complex cysts (Complex Group) and those operated on for non-complex cysts (non-Complex Group).In the Complex Group, 19% of patients had cysto-biliary communication with recurrent cholangitis, 9.5% had cysts eroding the diaphragm or chest wall, or communicating with the bronchial tree, 31% had cysts with contact with main vascular structures, 11.9% had multiple bilobar cysts, 14.3% had giant cysts with organ displacement, and 14.3% had a combination of the above-mentioned types. Type of surgical treatment was different between the two groups (P < .001). Additional procedures were statistically more frequent in the Complex Group (P = .02). Postoperative morbidity was higher in the Complex Group, although not in a significant manner (P = .07). Median hospital stay was longer in the Complex Group (12 vs 7 days, P < .001). No 30-day mortality occurred. Four patients (7.3%), all belonging to the Complex Group, required reoperation for postoperative complications.Surgery for complex hydatid cysts of the liver is potentially burdened by serious complications. This kind of benign liver disease requires skill-demanding procedures and should be treated in centers with expertise in both hepato-biliary surgery and hydatid disease management.
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Khairuddin A, Ong GH, Tan JS, Johan S, Hoe VC, Sharif MS, Hayati F. Emergency laparoscopic resection of spontaneous rupture of hepatocellular carcinoma: A case report. Int J Surg Case Rep 2019; 66:104-106. [PMID: 31830742 PMCID: PMC6926279 DOI: 10.1016/j.ijscr.2019.11.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/15/2019] [Accepted: 11/25/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Laparoscopic liver resection is currently performed as a therapeutic modality in hepatocellular carcinoma (HCC). In an emergency setting such as bleeding or rupture, however it has not been well documented. PRESENTATION OF CASE We describe a 55-year-old lady who presented to the emergency department with epigastric pain and symptoms of anaemia for one day duration. She was normotensive but tachycardic. Blood investigations revealed haemoglobin level of 6.5 g/dL and serum alpha-fetoprotein of 3136 g/dL. Contrast enhanced computed tomography scan revealed ruptured HCC of segment 2 and 3. She underwent emergency laparoscopic resection of the ruptured HCC. The postoperative recovery was uneventful and she was discharged well on postoperative day 7. Histology confirmed a 10 cm ruptured HCC with 3 mm tumour-free resection margin. DISCUSSION Ruptured HCC is associated with a high mortality rate of 25-75 %. Traditional treatment involves initial stabilization and hemostasis through transarterial embolization followed by staged hepatic resection. However, laparoscopic liver resection has been shown to be superior than open surgery in terms of postoperative outcomes. CONCLUSION Laparoscopic resection of bleeding HCC is achievable and can be considered in the treatment algorithm of selected patients.
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Affiliation(s)
- Allim Khairuddin
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Guang Hong Ong
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Jun Sam Tan
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Syamim Johan
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Vee Chuan Hoe
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | | | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
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Wilson GC, Geller DA. Evolving Surgical Options for Hepatocellular Carcinoma. Surg Oncol Clin N Am 2019; 28:645-661. [DOI: 10.1016/j.soc.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Zhu P, Liao W, Ding ZY, Chen L, Zhang WG, Zhang BX, Chen XP. Learning Curve in Robot-Assisted Laparoscopic Liver Resection. J Gastrointest Surg 2019; 23:1778-1787. [PMID: 30406576 DOI: 10.1007/s11605-018-3689-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/08/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the learning curve effect on the safety and feasibility of robot-assisted liver resection (RALR). METHODS In 140 consecutive cases, all data about demographic, surgical procedure, postoperative course were collected prospectively and analyzed. Risk-adjusted cumulative sum model was used for determining the learning curve based on the need for conversion. RESULTS Among all 140 patients, no patients suffered from any organ dysfunction postoperatively and the operative mortality was 0%. The CUSUM analysis showed that at the 30th consecutive patient, the open conversion rate reached to the average value, and it further improved thereafter. In the last 70 patients, only 3 patients (4.3%) required conversion and 7 patients (10%) needed blood transfusion. Only 1 patient (1.3%) out of 79 patients with HCC had a positive resection margin. Univariate analyses showed the following risk factors associated with significantly higher risks of conversion (P < 0.05): tumor number > 1, lesions in segments 1/4a/7/8, right posterior sectionectomy, and lesions which were beyond the indications of the Louisville statement. Multivariate logistic analysis revealed that both tumor number > 1 (OR: 2.10, P < 0.05) and right posterior sectionectomy (OR: 11.19, P < 0.01) were risk factors of conversion. CONCLUSIONS The robotic approach for hepatectomy is safe and feasible. A learning curve effect was demonstrated in this study after the 30th consecutive patient. The long-term oncological outcomes of robotic hepatectomy still need further investigation.
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Affiliation(s)
- Peng Zhu
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Liao
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ze-Yang Ding
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Chen
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wan-Guang Zhang
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bi-Xiang Zhang
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xiao-Ping Chen
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Stiles ZE, Glazer ES, Deneve JL, Shibata D, Behrman SW, Dickson PV. Long-Term Implications of Unplanned Conversion During Laparoscopic Liver Resection for Hepatocellular Carcinoma. Ann Surg Oncol 2019; 26:282-289. [DOI: 10.1245/s10434-018-7073-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Indexed: 08/30/2023]
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23
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Ciria R, Gomez-Luque I, Ocaña S, Cipriani F, Halls M, Briceño J, Okuda Y, Troisi R, Rotellar F, Soubrane O, Abu Hilal M. A Systematic Review and Meta-Analysis Comparing the Short- and Long-Term Outcomes for Laparoscopic and Open Liver Resections for Hepatocellular Carcinoma: Updated Results from the European Guidelines Meeting on Laparoscopic Liver Surgery, Southampton, UK, 2017. Ann Surg Oncol 2018; 26:252-263. [PMID: 30390167 DOI: 10.1245/s10434-018-6926-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The laparoscopic approach to liver resection has experienced exponential growth in recent years; however, its application is still under debate and objective, evidence-based guidelines for its safe future progression are needed. OBJECTIVE The aim of this study was to perform a systematic review and meta-analysis comparing the short- and long-term outcomes of laparoscopic and open liver resections for hepatocellular carcinoma (HCC). METHODS To identify all the comparative manuscripts reporting on laparoscopic and open liver resection for HCC, all published English-language studies with more than 10 cases were screened. In addition to the primary meta-analysis, four specific subgroup analyses were performed on patients with Child-Pugh A cirrhosis, resections for solitary tumors, and those undergoing minor and major resections. The quality of the studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology and the Newcastle-Ottawa Scale. RESULTS From the initial 361 manuscripts, 28 were included in the meta-analysis. Five of these 28 manuscripts were specific to patients with Child-Pugh A cirrhosis (321 cases), 11 focused on solitary tumors (1003 cases), 16 focused on minor resections (1286 cases), and 3 focused on major resections (164 cases). Three manuscripts compared 1079 cases but could not be assigned to any of the above subanalyses. In general terms, short-term outcomes were favorable when using a laparoscopic approach, especially in minor resections. The only advantage seen with an open approach was reduced operative time during major liver resections. No differences in long-term outcomes were observed between the approaches. CONCLUSIONS Laparoscopic liver resection for HCC is feasible and offers improved short-term outcomes, with comparable long-term outcomes as the open approach.
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Affiliation(s)
- Ruben Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, CIBER-EHD, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Cordoba, Spain.
| | - Irene Gomez-Luque
- Unit of Hepatobiliary Surgery and Liver Transplantation, CIBER-EHD, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Cordoba, Spain
| | - Sira Ocaña
- Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Clinic, University of Navarra, Pamplona, Spain
| | - Federica Cipriani
- Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy.,Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Halls
- Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Javier Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, CIBER-EHD, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Cordoba, Spain
| | - Yukihiro Okuda
- Unit of Hepatobiliary Surgery and Liver Transplantation, CIBER-EHD, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Cordoba, Spain.,Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Roberto Troisi
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy
| | - Fernando Rotellar
- Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Clinic, University of Navarra, Pamplona, Spain
| | - Olivier Soubrane
- Department of HPB Surgery and Liver Transplant, Beaujon Hospital, University Paris 7, Clichy, AP-HP, France
| | - Mohammed Abu Hilal
- Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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Vogel A, Cervantes A, Chau I, Daniele B, Llovet JM, Meyer T, Nault JC, Neumann U, Ricke J, Sangro B, Schirmacher P, Verslype C, Zech CJ, Arnold D, Martinelli E. Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv238-iv255. [PMID: 30285213 DOI: 10.1093/annonc/mdy308] [Citation(s) in RCA: 710] [Impact Index Per Article: 101.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- A Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany
| | - A Cervantes
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - I Chau
- Department of Medicine, Royal Marsden Hospital, Surrey, UK
| | - B Daniele
- Direttore Dipartimento di Oncologia e U.O.C. Oncologia Medica A.O., Benevento, Italy
| | - J M Llovet
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, Mount Sinai Liver Cancer Program, New York, USA
- Barcelona-Clínic Liver Cancer Group (BCLC), Unitat d'Hepatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - T Meyer
- Oncology, Royal Free Hospital, London
- UCL Cancer Institute, University College London, London, UK
| | - J-C Nault
- Service d'hépatologie, Hôpital Jean Verdier, Bondy, France
| | - U Neumann
- Klinik für Allgemein- und Viszeralchirurgie, Medizinische Fakultät der RWTH Aachen
| | - J Ricke
- Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität München, Munich, Germany
| | - B Sangro
- Liver Unit, Clinica Universidad de Navarra-IDISNA and CIBEREHD, Pamplona, Spain
| | - P Schirmacher
- Institute of Pathology, University Hospital, Heidelberg, Germany
| | - C Verslype
- Campus Gasthuisberg, UZ Leuven, Leuven, Belgium
| | - C J Zech
- Klinik für Radiologie und Nuklearmedizin Universität Basel, Basel, Switzerland
| | - D Arnold
- Department Oncology, Section Hematology and Palliative Care AK Altona, Asklepios Tumorzentrum Hamburg, Hamburg, Germany
| | - E Martinelli
- Faculty of Medicine, Università della Campania L. Vanvitelli Naples, Caserta, Italy
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25
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Pusceddu C, Melis L, Ballicu N, Sotgia B, Melis M, Sanna V, Meloni GB, Porcu A, Fancellu A. Percutaneous Microwave Ablation Under CT Guidance for Hepatocellular Carcinoma: a Single Institutional Experience. J Gastrointest Cancer 2018; 49:295-301. [PMID: 28530021 DOI: 10.1007/s12029-017-9951-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Microwave ablation (MWA) is an emerging treatment for treatment of patients with hepatocellular carcinoma (HCC) not amenable of surgical resection. PATIENTS AND METHODS We searched for patients diagnosed as having small-, medium-, and large HCCs treated with MWA under CT guidance between 2010 and 2014. The main outcomes of interest were rates of complete ablation, complications, and overall survival. Rates of complete ablation were compared with Chi-square test, and estimated survival rates were calculated by means of Kaplan-Meier method. RESULTS Thirty-two patients with 45 HCC nodules received MWA. Seventeen (37.8%) nodules were <3 cm (small), 15 (33.3%) between 3 and 5 cm (medium), and 13 (28.9%) > 5 cm (large). Complete ablation was obtained in 94.1% of small tumors, 80% of medium tumors, and 53.8% of large tumors (p = 0.03). Two patients had HCC located in risk area (paracardiac position). Minor complications occurred after seven procedures (15.5%). Estimated median survival was 37 months (95% confidence interval 11.97-62.02). One-year OS was 82.7%, 2-year survival 68.9%, and 3-year survival 55.2%. CONCLUSION MWA is a versatile ablative method that can be applied in HCC at various stages, and also in lesions located in risk areas.
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Affiliation(s)
- Claudio Pusceddu
- Division of Interventional Radiology, Department of Oncological Radiology, Oncological Hospital A. Businco, Cagliari, Italy
| | - Luca Melis
- Division of Interventional Radiology, Department of Oncological Radiology, Oncological Hospital A. Businco, Cagliari, Italy
| | - Nicola Ballicu
- Division of Interventional Radiology, Department of Oncological Radiology, Oncological Hospital A. Businco, Cagliari, Italy
| | - Barbara Sotgia
- Division of Interventional Radiology, Department of Oncological Radiology, Oncological Hospital A. Businco, Cagliari, Italy
| | - Marcovalerio Melis
- New York University School of Medicine and Department of Surgery, NY Harbor Healthcare System VAMC, New York, NY, USA
| | - Valeria Sanna
- Unit of Medical Oncology, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | | | - Alberto Porcu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Alessandro Fancellu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
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Abstract
Enhanced recovery after surgery (ERAS) pathways target specific areas within perioperative patient care in a multidisciplinary and evidence-based manner. Because of the subsequent positive outcomes associated with its use, ERAS has expanded to most surgical subspecialties, including hepatopancreatobiliary surgery. Although certain concepts are universal to all ERAS protocols, there are unique areas of emphasis pertaining to the hepatopancreatobiliary specialties, which will be highlighted throughout this article. In addition, some of the less frequently discussed aspects of enhanced recovery, including patient-reported outcomes, recovery assessment, cost, and auditing, will be addressed.
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Affiliation(s)
- Heather A Lillemoe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Marino MV, Gulotta G, Komorowski AL. Fully robotic left hepatectomy for malignant tumor: technique and initial results. Updates Surg 2018; 71:129-135. [PMID: 29981056 DOI: 10.1007/s13304-018-0560-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/30/2018] [Indexed: 12/12/2022]
Abstract
Robotic liver surgery has been considered as a unique opportunity to overcome the traditional limitations of laparoscopy; thus, it can potentially extend the indications of minimally invasive liver surgery. From April 2015 to May 2017, 35 patients underwent fully robotic left hepatectomy. The mean operative time was 315 min (200-445 min) and the mean estimated blood loss was 245 ml (125-628 ml). Pringle maneuver was required in six cases. Cancer was the indication for surgery in all patients (14 liver metastases, 18 hepatocellular carcinomas and 3 cholangiocarcinomas). There were one to four lesions in a patient and the mean lesion size was 39.2 mm (15-85 mm). The average length of hospital stay was 6.5 days (5-14 days). Perioperative morbidity rate was 17.2%. Two patients underwent conversion to open surgery. The 90-day mortality rate was nil. The mean surgical resection margin was 12 (1-22) mm, and R0-resection was reached in 33 out of 35 cases. The robotic left hepatectomy provides interesting surgical outcomes and good oncologic adequacy. It can be safely applied for the management of liver malignancies.
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Affiliation(s)
- Marco Vito Marino
- Department of Emergency and General Surgery, Azienda Ospedaliera "Villa Sofia-Cervello", Salerno place 1, 90146, Palermo (PA), Italy.
| | - Gaspare Gulotta
- Department of Emergency and General Surgery, Policlinico "Paolo Giaccone", University Hospital, Giuffrè street 5, 90127, Palermo, Italy
| | - Andrzej Lech Komorowski
- Department of Surgical Oncology, Maria Sklodowska Curie Cancer Center Memorial Hospital, Garncarska street 11, 31-115, Krakow, Poland
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Ratti F, Cipriani F, Reineke R, Comotti L, Paganelli M, Catena M, Beretta L, Aldrighetti L. The clinical and biological impacts of the implementation of fast-track perioperative programs in complex liver resections: A propensity score-based analysis between the open and laparoscopic approaches. Surgery 2018; 164:395-403. [PMID: 29887422 DOI: 10.1016/j.surg.2018.04.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/13/2018] [Accepted: 04/15/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of the fast-track approach in patients undergoing complex liver procedures and to analyse factors that influence morbidity and functional recovery. METHODS Hepatic resections (2014-2016) were stratified according to difficulty score, obtaining a group of 215 complex resections (102 laparoscopic, 163 open). The laparoscopic group was matched by propensity score with open patients to obtain the minimally invasive liver surgery group (n = 102) and the open group (n = 102). RESULTS Groups were similar in terms of patient and disease characteristics. The postoperative morbidity was 31.4% in the minimally invasive liver surgery and 38.2% in the open group (P = .05), and functional recovery was shorter in the minimally invasive liver surgery (respectively 4 versus 6 days, P = .041). The adherence to fast-track was high in both groups, with several items with higher penetrance in the minimally invasive liver surgery group. Among factors associated with morbidity and functional recovery, a laparoscopic approach and strict adherence to a fast-track protocol resulted in protective factors. CONCLUSION The combination of minimally invasive approaches and fast-track protocols allows a reduced rate of postoperative morbidity and satisfactory functional recovery even in the setting of complex liver resections. When the laparoscopic approach is not feasible, strict adherence to a fast-track program is associated with the achievement of adequate results and should be implemented.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy.
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Raffaella Reineke
- Anaesthesiology and Intensive Care Unit, IRCCS San Raffaele Hospital, Milano, Italy
| | - Laura Comotti
- Anaesthesiology and Intensive Care Unit, IRCCS San Raffaele Hospital, Milano, Italy
| | - Michele Paganelli
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Marco Catena
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Luigi Beretta
- Anaesthesiology and Intensive Care Unit, IRCCS San Raffaele Hospital, Milano, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
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29
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Fancellu A, Petrucciani N, Melis M, Porcu A, Feo CF, Zorcolo L, Nigri G. Usefulness of Infra-hepatic Inferior Vena Cava Clamping During Liver Resection: a Meta-analysis of Randomized Controlled Trials. J Gastrointest Surg 2018; 22:941-951. [PMID: 29508216 DOI: 10.1007/s11605-018-3720-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/11/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Infra-hepatic vena cava clamping (IIVCC) may reduce blood losses during liver resection. However, available literature is limited to reports from single institutions with a small sample size. To overcome those limitations, we performed a meta-analysis to examine the association between IIVCC and surgical outcomes. METHODS A systematic literature review was conducted to identify RCTs reporting on quantitative data on IIVCC. Random effects logistic regression calculated the pooled odds ratio (OR) for each surgical outcome. RESULTS Six studies were identified that included 714 patients, of whom 359 received IIVCC and 355 did not. Patients receiving IIVCC had significantly less total blood loss (MD - 353.08, 95% CI - 393.36 to 312.81, P < 0.00001), blood loss during parenchymal transection (MD - 243.28, 95% CI - 311.67 to - 174.88, P < 0.0001), blood loss volume per transection area (MD - 1.63, 95% CI - 2.14 to - 1.13, P < 0.00001), and intraoperative blood transfusion (OR 0.45, 95% CI 0.23 to 0.89, P = 0.02). Operative time was similar in the two groups (MD - 2.89, 95% CI - 18.45 to 12.68, P = 0.72). No differences between groups were observed in central venous pressure, heart rate, and mean arterial pressure before, after, and during parenchymal transection. Rates of overall morbidity (OR 0.79, 95% CI 0.56-1.13, P = 0.20), major complications (OR 0.89, 95% CI 0.47-1.80, P = 0.73), and perioperative mortality (OR 1.32, 95% CI 0.29-6.09, P = 0.72) were similar in the two groups. CONCLUSIONS IIVCC was associated to decreased blood loss (overall, during parenchymal transection, and per transection area) and decreased intraoperative transfusions, in the absence of increased operative times.
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Affiliation(s)
- Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, V.le San Pietro 43, 07100, Sassari, Italy.
| | - Niccolò Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Marcovalerio Melis
- Department of Surgery, Division of Surgical Oncology, New York University School of Medicine, NY Harbor Healthcare System VAMC, New York, NY, USA
| | - Alberto Porcu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, V.le San Pietro 43, 07100, Sassari, Italy
| | - Claudio F Feo
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, V.le San Pietro 43, 07100, Sassari, Italy
| | - Luigi Zorcolo
- Department of Surgery, Colorectal Surgery Center, University of Cagliari, Cagliari, Italy
| | - Giuseppe Nigri
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University of Rome, Rome, Italy
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30
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Sotiropoulos GC, Machairas N, Kostakis ID, Stamopoulos P, Charalampoudis P, Kykalos S, Kouraklis G, Mantas D. Early Experience in Starting a Laparoscopic Liver Resection Program in Greece. JSLS 2018; 21:JSLS.2016.00110. [PMID: 28701858 PMCID: PMC5506778 DOI: 10.4293/jsls.2016.00110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background and Objectives: Laparoscopic liver resections (LLRs) have gained wider acceptance during the decade as safe and efficient procedures in the management of several benign and malignant diseases when performed by experienced surgeons. We report our initial institutional experience with LLRs performed by 1 certified hepatobiliary surgeon. Methods: Patients undergoing LLRs by 1 senior hepatobiliary surgeon in our Institution during the period from January 2012 through January 2017 were prospectively sampled and retrospectively analyzed for the purposes of this study. Results: Forty-two of 175 patients (24%) who had surgery for liver tumors underwent LLR. Median age was 64 years; median body mass index and Charlson comorbidity index were 27.3 kg/m2 and 6.5, respectively. Patients underwent resections for benign (n = 22) or malignant (n = 20) lesions. Median total operating time was 115 minutes and liver resections included: 1 left hepatectomy, 11 bisegmentectomies, 7 segmentectomies, 5 wide wedge resections, 1 left lateral sectionectomy combined with segmentectomy and radiofrequency ablation, 15 liver cyst unroofing, 1 laparoscopic drainage of a pyogenic liver abscess, and 1 laparoscopic drainage of a hepatic hydatid cyst. Blood transfusion was needed in 10 patients. Six patients (14%) had postoperative complications, none of which necessitated reoperation. None of the patients was admitted to the intensive care unit after surgery, and the median hospital stay was 4 days. The tumor-free resection margin was documented in all primary or secondary oncologic cases. Conclusions: Careful patient selection and compliance with the international recommendations are the keys for the successful introduction and evolution of an LLR program with a certified hepatobiliary surgeon with laparoscopic experience.
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Affiliation(s)
| | - Nikolaos Machairas
- Second Department of Propedeutic Surgery, General Hospital Laiko, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propedeutic Surgery, General Hospital Laiko, Athens, Greece
| | | | | | - Stylianos Kykalos
- Second Department of Propedeutic Surgery, General Hospital Laiko, Athens, Greece
| | - Gregory Kouraklis
- Second Department of Propedeutic Surgery, General Hospital Laiko, Athens, Greece
| | - Dimitrios Mantas
- Second Department of Propedeutic Surgery, General Hospital Laiko, Athens, Greece
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Ryu T, Honda G, Kurata M, Kobayashi S, Sakamoto K, Honjo M. Perioperative and oncological outcomes of laparoscopic anatomical hepatectomy for hepatocellular carcinoma introduced gradually in a single center. Surg Endosc 2018; 32:790-798. [PMID: 28733745 DOI: 10.1007/s00464-017-5745-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/14/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anatomical hepatectomy is an ideal curative treatment for hepatocellular carcinoma (HCC). We have standardized our laparoscopic anatomical hepatectomy (LAH) procedure, gradually extending its indications. In the present study, we describe our experience and the perioperative and oncological outcomes of LAH for HCC compared to those of open anatomical hepatectomy (OAH) during the gradual introduction of LAH. METHODS Seventy patients with primary HCC underwent anatomical hepatectomy in our institution from November 2008 to April 2014. As we gained experience with LAH, our indications for choosing LAH over OAH gradually expanded. Ultimately, 40 and 30 patients underwent LAH and OAH, respectively. Perioperative and oncological outcomes were compared between the two groups. RESULTS There were no significant differences in age, sex, background of liver disease, liver function, tumor size, tumor number, or type of liver resection between the two groups. Major complications and mortality rates were similar between the LAH and OAH groups (12.5% vs. 20%; p = 0.582, and 0% vs. 3.3%; p = 0.429, respectively). The median follow-up time after surgery was 40.5 months in the LAH group and 32.9 months in the OAH group (p = 0.835). The 1-, 3-, and 5-year overall survival rates were 89.9, 84.7, and 70.9%, in the LAH group, and 89.8, 68.0, and 63.1% in the OAH group, respectively (p = 0.255). The 1-, 3-, and 5-year disease-free survival rates were 79.5, 58.0, and 42.5%, in the LAH group, and 72.4, 56.1, and 50.4% in the OAH group, respectively (p = 0.980). CONCLUSIONS Through gradual introduction of LAH, we obtained comparable results to those achieved with OAH. LAH can be a feasible surgical treatment for primary HCC, with good oncological outcomes.
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Affiliation(s)
- Tomoki Ryu
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
- Department of Hepato-biliary-Pancreatic Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Goro Honda
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Masanao Kurata
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Shin Kobayashi
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Katsunori Sakamoto
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Masahiko Honjo
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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32
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Stiles ZE, Behrman SW, Glazer ES, Deneve JL, Dong L, Wan JY, Dickson PV. Predictors and implications of unplanned conversion during minimally invasive hepatectomy: an analysis of the ACS-NSQIP database. HPB (Oxford) 2017; 19:957-965. [PMID: 28760630 DOI: 10.1016/j.hpb.2017.06.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 06/12/2017] [Accepted: 06/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Minimally-invasive hepatectomy (MIH) is increasingly utilized; however, predictors and outcomes for patients requiring conversion to an open procedure have not been adequately studied. METHODS The 2014-15 ACS-NSQIP database was analyzed. Unplanned conversion was compared to successful MIH and elective open hepatectomy. RESULTS Among 6918 hepatectomies, 1062 (15.4%) underwent attempted MIH: 989 laparoscopic, 73 robotic. Conversion occurred in 203 (19.1%). Compared to successful MIH, patients requiring unplanned conversion experienced higher rates of complications (34.5% vs 14.6%, p<0.001), including bile leaks (7.4% vs 2.8%, p=0.002), organ space infection (6.4% vs 2.9%, p=0.016), UTI (4.9% vs 1.2%, p=0.002), perioperative bleeding (21.2% vs 6.1%, p<0.001), DVT (3.0% vs 0.8%, p=0.024), and sepsis (5.9% vs 1.9%, p=0.001). Conversion led to greater LOS (5 days vs 3 days, p<0.001) and 30-day mortality (3.0% vs 0.5%, p=0.005). Compared to elective open hepatectomy, conversion was associated with greater perioperative bleeding (21.2% vs 15.3%, p = 0.037). On multivariate analysis, major hepatectomy (OR 2.21, p<0.001), concurrent ablation (OR 1.79, p=0.020), and laparoscopic approach (vs. robotic) (OR 3.22, p=0.014) were associated with conversion. CONCLUSION Analysis of this national database revealed unplanned conversion during MIH is associated with greater morbidity and mortality. MIH should be approached cautiously in patients requiring major hepatectomy.
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Affiliation(s)
- Zachary E Stiles
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Stephen W Behrman
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Evan S Glazer
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeremiah L Deneve
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lei Dong
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jim Y Wan
- Department of Preventive Medicine, Division of Biostatistics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Paxton V Dickson
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA.
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33
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Melloul E, Hübner M, Scott M, Snowden C, Prentis J, Dejong CHC, Garden OJ, Farges O, Kokudo N, Vauthey JN, Clavien PA, Demartines N. Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J Surg 2017; 40:2425-40. [PMID: 27549599 DOI: 10.1007/s00268-016-3700-1] [Citation(s) in RCA: 403] [Impact Index Per Article: 50.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) is a multimodal pathway developed to overcome the deleterious effect of perioperative stress after major surgery. In colorectal surgery, ERAS pathways reduced perioperative morbidity, hospital stay and costs. Similar concept should be applied for liver surgery. This study presents the specific ERAS Society recommendations for liver surgery based on the best available evidence and on expert consensus. METHODS A systematic review was performed on ERAS for liver surgery by searching EMBASE and Medline. Five independent reviewers selected relevant articles. Quality of randomized trials was assessed according to the Jadad score and CONSORT statement. The level of evidence for each item was determined using the GRADE system. The Delphi method was used to validate the final recommendations. RESULTS A total of 157 full texts were screened. Thirty-seven articles were included in the systematic review, and 16 of the 23 standard ERAS items were studied specifically for liver surgery. Consensus was reached among experts after 3 rounds. Prophylactic nasogastric intubation and prophylactic abdominal drainage should be omitted. The use of postoperative oral laxatives and minimally invasive surgery results in a quicker bowel recovery and shorter hospital stay. Goal-directed fluid therapy with maintenance of a low intraoperative central venous pressure induces faster recovery. Early oral intake and mobilization are recommended. There is no evidence to prefer epidural to other types of analgesia. CONCLUSIONS The current ERAS recommendations were elaborated based on the best available evidence and endorsed by the Delphi method. Nevertheless, prospective studies need to confirm the clinical use of the suggested protocol.
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Affiliation(s)
- Emmanuel Melloul
- Department of Visceral Surgery, University Hospital Lausanne, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Martin Hübner
- Department of Visceral Surgery, University Hospital Lausanne, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Michael Scott
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Chris Snowden
- Department of Perioperative and Critical Care Medicine, Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, The Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - James Prentis
- Department of Perioperative and Critical Care Medicine, Freeman Hospital, Newcastle upon Tyne, UK
| | - Cornelis H C Dejong
- Department of Surgery, Maastricht University Medical Center and NUTRIM School for Translational Research in Metabolism, Maastricht, The Netherlands
| | - O James Garden
- Department of Clinical Surgery, School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK
| | - Olivier Farges
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, U.T. MD Anderson Cancer Center, Houston, TX, USA
| | - Pierre-Alain Clavien
- Swiss Hepato-pancreato-biliary and Transplantation Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital Lausanne, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Otsuka Y, Kaneko H. Laparoscopic liver resection in the treatment of HCC with liver cirrhosis: would it provide superiority to conventional open hepatectomy? Hepatobiliary Surg Nutr 2017; 6:356-358. [PMID: 29152489 DOI: 10.21037/hbsn.2017.06.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Yuichiro Otsuka
- Division of General and Gastroenterological Surgery, Department of Surgery, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
| | - Hironori Kaneko
- Division of General and Gastroenterological Surgery, Department of Surgery, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
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35
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López-Ben S, Ranea A, Albiol MT, Falgueras L, Castro E, Casellas M, Codina-Barreras A, Figueras J. Evolution of laparoscopic surgery in a high volume hepatobiliary unit: 150 consecutive pure laparoscopic hepatectomies. Cir Esp 2017; 95:261-267. [PMID: 28583725 DOI: 10.1016/j.ciresp.2017.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 04/17/2017] [Accepted: 04/26/2017] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Compared to other surgical areas, laparoscopic liver resection (LLR) has not been widely implemented and currently less than 20% of hepatectomies are performed laparoscopically worldwide. The aim of our study was to evaluate the feasibility, and the ratio of implementation of LLR in our department. METHODS We analyzed a prospectively maintained database of 749 liver resections performed during the last 10-year period in a single centre. RESULTS A total of 150 (20%) consecutive pure LLR were performed between 2005 and 2015. In 87% of patients the indication was the presence ofprimary or metastatic liver malignancy. We performed 30 major hepatectomies (20%) and (80%) were minor resections, performed in all liver segments. Twelve patients were operated twice and 2 patients underwent a third LLR. The proportion of LLR increased from 12% in 2011 to 62% in the last year. Conversion rate was 9%. Overall morbidity rate was 36% but only one third were classified as severe. The 90-day mortality rate was 1%. Median hospital stay was 4 days and the rate of readmissions was 6%. CONCLUSIONS The implementation of LLR has been fast with morbidity and mortality comparable to other published series. In the last 2 years more than half of the hepatectomies are performed laparoscopically in our centre.
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Affiliation(s)
- Santiago López-Ben
- Unidad Hepatobiliopancreática, Servicio de Cirugía Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, España.
| | - Alejandro Ranea
- Unidad Hepatobiliopancreática, Servicio de Cirugía Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, España
| | - M Teresa Albiol
- Unidad Hepatobiliopancreática, Servicio de Cirugía Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, España
| | - Laia Falgueras
- Unidad Hepatobiliopancreática, Servicio de Cirugía Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, España
| | - Ernesto Castro
- Unidad Hepatobiliopancreática, Servicio de Cirugía Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, España
| | - Margarida Casellas
- Unidad Hepatobiliopancreática, Servicio de Cirugía Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, España
| | - Antoni Codina-Barreras
- Unidad Hepatobiliopancreática, Servicio de Cirugía Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, España
| | - Joan Figueras
- Unidad Hepatobiliopancreática, Servicio de Cirugía Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, España
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36
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Kaneko H, Otsuka Y, Kubota Y, Wakabayashi G. Evolution and revolution of laparoscopic liver resection in Japan. Ann Gastroenterol Surg 2017; 1:33-43. [PMID: 29863134 PMCID: PMC5881311 DOI: 10.1002/ags3.12000] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/15/2017] [Indexed: 12/21/2022] Open
Abstract
Due to important technological developments and improved endoscopic techniques, laparoscopic liver resection (LLR) is now considered the approach of choice and is increasingly performed worldwide. Recent systematic reviews and meta‐analyses of observational data reported that LLR was associated with less bleeding, fewer complications, and no oncological disadvantage; however, no prospective randomized trials have been conducted. LLR will continue to evolve as a surgical approach that improves patient's quality of life. LLR will not totally supplant open liver surgery, and major LLR remains to be technically challenging procedure. The success of LLR depends on individual learning curves and adherence to surgical indications. A recent study proposed a scoring system for stepwise application of LLR, which was based on experience at high‐volume Japanese centers. A cluster of deaths after major LLR was sensationally reported by the Japanese media in 2014. In response, the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery conducted emergency data collection on operative mortality. The results demonstrated that mortality was not higher than that for open procedures except for hemi‐hepatectomy with biliary reconstruction. An online prospective registry system for LLR was established in 2015 to be transparent for patients who might potentially undergo treatment with this newly developed, technically demanding surgical procedure.
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Affiliation(s)
- Hironori Kaneko
- Division of General and Gastroenterological Surgery Department of Surgery Toho University Faculty of Medicine Tokyo Japan
| | - Yuichiro Otsuka
- Division of General and Gastroenterological Surgery Department of Surgery Toho University Faculty of Medicine Tokyo Japan
| | - Yoshihisa Kubota
- Division of General and Gastroenterological Surgery Department of Surgery Toho University Faculty of Medicine Tokyo Japan
| | - Go Wakabayashi
- Division of General and Gastroenterological Surgery Department of Surgery Toho University Faculty of Medicine Tokyo Japan.,Department of Surgery Ageo Central General Hospital Saitama Japan
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37
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Sotiropoulos GC, Prodromidou A, Kostakis ID, Machairas N. Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma. Updates Surg 2017; 69:291-311. [PMID: 28220382 DOI: 10.1007/s13304-017-0421-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/06/2017] [Indexed: 02/07/2023]
Abstract
Laparoscopic liver resections (LLR) are widely accepted as safe and effective procedures for the management of hepatocellular carcinoma (HCC) in the hands of experienced surgeons. The efficacy and extent of benefits of pure as well as hand-assisted laparoscopic and laparoscopy-assisted liver resection over open liver resection (OLR) have been investigated by numerous studies during the last 10 years. The aim of our meta-analysis is to investigate the effect of LLR in short- and long-term outcomes compared to OLR in patients operated for HCC. A total of 5203 patients from forty-four studies were included in our meta-analysis reporting for short- and long-term results for both LLR and OLR for HCC. Among them, 1830 underwent pure laparoscopic hepatectomy, 282 underwent pure laparoscopic or hand-assisted laparoscopic or laparoscopy-assisted hepatectomy, and 3091 were operated through open approach. LLRs were found to be significantly associated with lower blood loss, need for blood transfusion, successful achievement of R0 resection as well as wider resection margin, shorter hospital stay, lower morbidity and 30-day mortality rates. Operative time, tumor recurrence, 1-, 3-, and 5-year overall survival as well as 1-, 3-, and 5-year disease-free survival were not found different between the groups. This meta-analysis clearly demonstrates the superiority of laparoscopic resection over the open approach for patients with small HCC.
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Affiliation(s)
- Georgios C Sotiropoulos
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, General Hospital Laiko, Agiou Thoma Str. 17, 11527, Athens, Greece
| | - Anastasia Prodromidou
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, General Hospital Laiko, Agiou Thoma Str. 17, 11527, Athens, Greece
| | - Ioannis D Kostakis
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, General Hospital Laiko, Agiou Thoma Str. 17, 11527, Athens, Greece
| | - Nikolaos Machairas
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, General Hospital Laiko, Agiou Thoma Str. 17, 11527, Athens, Greece.
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Xie W, Cao D, Yang J, Yu M, Shen K, Zhao L. Single-Port vs Multiport Laparoscopic Hysterectomy: A Meta-Analysis of Randomized Controlled Trials. J Minim Invasive Gynecol 2016; 23:1049-1056. [PMID: 27590569 DOI: 10.1016/j.jmig.2016.08.826] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/15/2016] [Accepted: 08/22/2016] [Indexed: 12/23/2022]
Abstract
Numerous studies have compared the surgical outcomes of single-port laparoscopic hysterectomy (LH) and conventional multiport LH, but the results are conflicting. The aim of this meta-analysis was to compare the safety and efficacy of single-port LH and multiport LH for benign gynecologic conditions based on published reports. PubMed, the Cochrane Central Register of Controlled Trials, and Embase were searched for relevant randomized controlled trials (RCTs). Outcome measures included intraoperative and postoperative complication rates, postoperative pain, conversion rate, operative time, estimated blood loss (EBL), and length of hospital stay. Pooled outcome measures (risk ratio [RR] and weighted mean difference [WMD]) were pooled with either a fixed-effects model or a random-effects model. Six RCTs encompassing 624 patients were included. There were no significant differences between single-port LH and multiport LH in terms of intraoperative complication rate (RR, 1.00; 95% confidence interval [CI], 0.14-7.05; p = .00), postoperative complication rate (RR, 0.95; 95% CI, 0.63-1.44; p = .82), postoperative pain (WMD, -0.42; 95% CI, -0.99 to 0.15; p = .15), conversion rate (p = .11), EBL (p = .51), or length of hospital stay (p = .27). However, single-port LH was associated with an average of 13.13 minutes longer operative time than multiport LH (p = .02). Our findings show that single-port LH is a safe and effective technique for benign gynecologic conditions, although it may require a longer operative time than multiport LH. Further large, prospective RCTs with long-term follow-up are needed to determine whether single-port LH really offers such benefits as better cosmetic outcome over multiport LH.
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Affiliation(s)
- Weimin Xie
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Mei Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Zhao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Guro H, Cho JY, Han HS, Yoon YS, Choi Y, Periyasamy M. Current status of laparoscopic liver resection for hepatocellular carcinoma. Clin Mol Hepatol 2016; 22:212-8. [PMID: 27304550 PMCID: PMC4946407 DOI: 10.3350/cmh.2016.0026] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 05/03/2016] [Indexed: 12/19/2022] Open
Abstract
Laparoscopic liver resection (LLR) is becoming widely accepted for the treatment of hepatocellular carcinoma (HCC). Laparoscopic left lateral sectionectomy and minor laparoscopic liver resection are now considered standard approaches, especially for tumors located in the anterolateral segments of the liver. Laparoscopic left lateral sectionectomy in adult donors is also gaining acceptance for child liver transplantation in many centers. Major LLRs, including left hepatectomy and right hepatectomy, have been recently attempted. Laparoscopic donor hepatectomy is becoming more popular owing to increasing demand from young living donors who appreciate its minimal invasiveness and excellent cosmetic outcomes. Several centers have performed total laparoscopic donor right hepatectomy in adult-to-adult living donor liver transplantation. Many meta-analyses have shown that LLR is better than open liver resection in terms of short-term outcomes, principally cosmetic outcomes. Although no randomized control trials have compared LLR with open liver resection, the long-term oncologic outcomes were similar for both procedures in recent case-matched studies.
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Affiliation(s)
- Hanisah Guro
- Department of Surgery, Amai Pakpak Medical Center, Marawi City, Philippines.,Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Mohan Periyasamy
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Department of Surgery, Tamil Nadu Dr. MGR Medical University, Chennai, India
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40
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Qi X, Zhao Y, Li H, Guo X, Han G. Management of hepatocellular carcinoma: an overview of major findings from meta-analyses. Oncotarget 2016; 7:34703-34751. [PMID: 27167195 PMCID: PMC5085185 DOI: 10.18632/oncotarget.9157] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/11/2016] [Indexed: 02/07/2023] Open
Abstract
This paper aims to systematically review the major findings from meta-analyses comparing different treatment options for hepatocellular carcinoma (HCC). A total of 153 relevant papers were searched via the PubMed, EMBASE, and Cochrane library databases. They were classified according to the mainstay treatment modalities (i.e., liver transplantation, surgical resection, radiofrequency ablation, transarterial embolization or chemoembolization, sorafenib, and others). The primary outcome data, such as overall survival, diseases-free survival or recurrence-free survival, progression-free survival, and safety, were summarized. The recommendations and uncertainties regarding the treatment of HCC were also proposed.
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Affiliation(s)
- Xingshun Qi
- Department of Gastroenterology and Meta-analysis Study Interest Group, General Hospital of Shenyang Military Area, Shenyang, 110840 China
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032 China
| | - Yan Zhao
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032 China
- Department of Gastroenterology, First Affiliated Hospital of the Medical College, Xi'an Jiaotong University, Xi'an, 710000 China
| | - Hongyu Li
- Department of Gastroenterology and Meta-analysis Study Interest Group, General Hospital of Shenyang Military Area, Shenyang, 110840 China
| | - Xiaozhong Guo
- Department of Gastroenterology and Meta-analysis Study Interest Group, General Hospital of Shenyang Military Area, Shenyang, 110840 China
| | - Guohong Han
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032 China
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41
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Krüger JAP, Fonseca GM, Coelho FF, Jeismann V, Herman P. Laparoscopic Right Hepatectomy for Cirrhotic Patients: Takasaki's Hilar Control and Caudal Approach. Ann Surg Oncol 2016; 24:558-559. [PMID: 27271928 DOI: 10.1245/s10434-016-5288-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cirrhotic patients bearing hepatocellular carcinomas (HCC) derive benefits from laparoscopic hepatectomy1 - 6 such as reduced bleeding, less overall and liver-specific complications, and fewer adhesions in the case of future reoperation or transplantation.7 - 10 Bleeding is concerning in the setting of cirrhosis,11 - 15 and adequate inflow control reduces blood loss. The caudal approach is the laparoscopic counterpart of the anterior approach to open surgery. It implies in parenchymal transection initiated from the visceral surface of the liver after limited hepatic mobilization, reducing the risk of increased circulating tumoral cells.16 - 18 Venous outflow transection and completion of ligament mobilization are left as last steps. METHODS A 46 years-old-male with hepatitis C virus and alcoholic cirrhosis was diagnosed with a 4-cm HCC (right hepatic lobe). Expected future liver remnant was 45 % of his total liver volume. A totally laparoscopic right hepatectomy was performed using six ports, and the specimen was removed through a Pfannenstiel auxiliary incision. A 10-mm 30° scope was used. The pneumoperitoneum pressure was set to 12 mmHg. The right hepatic pedicle, the caudate lobe, and the major hepatic veins were managed with laparoscopic vascular staplers. RESULTS Surgery was performed with limited liver mobilization and en bloc extrafascial right pedicle control (Takasaki's technique),19 followed by caudal parenchymal transection along the paracaval plane. The operative time was 450 min, and the estimated blood loss was 800 ml (no transfusion was required). CONCLUSION The laparoscopic Takasaki technique and caudal approach are feasible procedures in the setting of cirrhosis, resulting in an oncologic adequate intervention with less morbidity.
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Affiliation(s)
- Jaime Arthur Pirola Krüger
- Hospital das Clinicas (HC/FMUSP), University of Sao Paulo, São Paulo, Brazil. .,Instituto do Cancer do Estado de Sao Paulo (ICESP), University of Sao Paulo, São Paulo, Brazil.
| | | | | | - Vagner Jeismann
- Hospital das Clinicas (HC/FMUSP), University of Sao Paulo, São Paulo, Brazil.,Instituto do Cancer do Estado de Sao Paulo (ICESP), University of Sao Paulo, São Paulo, Brazil
| | - Paulo Herman
- Hospital das Clinicas (HC/FMUSP), University of Sao Paulo, São Paulo, Brazil
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Coelho FF, Kruger JAP, Fonseca GM, Araújo RLC, Jeismann VB, Perini MV, Lupinacci RM, Cecconello I, Herman P. Laparoscopic liver resection: Experience based guidelines. World J Gastrointest Surg 2016; 8:5-26. [PMID: 26843910 PMCID: PMC4724587 DOI: 10.4240/wjgs.v8.i1.5] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/07/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant (both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments (1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers’ practice. Continuous surgical training, as well as new technologies should augment the application of laparoscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation.
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43
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Cheung TT, Lo CM. Laparoscopic liver resection for hepatocellular carcinoma in patients with cirrhosis. Hepatobiliary Surg Nutr 2016; 4:406-10. [PMID: 26734625 DOI: 10.3978/j.issn.2304-3881.2015.06.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Liver resection for patients with cirrhosis remains a challenging operation. The presence of thrombocytopenia and portal hypertension could lead to severe bleeding during hepatectomy. The enthusiasm of laparoscopic hepatectomy has been growing and many studies have reported their initial favorable results for patients with hepatocellular carcinoma (HCC). The advancement in technology, better understanding of the use of pneumoperitoneum pressure and more experience accumulated make laparoscopic liver resection for patients with cirrhosis possible. Favorable outcome may be achieved if the patients are carefully selected and carried out in high volume centers.
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Affiliation(s)
- Tan To Cheung
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Chung Mau Lo
- Department of Surgery, The University of Hong Kong, Hong Kong, China
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Brytska N, Han HS, Shehta A, Yoon YS, Cho JY, Choi Y. Laparoscopic liver resection for hepatitis B and C virus-related hepatocellular carcinoma in patients with Child B or C cirrhosis. Hepatobiliary Surg Nutr 2016; 4:373-8. [PMID: 26734621 DOI: 10.3978/j.issn.2304-3881.2015.04.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the clinical and oncological outcomes after laparoscopic liver resection (LLR) in patients with hepatitis B and C virus-related hepatocellular carcinoma (HCC) with Child B or C cirrhosis. METHODS Between January 2004 and December 2013, LLR was performed in 232 patients with HCC. Of these, 141 patients also had pathologically proven cirrhosis. Sixteen patients with hepatitis B and C virus-related HCC with Child B or C cirrhosis were included in the study. Thirteen (81.3%) patients had Child B disease and three (18.8%) patients had Child C disease. RESULTS The median operation time was 215 min, the median estimated blood loss was 350 mL, and the median hospital stay was eight days. Three patients (18.8%) experienced complications after surgery. There was no postoperative mortality or reoperation. The mean follow-up period was 51.6 months. HCC recurred in eight (50%) patients: seven intrahepatic recurrences and one extrahepatic recurrence. The treatments for recurrence were laparoscopic reoperation in one (6.3%) patient, trans-catheter arterial chemo-embolization (TACE) in one (6.3%) patient, radiofrequency ablation (RFA) in one (6.3%) patient, and combined TACE and RFA in four (25%) patients. The five-year postoperative overall survival (OS) and disease-free survival (DFS) were 84.4% and 41.7%, respectively. CONCLUSIONS This study demonstrates that LLR can be safely used in patients with hepatitis B and C virus-related HCC and Child B or C cirrhosis, with acceptable survival outcomes.
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Affiliation(s)
- Nataliya Brytska
- 1 Department of Hepatobiliary and Pancreatic Surgery, State Institution "Zaycev V.T. Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine", Ukraine ; 2 Department of General Surgery, Seoul National University Bundang Hospital, Seoul National University, Seoul, South Korea ; 3 Gastroenterology Surgical Centre, Department of Surgery, Mansoura University, Mansoura, Egypt
| | - Ho-Seong Han
- 1 Department of Hepatobiliary and Pancreatic Surgery, State Institution "Zaycev V.T. Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine", Ukraine ; 2 Department of General Surgery, Seoul National University Bundang Hospital, Seoul National University, Seoul, South Korea ; 3 Gastroenterology Surgical Centre, Department of Surgery, Mansoura University, Mansoura, Egypt
| | - Ahmed Shehta
- 1 Department of Hepatobiliary and Pancreatic Surgery, State Institution "Zaycev V.T. Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine", Ukraine ; 2 Department of General Surgery, Seoul National University Bundang Hospital, Seoul National University, Seoul, South Korea ; 3 Gastroenterology Surgical Centre, Department of Surgery, Mansoura University, Mansoura, Egypt
| | - Yoo-Seok Yoon
- 1 Department of Hepatobiliary and Pancreatic Surgery, State Institution "Zaycev V.T. Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine", Ukraine ; 2 Department of General Surgery, Seoul National University Bundang Hospital, Seoul National University, Seoul, South Korea ; 3 Gastroenterology Surgical Centre, Department of Surgery, Mansoura University, Mansoura, Egypt
| | - Jai Young Cho
- 1 Department of Hepatobiliary and Pancreatic Surgery, State Institution "Zaycev V.T. Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine", Ukraine ; 2 Department of General Surgery, Seoul National University Bundang Hospital, Seoul National University, Seoul, South Korea ; 3 Gastroenterology Surgical Centre, Department of Surgery, Mansoura University, Mansoura, Egypt
| | - YoungRok Choi
- 1 Department of Hepatobiliary and Pancreatic Surgery, State Institution "Zaycev V.T. Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine", Ukraine ; 2 Department of General Surgery, Seoul National University Bundang Hospital, Seoul National University, Seoul, South Korea ; 3 Gastroenterology Surgical Centre, Department of Surgery, Mansoura University, Mansoura, Egypt
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Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: A qualified systematic review. World J Methodol 2015; 5:238-254. [PMID: 26713285 PMCID: PMC4686422 DOI: 10.5662/wjm.v5.i4.238] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To review current applications of the laparoscopic surgery while highlighting the standard procedures across different fields.
METHODS: A comprehensive search was undertaken using the PubMed Advanced Search Builder. A total of 321 articles were found in this search. The following criteria had to be met for the publication to be selected: Review article, randomized controlled trials, or meta-analyses discussing the subject of laparoscopic surgery. In addition, publications were hand-searched in the Cochrane database and the high-impact journals. A total of 82 of the findings were included according to matching the inclusion criteria. Overall, 403 full-text articles were reviewed. Of these, 218 were excluded due to not matching the inclusion criteria.
RESULTS: A total of 185 relevant articles were identified matching the search criteria for an overview of the current literature on the laparoscopic surgery. Articles covered the period from the first laparoscopic application through its tremendous advancement over the last several years. Overall, the biggest advantage of the procedure has been minimizing trauma to the abdominal wall compared with open surgery. In the case of cholecystectomy, fundoplication, and adrenalectomy, the procedure has become the gold standard without being proven as a superior technique over the open surgery in randomized controlled trials. Faster recovery, reduced hospital stay, and a quicker return to normal activities are the most evident advantages of the laparoscopic surgery. Positive outcomes, efficiency, a lower rate of wound infections, and reduction in the perioperative morbidity of minimally invasive procedures have been shown in most indications.
CONCLUSION: Improvements in surgical training and developments in instruments, imaging, and surgical techniques have greatly increased safety and feasibility of the laparoscopic surgical procedures.
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Han DH, Choi SH, Park EJ, Kang DR, Choi GH, Choi JS. Surgical outcomes after laparoscopic or robotic liver resection in hepatocellular carcinoma: a propensity-score matched analysis with conventional open liver resection. Int J Med Robot 2015; 12:735-742. [PMID: 26537176 DOI: 10.1002/rcs.1714] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 07/08/2015] [Accepted: 10/05/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study was designed to compare perioperative and oncologic outcomes between minimally invasive liver resection (MILR) and conventional open liver resection (COLR) for hepatocellular carcinoma (HCC) using a propensity-score matched analysis. METHODS Ninety-nine patients who received MILR were matched with 198 patients treated with COLR out of 928 patients with HCC who received curative liver resection from 2002 to 2012. A multivariable logistic model based on factors related to the patient, tumor, and surgical procedure was used to estimate a propensity score. RESULTS The MILR group experienced significantly less intraoperative blood loss (mean: 389.55 vs 580.66 mL; P = 0.008), lower complication rates (13.1% vs 24.7%; P = 0.020), and a shorter length of hospital stay (mean: 8.40 vs 13.39 days; P < 0.001). The two groups did not differ significantly in disease-free (P = 0.701) or overall survival (P = 0.086). CONCLUSIONS MILR produced better perioperative and comparable oncologic outcomes than COLR for HCC. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Dai Hoon Han
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Robot & MIS Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Robot & MIS Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jung Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Ryong Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Robot & MIS Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Gi Hong Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Robot & MIS Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sub Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Robot & MIS Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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47
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Wakabayashi G, Ikeda T, Otsuka Y, Nitta H, Cho A, Kaneko H. General Gastroenterological Surgery 3: Liver. Asian J Endosc Surg 2015; 8:365-73. [PMID: 26708579 DOI: 10.1111/ases.12225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 12/16/2022]
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Galun D, Basaric D, Zuvela M, Bulajic P, Bogdanovic A, Bidzic N, Milicevic M. Hepatocellular carcinoma: From clinical practice to evidence-based treatment protocols. World J Hepatol 2015; 7:2274-91. [PMID: 26380652 PMCID: PMC4568488 DOI: 10.4254/wjh.v7.i20.2274] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 07/06/2015] [Accepted: 08/30/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the major malignant diseases in many healthcare systems. The growing number of new cases diagnosed each year is nearly equal to the number of deaths from this cancer. Worldwide, HCC is a leading cause of cancer-related deaths, as it is the fifth most common cancer and the third most important cause of cancer related death in men. Among various risk factors the two are prevailing: viral hepatitis, namely chronic hepatitis C virus is a well-established risk factor contributing to the rising incidence of HCC. The epidemic of obesity and the metabolic syndrome, not only in the United States but also in Asia, tend to become the leading cause of the long-term rise in the HCC incidence. Today, the diagnosis of HCC is established within the national surveillance programs in developed countries while the diagnosis of symptomatic, advanced stage disease still remains the characteristic of underdeveloped countries. Although many different staging systems have been developed and evaluated the Barcelona-Clinic Liver Cancer staging system has emerged as the most useful to guide HCC treatment. Treatment allocation should be decided by a multidisciplinary board involving hepatologists, pathologists, radiologists, liver surgeons and oncologists guided by personalized -based medicine. This approach is important not only to balance between different oncologic treatments strategies but also due to the complexity of the disease (chronic liver disease and the cancer) and due to the large number of potentially efficient therapies. Careful patient selection and a tailored treatment modality for every patient, either potentially curative (surgical treatment and tumor ablation) or palliative (transarterial therapy, radioembolization and medical treatment, i.e., sorafenib) is mandatory to achieve the best treatment outcome.
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Affiliation(s)
- Danijel Galun
- Danijel Galun, Dragan Basaric, Marinko Zuvela, Predrag Bulajic, Aleksandar Bogdanovic, Nemanja Bidzic, Miroslav Milicevic, Clinic of Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dragan Basaric
- Danijel Galun, Dragan Basaric, Marinko Zuvela, Predrag Bulajic, Aleksandar Bogdanovic, Nemanja Bidzic, Miroslav Milicevic, Clinic of Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Marinko Zuvela
- Danijel Galun, Dragan Basaric, Marinko Zuvela, Predrag Bulajic, Aleksandar Bogdanovic, Nemanja Bidzic, Miroslav Milicevic, Clinic of Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Predrag Bulajic
- Danijel Galun, Dragan Basaric, Marinko Zuvela, Predrag Bulajic, Aleksandar Bogdanovic, Nemanja Bidzic, Miroslav Milicevic, Clinic of Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Aleksandar Bogdanovic
- Danijel Galun, Dragan Basaric, Marinko Zuvela, Predrag Bulajic, Aleksandar Bogdanovic, Nemanja Bidzic, Miroslav Milicevic, Clinic of Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nemanja Bidzic
- Danijel Galun, Dragan Basaric, Marinko Zuvela, Predrag Bulajic, Aleksandar Bogdanovic, Nemanja Bidzic, Miroslav Milicevic, Clinic of Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miroslav Milicevic
- Danijel Galun, Dragan Basaric, Marinko Zuvela, Predrag Bulajic, Aleksandar Bogdanovic, Nemanja Bidzic, Miroslav Milicevic, Clinic of Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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49
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Geller DA, Tsung A. Long-term outcomes and safety of laparoscopic liver resection surgery for hepatocellular carcinoma and metastatic colorectal cancer. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:728-30. [PMID: 26123552 DOI: 10.1002/jhbp.278] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- David A Geller
- Department of Surgery, University of Pittsburgh, 3459 Fifth Avenue, Pittsburgh, PA 15213-2582, USA.
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh, 3459 Fifth Avenue, Pittsburgh, PA 15213-2582, USA
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50
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Bruns H, Büchler MW, Schemmer P. [Liver transection: modern procedure: Technique, results and costs]. Chirurg 2015; 86:552-560. [PMID: 25298187 DOI: 10.1007/s00104-014-2892-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Liver resection has developed into the current standard procedure due to modern resection techniques, profound knowledge of the liver anatomy and optimized surgical and anesthesiological strategies to allow extended resections with both low morbidity and mortality. Initially major blood loss was the biggest concern with liver resection and a Pringle's manoeuvre was necessary. Nowadays, biliary leakage is the major problem after liver surgery. Besides the classical conventional clamp crushing technique for parenchymal transection, various devices including ultrasound, microwaves and staplers have been introduced. Minimally invasive techniques have become increasingly important for liver resection but are still applied in selected patients only. The selection of the resection technique and device mainly depends on the extent of the resection and also on the liver parenchyma, the liver disease, costs, personal experiences and preferences. This article presents a selection of techniques used in modern parenchymal transection during liver resection with special focus on transection time, blood loss, bile leakage and costs.
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Affiliation(s)
- H Bruns
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Ruprecht-Karls-Universität, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
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