Evaluation of stapler hepatectomy during a laparoscopic liver resection |
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| Authors: | Joseph F Buell Brice Gayet Ho-Seong Han Go Wakabayashi Ki-Hun Kim Giulio Belli Robert Cannon Bob Saggi Hiro Keneko Alan Koffron Guy Brock Ibrahim Dagher |
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| Institution: | 1. Tulane Transplant Institute, Tulane University, New Orleans, LA, USA;2. Department of Surgery, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA;3. Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA;4. Division of Transplantation, William Beaumont Hospital, Detroit, MI, USA;5. Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France;6. Department of General Surgery, Antoine Beclere Hospital, Paris-Sud School of Medicine, Clamart, France;7. Department of Surgery, Seoul National University, Bundang Hospital, Seoul, South Korea;8. Department of Surgery, Ulsan University and Asan Medical Center, Seoul, South Korea;9. Department of SurgeryIwate Medical University, Morioka City, Japan;10. Department of Surgery, Toho University School of Medicine, Tokyo, Japan;11. Department of Surgery, Loreto Nuovo Hospital, Naples, Italy |
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| Abstract: | MethodsAn international database of 1499 laparoscopic liver resections was analysed using multivariate and Kaplan–Meier analysis.ResultsIn total, 764 stapler hepatectomies (SH) were compared with 735 electrosurgical resections (ER). SH was employed in larger tumours (4.5 versus 3.8 cm; P < 0.003) with decreased operative times (2.6 versus 3.1 h; P < 0.001), blood loss (100 versus 200 cc; P < 0.001) and length of stay (3.0 versus 7.0 days; P < 0.001). SH incurred a trend towards higher complications (16% versus 13%; P = 0.057) including bile leaks (26/764, 3.4% versus 16/735, 2.2%: P = 0.091). To address group homogeneity, a subset analysis of lobar resections confirmed the benefits of SH. Kaplan–Meier analysis in non-cirrhotic and cirrhotic patients confirmed equivalent patient (P = 0.290 and 0.118) and disease-free survival (P = 0.120 and 0.268). Multivariate analysis confirmed the parenchymal transection technique did not increase the risk of cancer recurrence, whereas tumour size, the presence of cirrhosis and concomitant operations did.ConclusionsA SH provides several advantages including: diminished blood loss, transfusion requirements and shorter operative times. In spite of the smaller surgical margins in the SH group, equivalent recurrence and survival rates were observed when matched for parenchyma and extent of resection. |
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