Laparoscopic left hemihepatectomy a consideration for acceptance as standard of care |
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Authors: | Giulio Belli Brice Gayet Ho-Seong Han Go Wakabayashi Ki-hun Kim Robert Cannon Hironori Kaneko Thomas Gamblin Alan Koffron Ibrahim Dagher Joseph F. Buell |
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Affiliation: | 1. S. Maria Loreto Nuovo Hospital, General and Hepato-Pancreato-Biliary Surgery, Naples, Italy 2. Department of Digestive Diseases, Institut Mutualiste Montsouris, University Paris V, Paris, France 3. Department of Surgery, Seoul National University Bundang Hospital, Seoul, Korea 4. Iwate Medical University, Surgery Keio University, Tokyo, Japan 5. Division of Hepatobiliary Surgery and Liver Transplantation, University of Ulsan College of Medicine and Asan Medical Centre, Songpa-gu, Seoul, Korea 6. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA 7. Department of Surgery, Toho University School of Medicine, Tokyo, Japan 8. Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA 9. William Beaumont Hospital, Chicago, IL, USA 10. Department of Digestive and Minimally Invasive Surgery, AP-HP, Antoine Béclère Hospital, Clamart, France 11. Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Abstract: | Introduction Since the inception of laparoscopic liver surgery, the left-lateral sectionectomy has become the standard of care for resection of lesions located in segments II and III. However, few centers employee laparoscopic left hemihepatectomy on a routine basis. This study evaluated the safety and efficacy of the laparoscopic left hemihepatectomy as a standard of care. Methods An international database of 1,620 laparoscopic liver resections was established and outcomes analyzed comparing the laparoscopic left lateral sectionectomy (L lat) to laparoscopic left hemihepatectomy (LH). All data are presented as mean ± standard deviation. Results A total of 222 laparoscopic L lat and 82 LH were identified. The L lat group compared with LH group had a higher incidence of cirrhosis (27 vs. 21 %; p = 0.003) and cancer (48 vs. 35 %; p = 0.043). Tumors were larger in the LH group (7.09 ± 4.2 vs. 4.89 ± 3.1 cm; p = 0.001). Operating time for LH was longer than L lat (3.9 ± 2.3 vs. 2.9 ± 1.4 h; p < 0.001). Operative blood loss was higher in LH (306 vs. 198 cc; p = 0.003). Patient morbidity (20 vs. 18 %; p = 0.765) was equivalent with a longer length of stay (7.1 ± 5.1 vs. 2.5 ± 2.3 days; p < 0.001) for LH. Patient mortality and tumor recurrence were equivalent. Conclusions Laparoscopic left hemihepatectomy is a more technically challenging and often time-consuming procedure than a left-lateral sectionectomy. This international multi-institutional confirmed that intraoperative blood loss, complications, and conversions are more than acceptable for laparoscopic left hemihepatectomy in expert hands. Postoperative morbidity and mortality rates together with adequate surgical margins and long-term recurrence are not compromised by the laparoscopic approach. |
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