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1.
Alvaro Bueno Fernando Rotellar Alberto Benito Pablo Martí-Cruchaga Gabriel Zozaya José Hermida Fernando Pardo 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2014,16(4):320-326
Objectives
The laparoscopic approach is widely used in abdominal surgery. However, the benefits of laparoscopy in liver surgery have hitherto been insufficiently established. This study sought to investigate these benefits and, in particular, to establish whether or not the laparoscopic approach is beneficial in patients with lesions involving the posterosuperior segments of the liver.Methods
Outcomes in a cohort of patients undergoing mostly minor hepatectomy (50 laparoscopic and 52 open surgery procedures) between January 2000 and December 2010 at the University Clinic of Navarra were analysed. The two groups displayed similar clinical characteristics.Results
Patients submitted to laparoscopic liver resection (LLR) had a lower risk for complications [odds ratio (OR) = 0.24, 95% confidence interval (CI) 0.07–0.74; P = 0.013] and shorter hospital stay (OR = 0.08, 95% CI 0.02–0.27; P < 0.001) independently of the presence of classical risk factors for complications. In the cohort of patients with lesions involving posterosuperior liver segments (20 laparoscopic, 21 open procedures), LLR was associated with significantly fewer complications (OR = 0.16, 95% CI 0.04–0.71) and a lower risk for a long hospital stay (OR = 0.1, 95% CI 0.02–0.43).Conclusions
This study confirms that the laparoscopic approach to hepatic resection decreases the risk for post-surgical complications and lengthy hospitalization in patients undergoing minor liver resections. This beneficial effect is observed even in patients with lesions located in segments that require technically difficult resections. 相似文献2.
Tranchart H Diop PS Lainas P Pourcher G Catherine L Franco D Dagher I 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2011,13(1):46-50
Background
The optimal strategy for resectable synchronous colorectal liver metastases remains controversial. Although some authors advocate a staged treatment, an increasing number of studies have reported that combined colorectal and liver resection is safe. Laparoscopic combined resection in primary colorectal cancer with synchronous liver metastases has been reported but there are no specific data for major liver resections. In the present study, we evaluated the feasibility of a simultaneous entirely laparoscopic procedure, in the light of the benefits of laparoscopy in both colon and liver surgery, and discussed the benefits of this strategy.Methods
Two cases are presented of totally laparoscopic major liver resections associated with laparoscopic colorectal resections for synchronous liver metastases with the emphasis on the technical aspects. Duration of surgery, blood loss and post-operative outcome were evaluated.Results
Laparoscopic right hepatectomy or left hepatectomy with simultaneous colon resection for liver metastasis was feasible and safe with only one suprapubic 5-mm trocar added to the usual trocar sites. The mean duration of surgery was 327 min with a mean estimated blood loss of 200 ml. The post-operative course was uneventful.Discussion
In selected patients, laparoscopic major hepatectomies for unilobular synchronous metastases can be safely performed simultaneously with colorectal surgery. 相似文献3.
Mirnezami R Mirnezami AH Chandrakumaran K Abu Hilal M Pearce NW Primrose JN Sutcliffe RP 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2011,13(5):295-308
Background
Laparoscopic liver resection (LLR) is now considered a feasible alternative to open liver resection (OLR) in selected patients. Nevertheless studies comparing LLR and OLR are few and concerns remain about long-term oncological equivalence. The present study compares outcomes with LLR vs. OLR using meta-analytical methods.Methods
Electronic literature searches were conducted to identify studies comparing LLR and OLR. Short-term outcomes evaluated included operating time, blood loss, length of hospital stay, peri-operative morbidity and resection margin status. Longer-term outcomes included local and distant recurrence, and overall (OS) and disease-free survival (DFS). Meta-analyses were performed using the Mantel–Haenszel method and Cohen''s d method, with results expressed as odds ratio (OR) or standardized mean difference (SMD), respectively, with 95% confidence intervals (CI).Results
Twenty-six studies met the inclusion criteria with a population of 1678 patients. LLR resulted in longer operating time, but reduced blood loss, portal clamp time, overall and liver-specific complications, ileus and length of stay. No difference was found between LLR and OLR for oncological outcomes.Discussion
LLR has short-term advantages and seemingly equivalent long-term outcomes and can be considered a feasible alternative to open surgery in experienced hands. 相似文献4.
Thomas van Gulik 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2009,11(6):465-468
Background:
The issue under debate is whether laparoscopic liver resections for malignant tumours produce outcomes which are comparable with conventional, open liver resections.Methods:
Literature review on liver resection and laparoscopy.Results:
There are no randomized controlled trials (RCTs) published that provide any evidence for the benefits of laparoscopic liver resections for liver tumours. In case–control series reporting short-term outcomes, laparoscopic liver resection has been shown to have the advantage of a reduced length of hospital stay. There are as yet, however, no adequate long-term survival studies demonstrating that laparoscopic liver resection is oncologically equivalent to open resection.Discussion:
The challenge for the near future is to test the oncological integrity of laparoscopic liver resection in controlled trials in the same way that we have learned from the RCTs carried out in laparoscopic resection for colorectal cancer. It is likely that laparoscopic liver resection will then have to compete with fast-track, open liver resection. Already, concerns have been raised regarding the learning curve required to master the techniques of laparoscopic liver resection. 相似文献5.
Stoot JH Coelen RJ De Jong MC Dejong CH 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2010,12(8):509-522
Background
Malignant transformation of hepatocellular adenomas (HCAs) into hepatocellular carcinomas (HCCs) has been reported repeatedly and is considered to be one of the main reasons for surgical treatment. However, its actual risk is currently unknown.Objective
To provide an estimation of the frequency of malignant transformation of HCAs and to discuss its clinical implications.Methods
A systematic literature search was conducted using the following databases: The Cochrane Hepatobiliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, MEDLINE and EMBASE.Results
One hundred and fifty-seven relevant series and 17 case reports (a total of 1635 HCAs) were retrieved, reporting an overall frequency of malignant transformation of 4.2%. Only three cases (4.4%) of malignant alteration were reported in a tumour smaller than 5 cm in diameter.Discussion
Malignant transformation of HCAs into HCCs remains a rare phenomenon with a reported frequency of 4.2%. A better selection of exactly those patients presenting with an HCA with an amplified risk of malignant degeneration is advocated in order to reduce the number of liver resections and thus reducing the operative risk for these predominantly young patients. The Bordeaux adenoma tumour markers are a promising method of identifying these high-risk adenomas. 相似文献6.
Nicola de'Angelis Riccardo Memeo Julien Calderaro Emanuele Felli Chady Salloum Philippe Compagnon Alain Luciani Alexis Laurent Daniel Cherqui Daniel Azoulay 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2014,16(9):783-788
Background
Hepatocellular adenoma (HCA) is a rare benign liver epithelial tumour that can require surgery. This retrospective study reports a 23-year experience of open and laparoscopic resections for HCA.Methods
Patients with a histological diagnosis of HCA were included in this analysis. Surgical resection was performed in all symptomatic patients and in those with lesions measuring > 5 cm.Results
Between 1989 and 2012, 62 patients, 59 of whom were female, underwent surgery for HCA (26 by open surgery and 36 by laparoscopic surgery). Overall, 96.6% of female patients had a history of contraceptive use; 54.8% of patients presented with abdominal pain and 11.2% with haemorrhage; the remaining patients were asymptomatic. Patients who underwent laparoscopy had smaller lesions (mean ± standard deviation diameter: 68.3 ± 35.2 mm versus 91.9 ± 42.5 mm; P = 0.022). Operatively, laparoscopic and open liver resection did not differ except in the number of pedicle clamps, which was significantly lower in the laparoscopic group (27.8% versus 57.7% of patients; P = 0.008). Postoperative variables did not differ between the groups. Mortality was nil. Two surgical specimens were classified as HCA/borderline hepatocellular carcinoma. At the 3-year follow-up, all patients were alive with no recurrence of HCA.Conclusions
Open and laparoscopic liver resections are both safe and feasible approaches for the surgical management of HCA. However, laparoscopic liver resections may be limited by lesion size and location and require advanced surgical skills. 相似文献7.
Joel W. Lewin Nicholas A. O'Rourke Adrian K.H. Chiow Richard Bryant Ian Martin Leslie K. Nathanson David J. Cavallucci 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2016,18(2):183-191
Background
This study compares long-term outcomes between intention-to-treat laparoscopic and open approaches to colorectal liver metastases (CLM), using inverse probability of treatment weighting (IPTW) based on propensity scores to control for selection bias.Method
Patients undergoing liver resection for CLM by 5 surgeons at 3 institutions from 2000 to early 2014 were analysed. IPTW based on propensity scores were generated and used to assess the marginal treatment effect of the laparoscopic approach via a weighted Cox proportional hazards model.Results
A total of 298 operations were performed in 256 patients. 7 patients with planned two-stage resections were excluded leaving 284 operations in 249 patients for analysis. After IPTW, the population was well balanced. With a median follow up of 36 months, 5-year overall survival (OS) and recurrence-free survival (RFS) for the cohort were 59% and 38%. 146 laparoscopic procedures were performed in 140 patients, with weighted 5-year OS and RFS of 54% and 36% respectively. In the open group, 138 procedures were performed in 122 patients, with a weighted 5-year OS and RFS of 63% and 38% respectively. There was no significant difference between the two groups in terms of OS or RFS.Conclusion
In the Brisbane experience, after accounting for bias in treatment assignment, long term survival after LLR for CLM is equivalent to outcomes in open surgery. 相似文献8.
Roberto I Troisi Roberto Montalti Jurgen GM Van Limmen Daniele Cavaniglia Koen Reyntjens Xavier Rogiers Bernard De Hemptinne 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2014,16(1):75-82
Background
As a consequence of continuous technical developments in liver surgery, laparoscopic liver resection (LLR) is increasingly performed worldwide.Methods
Between January 2004 and December 2011, 265 LLR were performed in 242 patients for various diseases. The experience of LLR is reported focusing on risk factors of conversion and their management.Results
The overall conversion rate was 17/265 (6.4%), equally distributed over the period of the study. Statistically significant factors for conversion were found to be LLR of the postero-superior (P-S) segments (SI, SIVa; SVII; SVIII) (12.7% converted versus 2.5% non-converted groups, P = 0.01) and a major compared with a minor hepatectomy (15.2% vs. 4.6%, P = 0.02 respectively). A R0 resection was achieved in 93.2% of cases. According to Dindo''s classification, complications were recorded as grade I (n = 20); grade II (6); grade III (11) and grade IV(1) events (total morbidity rate of 14%). Univariate analysis identified a major hepatectomy and resection involving P-S segments as prognostic factors for conversion whereas multivariate analysis identified the latter as an independent risk factor [P = 0.003, odds ratio (OR) = 5.9, 95% confidence interval (CI) = 1.8–18.8].Conclusions
LLR can be safely performed with low overall morbidity. According to this experience and irrespective of the learning curve, resections of P-S segments were identified as an independent risk factor for conversion in LLR. 相似文献9.
Lee KF Wong J Cheung YS Ip P Wong J Lai PB 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2010,12(9):649-653
Background
Experience from open hepatectomy shows that anatomic liver resection achieves a better resection margin than wedge resection. In recent years, laparoscopic hepatectomy has increasingly been performed in patients with liver pathology including malignant lesions. Wedge resection (WR) and left lateral sectionectomy (LLS), which also represent non-anatomic and anatomic resection respectively, are the two most common types of laparoscopic hepatectomy performed. The aim of the present study was to compare the two types of laparoscopic hepatectomy with emphasis on resection margin.Methods
Between November 2003 and July 2009, 44 consecutive patients who underwent laparoscopic hepatectomy were identified and retrospectively reviewed. The WR and LLS group of patients were compared in terms of operative outcomes, pathological findings, recurrence patterns and survival.Results
Out of the 44 patients, 21 underwent LLS and 23 a WR. The two groups of patients were comparable in demographics. The two groups did not differ in conversion rate, blood loss, blood transfusion, mortality, morbidity and post-operative length of stay. The LLS group patients had significantly larger liver lesions, wider resection margin and less sub-centimetre margins. In patients with malignant liver lesions, there was no difference between the two groups in incidence of intra-hepatic recurrence and 3-year overall and disease-free survival.Conclusion
Operative outcomes are similar between laparoscopic WR and LLS. However, WR is less reliable than LLS in achieving a resection margin of more than 1 cm. Larger studies involving more patients with longer follow-up are warranted to determine the impact of the resection margin on intra-hepatic recurrence and survival. 相似文献10.
Tamara M H Gall Gabriel C Oniscu Krishnakumar Madhavan Rowan W Parks O James Garden 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2009,11(3):235-241
Background:
Despite the increasing use of laparoscopic techniques, the optimal surgical approach for cystic liver disease has not been well defined. This study aims to determine the optimum operative approach for these patients.Methods:
Data were identified from the Lothian Surgical Audit, case note review and general practitioner contact. Patients were contacted and asked to complete the SF-36 questionnaire on quality of life.Results:
A total of 102 patients (67 with simple cysts, 31 with polycystic liver disease [PCLD], four with cystic tumours) underwent 62 laparoscopic deroofings, 15 open deroofings, 36 resections and one liver transplant between June 1985 and April 2006. The median follow-up was 77 months (range 3–250 months). Morbidity and recurrent symptom rates after laparoscopic surgery were greater in PCLD patients compared with simple cyst patients, at 31% (four patients) vs. 15% (seven patients) and 85% (11 patients) vs. 29% (24 patients), respectively. Four patients with simple cysts and eight with PCLD required further surgery. All patients with simple cysts had comparable quality of life after surgery. Patients with recurrent symptoms after surgery for PCLD had a significantly better quality of life following laparoscopic deroofing than after resection.Conclusions:
Most simple cysts can be managed laparoscopically, but there is a definite role for open resection in some patients. Open deroofing is the preferred approach for a dominant cyst pattern in PCLD, whereas resection is necessary for diffuse cystic disease. 相似文献11.
Berber E Akyildiz HY Aucejo F Gunasekaran G Chalikonda S Fung J 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2010,12(8):583-586
Background
There are scant data in the literature regarding the role of robotic liver surgery. The aim of the present study was to develop techniques for robotic liver tumour resection and to draw a comparison with laparoscopic resection.Methods
Over a 1-year period, nine patients underwent robotic resection of peripherally located malignant lesions measuring <5 cm. These patients were compared prospectively with 23 patients who underwent laparoscopic resection of similar tumours at the same institution. Statistical analyses were performed using Student''s t-test, χ2-test and Kaplan–Meier survival. All data are expressed as mean ± SEM.Results
The groups were similar with regards to age, gender and tumour type (P = NS). Tumour size was similar in both groups (robotic −3.2 ± 1.3 cm vs. laparoscopic −2.9 ± 1.3 cm, P = 0.6). Skin-to-skin operative time was 259 ± 28 min in the robotic vs. 234 ± 17 min in the laparoscopic group (P = 0.4). There was no difference between the two groups regarding estimated blood loss (EBL) and resection margin status. Conversion to an open operation was only necessary in one patient in the robotic group. Complications were observed in one patient in the robotic and four patients in the laparoscopic groups. The patients were followed up for a mean of 14 months and disease-free survival (DFS) was equivalent in both groups (P = 0.6).Conclusion
The results of this initial study suggest that, for selected liver lesions, a robotic approach provides similar peri-operative outcomes compared with laparoscopic liver resection (LLR). 相似文献12.
Matthew R Porembka M B Majella Doyle Nicholas A Hamilton Peter O Simon Steven M Strasberg David C Linehan William G Hawkins 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2009,11(3):258-263
Objective:
This study aimed to evaluate if the Gyrus open forceps is a safe and efficient tool for hepatic parenchymal transection.Background:
Blood loss during hepatic transection remains a significant risk factor for morbidity and mortality associated with liver surgery. Various electrosurgical devices have been engineered to reduce blood loss. The Gyrus open forceps is a bipolar cautery device which has recently been introduced into hepatic surgery.Methods:
We conducted a single-institution, retrospective review of all liver resections performed from November 2005 through November 2007. Patients undergoing resection of at least two liver segments where the Gyrus was the primary method of transection were included. Patient charts were reviewed; clinicopathological data were collected.Results:
Of the 215 open liver resections performed during the study period, 47 patients met the inclusion criteria. Mean patient age was 61 years; 34% were female. The majority required resection for malignant disease (94%); frequent indications included colorectal metastasis (66%), hepatocellular carcinoma (6%) and cholangiocarcinoma (4%). Right hemihepatectomy (49%), left hemihepatectomy (13%) and right trisectionectomy (13%) were the most frequently performed procedures. A total of 26 patients (55%) underwent a major ancillary procedure concurrently. There were no operative mortalities. Median operative time was 220 min (range 97–398 min). Inflow occlusion was required in nine patients (19%) for a median time of 12 min (range 3–30 min). Median total estimated blood loss was 400 ml (range 10–2000 ml) and 10 patients (21%) required perioperative transfusion. All patients had macroscopically negative margins. Median length of stay was 8 days. Two patients (4%) had clinically significant bile leak. The 30-day postoperative mortality was zero.Conclusions:
Use of the Gyrus open forceps appears to be a safe and efficient manner of hepatic parenchymal transection which allows rapid transection with acceptable blood loss, a low rate of perioperative transfusion, and minimal postoperative bile leak. 相似文献13.
Edgar M Wong-Lun-Hing Toine M Lodewick Jan H M B Stoot Marc H A Bemelmans Steven W M Olde Damink Cornelis H C Dejong Ronald M van Dam 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2012,14(12):818-827
Objectives
Both laparoscopic techniques and multimodal enhanced recovery programmes have been shown to improve recovery and reduce length of hospital stay. Interestingly, evidence-based care programmes are not widely implemented, whereas new, minimally invasive surgical procedures are often adopted with very little evidence to support their effectiveness. The present survey aimed to shed light on experiences of the adoption of both methods of optimizing recovery.Methods
An international, web-based, 18-question, electronic survey was composed in 2010. The survey was sent out to 673 hepatopancreatobiliary (HPB) centres worldwide in June 2010 to investigate international experiences with laparoscopic liver surgery, fast-track recovery programmes and surgery-related equipoise in open and laparoscopic techniques and to assess opinions on strategies for adopting laparoscopic liver surgery in HPB surgical practice.Results
A total of 507 centres responded (response rate: 75.3%), 161 of which finished the survey completely. All units reported performing open liver resections, 24.2% performed open living donor resections, 39.1% carried out orthotopic liver transplantations, 87.6% had experience with laparoscopic resections and 2.5% performed laparoscopic living donor resections. A median of 50 (range: 2–560) open and 9.5 (range: 1–80) laparoscopic liver resections per surgical unit were performed in 2009. Patients stayed in hospital for a median of 7 days (range: 2–15 days) after uncomplicated open liver resection and a median of 4 days (range: 1–10 days) after uncomplicated laparoscopic liver resection. Only 28.0% of centres reported having experience with fast-track programmes in liver surgery. The majority considered the instigation of a randomized controlled trial or a prospective register comparing the outcomes of open and laparoscopic techniques to be necessary.Conclusions
Worldwide dissemination of laparoscopic liver resection is substantial, although laparoscopic volumes are low in the majority of HPB centres. The adoption of enhanced recovery programmes in liver surgery is limited and should be given greater attention. 相似文献14.
Jan H Stoot Ronald M van Dam Olivier R Busch Richard van Hillegersberg Marieke De Boer Steven WM Olde Damink Marc H Bemelmans Cornelis HC Dejong 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2009,11(2):140-144
Objectives:
This study was conducted to evaluate the added value of an enhanced recovery after surgery (ERAS) programme in laparoscopic liver resections for solid tumours.Methods:
Patients undergoing laparoscopic liver resection between July 2005 and July 2008 were included. Indications for resections included presumed benign and malignant liver lesions. Primary outcome was total length of hospital stay (LOS). Secondary outcomes were functional recovery, complications, conversions, blood loss and duration of operation.Results:
Thirteen patients were treated by laparoscopic liver resections in the ERAS programme in one centre (group 1). Their outcomes were compared with outcomes of 13 laparoscopic procedures performed either before the introduction of the ERAS programme during 2003–2005 in the same centre or during the same period in other centres using traditional care (group 2). Median total LOS was 5.0 days (range 3–10 days) in group 1 and 7.0 days (3–12 days) in group 2. This difference was not statistically significant. Functional recovery occurred 2 days earlier in group 1 (median 3.0 days [range 1–7 days] vs. median 5.0 days [range 2–8 days]; P < 0.044). There were no significant differences in complications, conversions or duration of operation. Blood loss was significantly less in the ERAS group (median 50 ml [range 50–200 ml] vs. median 250 ml [range 50–800 ml]; P < 0.002).Conclusions:
This exploratory, multicentre, fast-track laparoscopic liver resection study is the first such study conducted. Although small, the study suggests that a multimodal enhanced recovery programme in laparoscopic liver surgery is feasible, safe and may lead to accelerated functional recovery and reductions in LOS. 相似文献15.
Bing Yi Ponnandai Somasundar N Joseph Espat 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2009,11(2):135-139
Background:
Monopolar radiofrequency ablation (RFA) is a well accepted modality for local control of hepatic tumours, but its effectiveness is challenged by prolonged ablation time, an inconsistent ablation zone and susceptibility to energy loss from convective heat loss from adjacent high-velocity blood flows (‘heat sinks’). Bipolar RFA employs a dual parallel electrode array; the energy wave travels unidirectionally between and not around electrodes. This ‘line-of-sight’ delivery streams energy between two fixed points and concentrates energy delivery to the area between the probes. Bipolar RFA is postulated to yield reduced ablation time and to reduce or eliminate convective heat loss from adjacent high-velocity blood flows. The current study evaluated the feasibility, time and safety of this novel FDA-approved bipolar RFA technology using a laparoscopic approach in human liver tumours.Methods:
Using the prospectively maintained surgical oncology hepatic-pancreatic-biliary database, 17 consecutive patients (26 liver tumours) who underwent laparoscopic bipolar ablations were reviewed. Electrodes were placed using guidance by intraoperative ultrasound and trajectory planning needles. Ablation time was recorded and postoperative computed tomography scans were obtained.Results:
A total of 18 lesions (in 12 patients) represented metastatic colorectal cancer. Three lesions (in two patients) were hepatocellular carcinoma. Four lesions (in two patients) represented locally advanced symptomatic gallbladder cancer invading the liver bed or symptomatic intrahepatic liver metastases from gallbladder cancer. One lesion was benign hepatic adenoma. Mean tumour size was 3.07 ± 1.42 cm. Mean ablation time was 358 ± 120 sec. No major complications were observed in the ≤30-day or >30-day periods post-RFA.Conclusions:
Laparoscopic bipolar RFA is a quick, safe technique which adds a new tool to our armamentarium for treating hepatic tumours. Establishing its longterm oncological outcome will require longer follow-up and the exact role of this technique in the current multimodality management remains to be defined. 相似文献16.
Spiros G Delis Andreas Bakoyiannis Dimitrios Karakaxas Kostantinos Athanassiou Nikolaos Tassopoulos Emanouel Manesis Ioannis ketikoglou Pavlos Papakostas Christos Dervenis 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2009,11(1):38-44
Background
Stapler-assisted hepatectomy has not been well established, as a routine procedure, although few reports exist in the literature. This analysis assesses the safety and outcome of the method based on peri-operative data.Materials and Methods
From February 2005 to December 2006, endo GIA vascular staplers were used for parenchymal liver transection in 62 consecutive cases in our department. There were 18 (29%) patients with hepatocellular carcinoma (HCC), 31 (50%) with metastatic lesions and 13 (21%) with benign lesions [adenoma, focal nodular hyperplasia (FNH), simple cysts]. Twenty-one patients underwent major resections (33.9%) (i.e. removal of three segments or more) and 41 (66.1%) minor hepatic resections.Results
Median blood loss was 260 ml. The median total operative time was 150 min and median transection time was 35 min. No patient required more than 2 days of intensive care unit (ICU) treatment. The median hospital stay was 8 days. Surgical complications included two (3%) cases of bile leak, two (3%) cases of pneumonia, two (3%) cases with wound infection and two (3%) cases with pleural effusion. The peri-operative mortality was zero. In a 30-month median follow-up, all patients with benign lesions were alive and free of disease. The 3-year disease-free survival for patients with HCC was 61% (57% for patients with colorectal metastases) and the 3-year survival 72% (68% for patients with colorectal metastases).Conclusion
Stapler-assisted liver resection is feasible with a low incidence of surgical complications. It can be used as an alternative for parenchyma transection especially in demanding hepatectomies for elimination of the operating time and control of bleeding. 相似文献17.
Dae Wook Hwang Ho-Seong Han Yoo-Seok Yoon Jai Young Cho Yujin Kwon Ji Hoon Kim Joon Seong Park Dong Sup Yoon In Seok Choi Keun Soo Ahn Yong Hoon Kim Koo Jeong Kang Young Hoon Kim Young Hoon Roh Chong Woo Chu Hyung Chul Kim Chang Moo Kang Gi Hong Choi Jin Sub Choi Kyung Sik Kim Woo Jung Lee Sung Su Yun Hong Jin Kim Seog Ki Min Hyeon Kook Lee In-Sang Song Kwang-Sik Chun Eung-Ho Cho Sung-Sik Han Sang-Jae Park 《Journal of hepato-biliary-pancreatic sciences》2013,20(2):125-130
Introduction
We report our experience with laparoscopic major liver resection in Korea based on a multicenter retrospective study.Materials and methods
Data from 1,009 laparoscopic liver resections conducted from 2001 to 2011 were retrospectively collected. Twelve tertiary medical centers with specialized hepatic surgeons participated in this study.Results
Among 1,009 laparoscopic liver resections, major liver resections were performed in 265 patients as treatment for hepatocellular carcinoma, metastatic tumor, intrahepatic duct stone, and other conditions. The most frequently performed procedure was left hemihepatectomy (165 patients), followed by right hemihepatectomy (53 patients). Pure laparoscopic procedure was performed in 190 patients including 19 robotic liver resections. Hand-assisted laparoscopic liver resection was performed in three patients and laparoscopy-assisted liver resection in 55 patients. Open conversion was performed in 17 patients (6.4 %). Mean operative time and estimated blood loss in laparoscopic major liver resection was 399.3 ± 169.8 min and 836.0 ± 1223.7 ml, respectively. Intraoperative transfusion was required in 65 patients (24.5 %). Mean postoperative length of stay was 12.3 ± 7.9 days. Postoperative complications were detected in 53 patients (20.0 %), and in-hospital mortality occurred in two patients (0.75 %). Mean number and mean maximal size of resected tumors was 1.22 ± 1.54 and 40.0 ± 27.8 mm, respectively. R0 resection was achieved in 120 patients with hepatic tumor, but R1 resection was performed in eight patients. Mean distance of safe resection margin was 14.6 ± 15.8 mm.Conclusions
Laparoscopic major liver resection has become a reliable option for treatment of liver disease in Korea. 相似文献18.
Kerkar SP Kemp CD Avital I 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2010,12(9):589-596
Background
The 5-year survival of patients receiving standard-of-care chemotherapy for metastatic gastric cancer (MGC) to the liver is <2%. This review examines the published data on liver resections for MGC and analyses the rationale for potentially aggressive surgical management.Methods
A search of the PubMed and Scopus databases was used to identify studies published in English from 1990 to 2009 that reported on 10 or more patients who underwent liver resections for MGC. All available clinicopathologic data were analysed. In particular, we examined longterm survival and the characteristics of individuals surviving for >5 years.Results
Nineteen studies reported on 436 patients. Median 5-year survival was 26.5% (range: 0–60%). Overall, 13.4% (48/358) of patients were alive at 5 years and studies with extended follow-up reported that 4.0% (7/174) of patients survived for >10 years. Overall in-hospital mortality was 3.5% (12/340 patients); however, the median mortality rate across the studies was 0%. No prognostic factor was found to be consistently statistically significant across these small studies.Conclusions
Despite the limitations of any analysis of retrospective data for highly selected groups of patients, it would appear that liver resections combined with systemic therapy for MGC can result in prolonged survival. 相似文献19.
Ronald M Woodfield J McCall J Koea J 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2004,6(1):25-27
Background
Hepatic adenomas are benign tumours of the liver most commonly seen in premenopausal women. However, it is now clear that adenomas may occur in males. This small series reviews the characteristics of hepatic adenomas in males.Case outlines
Three cases of solitary hepatic adenoma occurring in otherwise well male patients (age 22–48 years) are presented. Two patients presented with abnormal liver function tests while one presented with abdominal pain. Imaging of the lesions demonstrated typical appearances of hepatocellular adenoma, resection was undertaken in all cases and all patients remain alive and well.Discussion
Up to 20% of adenomas are documented as occurring in male patients. Most are solitary and occur in patients without recognised risk factors (steroid therapy and glycogen storage diseases types I and III). However, multiple adenomas are most commonly seen in male patients with risk factors. The imaging characteristics and presentation of adenomas in males are similar to female patients and, most importantly, intraperitoneal rupture and malignant transformation are documented in untreated adenomas in males. 相似文献20.
Ponnandai Somasundar Cherif Boutros W Scott Helton N Joseph Espat 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2009,11(2):145-149