Minor laparoscopic liver resection as day-case surgery (without overnight hospitalisation): a pilot study
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Day-case surgery (DCS) has become increasingly popular over recent years, as has laparoscopic liver resection (LLR) for the treatment of benign or malignant liver tumours. The purpose of this prospective study was to demonstrate the feasibility of minor LLR as DCS.
Prospective, intention-to-treat, non-randomised study of patients undergoing minor LLR between July 2015 and December 2017. Exclusion criteria were resection by laparotomy, major LLR, difficult locations for minor LLR, history of major abdominal surgery, hepatobiliary procedures without liver parenchyma resection, cirrhosis with Child > A and/or portal hypertension, significant medical history and exclusion criteria for DCS. The primary endpoint was the unplanned overnight admission rate. Secondary endpoints were the reason for exclusion, complication data, criteria for DCS evaluation, satisfaction and compliance with the protocol.
One hundred sixty-seven patients underwent liver resection during the study period. LLR was performed in 92 patients (55%), as DCS in 23 patients (25%). Reasons for minor LLR were liver metastasis (n = 9), hepatic adenoma (n = 5), hepatocellular carcinoma (n = 4), ciliated hepatic foregut cyst (n = 2) and other benign tumours (n = 3). All day-case minor LLR, except two patients, consisted of single wedge resection, while one patient underwent left lateral sectionectomy. There were four unplanned overnight admissions (17.4%), one unscheduled consultation (4.3%), two hospital readmissions (8.6%) and no major complications/mortality. Compliance with the protocol was 69.5%. Satisfaction rate was 91%.
In selected patients, day-case minor LLR is feasible with acceptable complication and readmission rates. Day-case minor LLR can therefore be legitimately proposed in selected patients.
KeywordsLaparoscopic liver resection Day-case surgery Outpatient surgery Ambulatory surgery
Laparoscopic liver resection
Compliance with ethical standards
Lionel Rebibo, Pauline Leourier, Rachid Badaoui, Fabien Le Roux, Emmanuel Lorne and Jean-Marc Regimbeau have no conflicts of interest or financial ties to disclose.
- 7.Gagner M, Rheault M, Dubuc J (1992) Laparoscopic partial hepatectomy for liver tumor [abstract]. Surg Endosc 6:97–98Google Scholar
- 16.Kraft K, Mariette C, Sauvanet A, Balon JM, Douard R, Fabre S, Guidat A, Huten N, Johanet H, Laurent A, Muscari F, Pessaux P, Piermé JP, Piessen G, Raucoules-Aimé M, Rault A, Vons C; French Society of Gastrointestinal Surgery; Association for Hepatobiliary and Transplantation Surgery (2011) Indications for ambulatory gastrointestinal and endocrine surgery in adults. J Visc Surg 148:69–74CrossRefPubMedGoogle Scholar
- 21.Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, Fan ST, Yokoyama Y, Crawford M, Makuuchi M, Christophi C, Banting S, Brooke-Smith M, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Nimura Y, Figueras J, DeMatteo RP, Büchler MW, Weitz J (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149:680–688CrossRefPubMedGoogle Scholar
- 22.Rahbari NN, Garden OJ, Padbury R, Maddern G, Koch M, Hugh TJ, Fan ST, Nimura Y, Figueras J, Vauthey JN, Rees M, Adam R, Dematteo RP, Greig P, Usatoff V, Banting S, Nagino M, Capussotti L, Yokoyama Y, Brooke-Smith M, Crawford M, Christophi C, Makuuchi M, Büchler MW, Weitz J (2011) Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB (Oxford) 13:528–535CrossRefGoogle Scholar
- 24.Hallet J, Sa Cunha A, Cherqui D, Gayet B, Goéré D, Bachellier P, Laurent A, Fuks D, Navarro F, Pessaux P, French Colorectal Liver Metastases Working Group, Association Française de Chirurgie (2017) Laparoscopic compared to open repeat hepatectomy for colorectal liver metastases: a multi-institutional propensity-matched analysis of short- and long-term outcomes. World J Surg 41:3189–3198CrossRefPubMedGoogle Scholar
- 29.Wong-Lun-Hing EM, van Dam RM, van Breukelen GJ, Tanis PJ, Ratti F, van Hillegersberg R, Slooter GD, de Wilt JH, Liem MS, de Boer MT, Klaase JM, Neumann UP, Aldrighetti LA, Dejong CH, ORANGE II Collaborative Group (2017) Randomized clinical trial of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study). Br J Surg 104:525–535CrossRefPubMedGoogle Scholar