Advertisement

Laparoscopic Parenchymal-Sparing Hepatectomy: the New Maximally Minimal Invasive Surgery of the Liver—a Systematic Review and Meta-Analysis

  • Jennifer A. Kalil
  • Jennifer Poirier
  • Bjoern Becker
  • Robert Van Dam
  • Xavier Keutgen
  • Erik SchaddeEmail author
Review Article

Abstract

Background

Parenchymal-sparing hepatectomies (PSH) are liver resections with preservation of as much liver parenchyma as possible. PSH can be performed laparoscopically (LPSH), but access to the posterosuperior segments is difficult and they are challenging when there are multiple bilobar lesions; the procedure may require repositioning and may be long and cumbersome. The objective of this systematic review is to analyze the feasibility and limitations of laparoscopic PSH in the literature.

Methods

A systematic review of the literature was performed by searching Medline/PubMed, Scopus, and Cochrane databases. Resections were categorized by segment(s), and data regarding operative time, blood loss, length of hospital stay, complications, and R0 resection were analyzed.

Results

Of 351 studies screened for relevance, 48 studies were reviewed. Ten publications fulfilled inclusion criteria, reporting data from 579 patients undergoing LPSH. The most common indication was CRLM (58%) followed by hepatocellular carcinoma (16%). Only 92 patients were reported to have resections of more than one tumor; the maximum number of lesions resected was seven. Of resected lesions, 21.5% were located in the cranial segments. Mean operating time was 335.2 min, estimated blood loss was 462 cc, and hospital stay was 7.6 days. Conversion rate was 9.7%, and complications occurred in 19.4% of cases. No perioperative mortality was reported. R0 resections were achieved in 87.7% of cases.

Conclusion

Laparoscopic PSH is performed and reported, but the data quality is low so far. The main limitation of LPSH is the low number of lesions resected, especially for bilobar, metastatic disease. Prospective reports with tumor-specific oncological data are desirable.

Keywords

Laparoscopic parenchymal-sparing hepatectomy Parenchymal-sparing liver surgery Colorectal liver metastasis 

Notes

Acknowledgements

The authors thank Jennifer Westrick, reference librarian, in assisting with the search terms and search process.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Billingsley, K., et al., Segment-Oriented Hepatic Resection in the Management of Malignant Neoplasms of the Liver. J Am Coll Surg, 1998. 187(5): p. 10.CrossRefGoogle Scholar
  2. 2.
    Weber, S., et al., Survival After Resection of Multiple Hepatic Colorectal Metastases. Ann Surg Oncol, 2000. 7(9): p. 7.CrossRefGoogle Scholar
  3. 3.
    Gold, J.S., et al., Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Ann Surg, 2008. 247(1): p. 109–17.CrossRefGoogle Scholar
  4. 4.
    Alvarez, F.A., et al., Parenchymal-sparing liver surgery in patients with colorectal carcinoma liver metastases. World J Gastrointest Surg, 2016. 8(6): p. 407–23.CrossRefGoogle Scholar
  5. 5.
    Moris, D., et al., Parenchymal-sparing Hepatectomy as the New Doctrine in the Treatment of Liver-metastatic Colorectal Disease: Beyond Oncological Outcomes. Anticancer Res, 2017. 37(1): p. 9–14.CrossRefGoogle Scholar
  6. 6.
    Vauthey, J.N., et al., Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery, 2000. 127(5): p. 512–9.CrossRefGoogle Scholar
  7. 7.
    Mise, Y., et al., Parenchymal-sparing Hepatectomy in Colorectal Liver Metastasis Improves Salvageability and Survival. Ann Surg, 2016. 263(1): p. 146–52.CrossRefGoogle Scholar
  8. 8.
    Buell, J.F., et al., The International Position on Laparoscopic Liver Surgery. Annals of Surgery, 2009. 250(5): p. 825–830.CrossRefGoogle Scholar
  9. 9.
    Cho, J.Y., et al., Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location. Surgery, 2008. 144(1): p. 32–8.CrossRefGoogle Scholar
  10. 10.
    Kazaryan, A.M., et al., Comparative evaluation of laparoscopic liver resection for posterosuperior and anterolateral segments. Surg Endosc, 2011. 25(12): p. 3881–9.CrossRefGoogle Scholar
  11. 11.
    Montalti, R., et al., Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison. Surg Endosc, 2016. 30(3): p. 1004–13.CrossRefGoogle Scholar
  12. 12.
    D'Hondt, M., et al., Laparoscopic parenchymal preserving hepatic resections in semiprone position for tumors located in the posterosuperior segments. Langenbecks Arch Surg, 2016. 401(2): p. 255–62.CrossRefGoogle Scholar
  13. 13.
    Ishizawa, T., et al., Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg, 2012. 256(6): p. 959–64.CrossRefGoogle Scholar
  14. 14.
    Ogiso, S., et al., Laparoscopic Transabdominal With Transdiaphragmatic Access Improves Resection of Difficult Posterosuperior Liver Lesions. Ann Surg, 2015. 262(2): p. 358–65.CrossRefGoogle Scholar
  15. 15.
    Chen, Y.X., et al., Pure Laparoscopic Liver Resection for Malignant Liver Tumor: Anatomic Resection Versus Nonanatomic Resection. Chin Med J (Engl), 2016. 129(1): p. 39–47.CrossRefGoogle Scholar
  16. 16.
    Cipriani, F., et al., Laparoscopic Parenchymal-Sparing Resections for Nonperipheral Liver Lesions, the Diamond Technique: Technical Aspects, Clinical Outcomes, and Oncologic Efficiency. J Am Coll Surg, 2015. 221(2): p. 265–72.CrossRefGoogle Scholar
  17. 17.
    Conrad, C., et al., Laparoscopic parenchymal-sparing liver resection of lesions in the central segments: feasible, safe, and effective. Surg Endosc, 2015. 29(8): p. 2410–7.CrossRefGoogle Scholar
  18. 18.
    Lee, K.F., et al., Resection margin in laparoscopic hepatectomy: a comparative study between wedge resection and anatomic left lateral sectionectomy. HPB (Oxford), 2010. 12(9): p. 649–53.CrossRefGoogle Scholar
  19. 19.
    Montalti, R., et al., Impact of surgical margins on overall and recurrence-free survival in parenchymal-sparing laparoscopic liver resections of colorectal metastases. Surg Endosc, 2015. 29(9): p. 2736–47.CrossRefGoogle Scholar
  20. 20.
    Dindo, D., N. Demartines, and P.-A. Clavien, Classification of Surgical Complications. Annals of Surgery, 2004. 240(2): p. 205–213.CrossRefGoogle Scholar
  21. 21.
    Strasberg, S.M., D.C. Linehan, and W.G. Hawkins, The accordion severity grading system of surgical complications. Ann Surg, 2009. 250(2): p. 177–86.CrossRefGoogle Scholar
  22. 22.
    Nguyen, K.T., et al., Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch Surg, 2011. 146(3): p. 348–56.CrossRefGoogle Scholar
  23. 23.
    Marvin, M.R. and J.F. Buell, Laparoscopic Liver Surgery. Advances in Surgery, 2009. 43(1): p. 159–173.CrossRefGoogle Scholar
  24. 24.
    de'Angelis, N., et al., Laparoscopic versus open resection for colorectal liver metastases: a single-center study with propensity score analysis. J Laparoendosc Adv Surg Tech A, 2015. 25(1): p. 12–20.CrossRefGoogle Scholar
  25. 25.
    Montalti, R., et al., Laparoscopic liver resection compared to open approach in patients with colorectal liver metastases improves further resectability: Oncological outcomes of a case-control matched-pairs analysis. Eur J Surg Oncol, 2014. 40(5): p. 536–44.CrossRefGoogle Scholar
  26. 26.
    Di Fabio, F., et al., Laparoscopic major hepatectomies: clinical outcomes and classification. World J Surg, 2014. 38(12): p. 3169–74.CrossRefGoogle Scholar
  27. 27.
    Moris, D., et al., Parenchymal-Sparing Versus Anatomic Liver Resection for Colorectal Liver Metastases: a Systematic Review. J Gastrointest Surg, 2017. 21(6): p. 1076–1085.CrossRefGoogle Scholar
  28. 28.
    Matsuki, R., et al., Parenchymal-sparing hepatectomy for deep-placed colorectal liver metastases. Surgery, 2016. 160(5): p. 1256–1263.CrossRefGoogle Scholar
  29. 29.
    Pawlik, T.M., et al., Effect of Surgical Margin Status on Survival and Site of Recurrence After Hepatic Resection for Colorectal Metastases. Annals of Surgery, 2005. 241(5): p. 715–724.CrossRefGoogle Scholar
  30. 30.
    Regimbeau, J.-M., et al., Extent of liver resection influences the outcome in patients with cirrhosis and small hepatocellular carcinoma. Surgery, 2002. 131(3): p. 311–317.CrossRefGoogle Scholar
  31. 31.
    Kaibori, M., et al., Comparison of anatomic and non-anatomic hepatic resection for hepatocellular carcinoma. J Hepatobiliary Pancreat Sci, 2017. 24(11): p. 616–626.CrossRefGoogle Scholar
  32. 32.
    Hasegawa, K., et al., Prognostic Impact of Anatomic Resection for Hepatocellular Carcinoma. Annals of Surgery, 2005. 242(2): p. 252–259.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of Surgery – Transplant SurgeryRush University Medical CenterChicagoUSA
  2. 2.Department of GastroenterologyCantonal Hospital WinterthurWinterthurSwitzerland
  3. 3.Department of SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
  4. 4.Department of SurgeryCantonal Hospital WinterthurWinterthurSwitzerland

Personalised recommendations