Laparoscopic Repeat Hepatic Resection for the Management of Liver Tumors
Laparoscopic hepatic resection has been developed as a minimally invasive surgery; however, laparoscopic repeat minor hepatic resection (LRH) carries a higher risk of damage to other organs because of postoperative changes to and losses of anatomical landmarks. The current standard approach at many facilities has been to perform open repeat minor hepatic resection (ORH). This paper describes the surgical outcomes, procedure safety, and utility of ORH versus LRH, as well as the laparoscopic techniques used in LRH.
Between February 2010 and May 2018, the data of 142 patients who underwent LRH or ORH at a single institution were retrospectively reviewed. Surgical outcomes, procedure safety, and procedure utility data were analyzed.
Forty-five patients underwent LHR and 97 patients underwent ORH. The conversion rate from LHR to OHR was 13.3%. After propensity score matching (PSM), the estimated blood loss was significantly lower in the LRH group than in the ORH group (50 mL vs. 350 mL; P < 0.001). The LRH group had an 8.1% complication rate, while the ORH group had a complication rate of 24.3% (P = 0.044). The postoperative length of stay was significantly shorter in the LHR group than in the OHR group (9 days vs. 11 days) (P = 0.024).
LRH can be performed safely using various surgical devices. More favorable results are achieved with LRH than with ORH in terms of surgical outcomes including intraoperative bleeding, postoperative complications, and postoperative lengths of stay.
KeywordsLaparoscopic repeat hepatic resection Surgical outcomes Liver tumor
YI conceived the study concept and design, was involved with patient care, and drafted the manuscript. KF, MI, SK, AT, HH, WO, YT, TT, TO, SM, MY, AI, AA, KK, SF, FH, MG, KT, JO, KH, and KU were involved with formation of the study concept and design, patient care, and drafting of the manuscript. All authors have read and approved the final version of the manuscript.
Compliance with Ethical Standards
All patients were fully informed of the study design according to the Ethics Committee on Clinical Investigation of Osaka Medical College Hospital (No. 1828 and 1997) and provided written informed consent.
Conflict of Interest
Drs. Y. Inoue, K. Fujii, M. Ishii, S. Kagota, A. Tomioka, H. Hamamoto, W. Osumi, Y. Tsuchimoto, T. Terasawa, T. Ogura, S. Masubuchi, M. Yamamoto, A Imoto, A Asai, K. Komeda, S. Fukunishi, F. Hirokawa, M. Goto, K. Higuchi, and K. Uchiyama declare no conflict of interests.
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