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Journal of Gastrointestinal Surgery

, Volume 23, Issue 11, pp 2314–2321 | Cite as

Laparoscopic Repeat Hepatic Resection for the Management of Liver Tumors

  • Yoshihiro InoueEmail author
  • Kensuke Fujii
  • Masatsugu Ishii
  • Syuji Kagota
  • Atsushi Tomioka
  • Hiroki Hamamoto
  • Wataru Osumi
  • Yusuke Tsuchimoto
  • Tetsuji Terasawa
  • Takeshi Ogura
  • Shinsuke Masubuchi
  • Masashi Yamamoto
  • Akira Imoto
  • Akira Asai
  • Koji Komeda
  • Shinya Fukunishi
  • Fumitoshi Hirokawa
  • Masahiro Goto
  • Keitaro Tanaka
  • Junji Okuda
  • Kazuhide Higuchi
  • Kazuhisa Uchiyama
Multimedia Article

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Laparoscopic repeat hepatic resection Surgical outcomes Liver tumor 

Notes

Author Contributions

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.

Supplementary material

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References

  1. 1.
    Inoue Y, Suzuki Y, Fujii K, Kawaguchi N, Ishii M, Masubuchi S, Yamamoto M, Hirokawa F, Hayashi M, Uchiyama K. Laparoscopic Liver Resection Using the Lateral Approach from Intercostal Ports in Segments VI, VII, and VIII. J Gastrointest Surg 2017;21:2135–2143.CrossRefGoogle Scholar
  2. 2.
    Inoue Y, Suzuki Y, Ota M, Fujii K, Kawaguchi N, Hirokawa F, Hayashi M, Uchiyama K. Short- and Long-Term Results of Laparoscopic Parenchyma-Sparing Hepatectomy for Small-Sized Hepatocellular Carcinoma: A Comparative Study Using Propensity Score Matching Analysis. Am Surg 2018;84:230–237.PubMedGoogle Scholar
  3. 3.
    Inoue Y, Hayashi M, Tanaka R, Komeda K, Hirokawa F, Uchiyama K. Short-term results of laparoscopic versus open liver resection for liver metastasis from colorectal cancer: a comparative study. Am Surg 2013;79:495–501.PubMedGoogle Scholar
  4. 4.
    Nord HJ. Laparoscopy - a historical perspective: are gastroenterologists going to reclaim it? Gastrointest Endosc 2008;68:67–68.CrossRefGoogle Scholar
  5. 5.
    Ishizawa T, Gumbs AA, Kokudo N, Gayet B. Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 2012;256:959–964.CrossRefGoogle Scholar
  6. 6.
    Inoue Y, Suzuki Y, Ota M, Fujii K, Kawaguchi N, Hirokawa F, Hayashi M, Uchiyama K. Short and long-term results of laparoscopic versus open hepatic resection for small-sized hepatocellular carcinoma: a comparative study using propensity score matching analyses. Am Surg 2018;84:230–237.PubMedGoogle Scholar
  7. 7.
    Inoue Y, Hayashi M, Komeda K, Masubuchi S, Yamamoto M, Yamana H, Kayano H, Shimizu T, Asakuma M, Hirokawa F, Miyamoto Y, Takeshita A, Shibayama Y, Uchiyama K. Resection margin with anatomic or nonanatomic hepatectomy for liver metastasis from colorectal cancer. J Gastrointest Surg 2012;16:1171–1180.CrossRefGoogle Scholar
  8. 8.
    Inoue Y, Tanaka R, Komeda K, Hirokawa F, Hayashi M, Uchiyama K. Fluorescence detection of malignant liver tumors using 5-aminolevulinic acid-mediated photodynamic diagnosis: principles, technique, and clinical experience. World J Surg 2014;38:1786–1794.CrossRefGoogle Scholar
  9. 9.
    Strasberg SM. Nomenclature of hepatic anatomy and resection: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 2005;12:351–355.CrossRefGoogle Scholar
  10. 10.
    International Union Against Cancer (UICC), Sobin LH, Gospodarowicz MK, Wittekind Ch. (2009) TNM classification of malignant tumours. 7th edition. Wiley-Blackwell, New YorkGoogle Scholar
  11. 11.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–213.CrossRefGoogle Scholar
  12. 12.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;2250:187–196.CrossRefGoogle Scholar
  13. 13.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97–132.Google Scholar
  14. 14.
    Shelat VG, Serin K, Samim M, Besselink MG, Al Saati H, Gioia PD, Pearce NW, Abu Hilal M. Outcomes of repeat laparoscopic liver resection compared to the primary resection. World J Surg 2014;38:3175–3180.CrossRefGoogle Scholar
  15. 15.
    Goh BKP, Teo JY, Chan CY, Lee SY, Cheow PC, Chung AYF. Laparoscopic repeat liver resection for recurrent hepatocellular carcinoma. ANZ J Surg 2017;87:E143-E146.CrossRefGoogle Scholar
  16. 16.
    Noda T, Eguchi H, Wada H, Iwagami Y, Yamada D, Asaoka T, Gotoh K, Kawamoto K, Takeda Y, Tanemura M, Umeshita K, Doki Y, Mori M. Short-term surgical outcomes of minimally invasive repeat hepatectomy for recurrent liver cancer. Surg Endosc 2018;32:46–52.CrossRefGoogle Scholar
  17. 17.
    Kolecki RV, Golub RM, Sigel B, Machi J, Kitamura H, Hosokawa T, Justin J, Schwartz J, Zaren HA. Accuracy of viscera slide detection of abdominal wall adhesions by ultrasound. Surg Endosc 1994;8:871–874.CrossRefGoogle Scholar
  18. 18.
    Terasawa M, Ishizawa T, Mise Y, Inoue Y, Ito H, Takahashi Y, Saiura A. Applications of fusion-fluorescence imaging using indocyanine green in laparoscopic hepatectomy. Surg Endosc 2017;31:5111–5118.CrossRefGoogle Scholar
  19. 19.
    Uchiyama K, Ueno M, Ozawa S, Hayami S, Kawai M, Tani M, Mizumoto K, Haba M, Hatano Y, Yamaue H. Half clamping of the infrahepatic inferior vena cava reduces bleeding during a hepatectomy by decreasing the central venous pressure. Langenbecks Arch Surg 2009;394:243–247.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Yoshihiro Inoue
    • 1
    Email author
  • Kensuke Fujii
    • 1
  • Masatsugu Ishii
    • 1
  • Syuji Kagota
    • 1
  • Atsushi Tomioka
    • 1
  • Hiroki Hamamoto
    • 1
  • Wataru Osumi
    • 1
  • Yusuke Tsuchimoto
    • 2
  • Tetsuji Terasawa
    • 2
  • Takeshi Ogura
    • 2
  • Shinsuke Masubuchi
    • 1
  • Masashi Yamamoto
    • 1
  • Akira Imoto
    • 2
  • Akira Asai
    • 2
  • Koji Komeda
    • 1
  • Shinya Fukunishi
    • 2
  • Fumitoshi Hirokawa
    • 1
  • Masahiro Goto
    • 2
  • Keitaro Tanaka
    • 1
  • Junji Okuda
    • 1
  • Kazuhide Higuchi
    • 2
  • Kazuhisa Uchiyama
    • 1
  1. 1.Department of General and Gastroenterological SurgeryOsaka Medical College HospitalTakatsuki CityJapan
  2. 2.Second Department of Internal MedicineOsaka Medical College HospitalOsakaJapan

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