Skip to main content
SpringerLink
Log in

Laparoscopic extended liver resection: are postoperative outcomes different?

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Although laparoscopic major hepatectomy (LMH) is becoming increasingly common in specialized centers, data regarding laparoscopic extended major hepatectomies (LEMH) and their outcomes are limited. The aim of this study was to compare the perioperative characteristics and postoperative outcomes of LEMH to standard LMH.

Methods

All patients who underwent purely laparoscopic anatomical right or left hepatectomy and right or left trisectionectomy between February 1998 and January 2016 are enrolled. Demographic, clinicopathological, and perioperative factors were collected prospectively and analyzed retrospectively. Perioperative characteristics and postoperative outcomes in LEMH were compared to those of standard LMH.

Results

Among 195 patients with LMH, 47 (24.1%) underwent LEMH, colorectal liver metastases representing 66.7% of all indications. Preoperative portal vein embolization was undertaken in 31 (15.9%) patients. Despite more frequent vascular clamping, blood loss was higher in LEMH group (400 vs. 214 ml; p = 0.006). However, there was no difference in intraoperative transfusion requirements. Thirty-one patients experienced liver failure with no differences between LMH and LEMH groups. Postoperative mortality was comparable in the two groups [3 (2.5%) LMH patients vs. 2 (5%) LEMH patients (p = 0.388)]. Overall morbidity was higher in the LEMH group [49 LMH patients (41.5%) vs. 24 LEMH patients (60%) (p = 0.052)]. Patients treated with left LEMH experienced more biliary leakage (p = 0.011) and more major pulmonary complications (p = 0.015) than left LMH.

Conclusion

LEMH is feasible at the price of important morbidity, with manageable and acceptable outcomes. These exigent procedures require high-volume centers with experienced surgeons.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS, World Consensus Conference on Laparoscopic S (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830

    Article  Google Scholar 

  2. Abu Hilal M, Di Fabio F, Teng MJ, Lykoudis P, Primrose JN, Pearce NW (2011) Single-centre comparative study of laparoscopic versus open right hepatectomy. J Gastrointest Surg 15:818–823

    Article  Google Scholar 

  3. Berardi G, Van Cleven S, Fretland AA, Barkhatov L, Halls M, Cipriani F, Aldrighetti L, Abu Hilal M, Edwin B, Troisi RI (2017) Evolution of laparoscopic liver surgery from innovation to implementation to mastery: perioperative and oncologic outcomes of 2,238 patients from 4 European Specialized Centers. J Am Coll Surg 225:639–649

    Article  Google Scholar 

  4. Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC, Lainas P, Laurent A, Nguyen KT, Marvin MR, Thomas M, Ravindra K, Fielding G, Franco D, Buell JF (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250:856–860

    Article  Google Scholar 

  5. Belli G, Limongelli P, Fantini C, D’Agostino A, Cioffi L, Belli A, Russo G (2009) Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg 96:1041–1048

    Article  CAS  Google Scholar 

  6. Ito K, Ito H, Are C, Allen PJ, Fong Y, DeMatteo RP, Jarnagin WR, D’Angelica MI (2009) Laparoscopic versus open liver resection: a matched-pair case control study. J Gastrointest Surg 13:2276–2283

    Article  Google Scholar 

  7. Laurent A, Cherqui D, Lesurtel M, Brunetti F, Tayar C, Fagniez PL (2003) Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 138:763–769, discussion 769

    Article  Google Scholar 

  8. Chang S, Laurent A, Tayar C, Karoui M, Cherqui D (2007) Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg 94:58–63

    Article  CAS  Google Scholar 

  9. Bryant R, Laurent A, Tayar C, Cherqui D (2009) Laparoscopic liver resection-understanding its role in current practice: the Henri Mondor Hospital experience. Ann Surg 250:103–111

    Article  Google Scholar 

  10. Castaing D, Vibert E, Ricca L, Azoulay D, Adam R, Gayet B (2009) Oncologic results of laparoscopic versus open hepatectomy for colorectal liver metastases in two specialized centers. Ann Surg 250:849–855

    Article  Google Scholar 

  11. Tranchart H, Di Giuro G, Lainas P, Roudie J, Agostini H, Franco D, Dagher I (2010) Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 24:1170–1176

    Article  Google Scholar 

  12. Buell JF, Thomas MT, Rudich S, Marvin M, Nagubandi R, Ravindra KV, Brock G, McMasters KM (2008) Experience with more than 500 minimally invasive hepatic procedures. Ann Surg 248:475–486

    PubMed  Google Scholar 

  13. Fuks D, Cauchy F, Fteriche S, Nomi T, Schwarz L, Dokmak S, Scatton O, Fusco G, Belghiti J, Gayet B, Soubrane O (2015) Laparoscopy decreases pulmonary complications in patients undergoing major liver resection: a propensity score analysis. Ann Surg 263:353–361

    Article  Google Scholar 

  14. Gayet B, Cavaliere D, Vibert E, Perniceni T, Levard H, Denet C, Christidis C, Blain A, Mal F (2007) Totally laparoscopic right hepatectomy. Am J Surg 194:685–689

    Article  Google Scholar 

  15. Gumbs AA, Gayet B (2007) Totally laparoscopic left hepatectomy. Surg Endosc 21:1221

    Article  Google Scholar 

  16. Xu H, Liu F, Li H, Wei Y, Li B (2017) Outcomes following laparoscopic versus open major hepatectomy: a meta-analysis. Scand J Gastroenterol 52:1307–1314

    Article  Google Scholar 

  17. Yoon YI, Kim KH, Kang SH, Kim WJ, Shin MH, Lee SK, Jung DH, Park GC, Ahn CS, Moon DB, Ha TY, Song GW, Hwang S, Lee SG (2017) Pure laparoscopic versus open right hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a propensity score matched analysis. Ann Surg 265:856–863

    Article  Google Scholar 

  18. Komatsu S, Brustia R, Goumard C, Perdigao F, Soubrane O, Scatton O (2015) Laparoscopic versus open major hepatectomy for hepatocellular carcinoma: a matched pair analysis. Surg Endosc 30:1965–1974

    Article  Google Scholar 

  19. Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G (2016) Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg 263:761–777

    Article  Google Scholar 

  20. Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R, Aroori S, Belli G, Besselink M, Briceno J, Gayet B, D’Hondt M, Lesurtel M, Menon K, Lodge P, Rotellar F, Santoyo J, Scatton O, Soubrane O, Sutcliffe R, Van Dam R, White S, Halls MC, Cipriani F, Van der Poel M, Ciria R, Barkhatov L, Gomez-Luque Y, Ocana-Garcia S, Cook A, Buell J, Clavien PA, Dervenis C, Fusai G, Geller D, Lang H, Primrose J, Taylor M, Van Gulik T, Wakabayashi G, Asbun H, Cherqui D (2017) The Southampton consensus guidelines for laparoscopic liver surgery: from indication to implementation. Ann Surg. https://doi.org/10.1097/SLA.0000000000002524

    Article  PubMed  Google Scholar 

  21. Gumbs AA, Bar-Zakai B, Gayet B (2008) Totally laparoscopic extended left hepatectomy. J Gastrointest Surg 12:1152

    Article  Google Scholar 

  22. Gumbs AA, Gayet B (2008) Multimedia article. Totally laparoscopic extended right hepatectomy. Surg Endosc 22:2076–2077

    Article  Google Scholar 

  23. Azoulay D, Castaing D, Krissat J, Smail A, Hargreaves GM, Lemoine A, Emile JF, Bismuth H (2000) Percutaneous portal vein embolization increases the feasibility and safety of major liver resection for hepatocellular carcinoma in injured liver. Ann Surg 232:665–672

    Article  CAS  Google Scholar 

  24. Nomi T, Fuks D, Govindasamy M, Mal F, Nakajima Y, Gayet B (2015) Risk factors for complications after laparoscopic major hepatectomy. Br J Surg 102:254–260

    Article  CAS  Google Scholar 

  25. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  26. Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F (2005) The “50–50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242:824–828, discussion 828–829

    Article  Google Scholar 

  27. Ishizawa T, Hasegawa K, Kokudo N, Sano K, Imamura H, Beck Y, Sugawara Y, Makuuchi M (2009) Risk factors and management of ascites after liver resection to treat hepatocellular carcinoma. Arch Surg 144:46–51

    Article  Google Scholar 

  28. 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, Buchler 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 149:680–688

    Article  Google Scholar 

  29. Dagher I, Gayet B, Tzanis D, Tranchart H, Fuks D, Soubrane O, Han HS, Kim KH, Cherqui D, O’Rourke N, Troisi RI, Aldrighetti L, Bjorn E, Abu Hilal M, Belli G, Kaneko H, Jarnagin WR, Lin C, Pekolj J, Buell JF, Wakabayashi G (2014) International experience for laparoscopic major liver resection. J Hepato-Biliary-Pancreat Sci 21:732–736

    Article  Google Scholar 

  30. Medbery RL, Chadid TS, Sweeney JF, Knechtle SJ, Kooby DA, Maithel SK, Lin E, Sarmiento JM (2014) Laparoscopic vs open right hepatectomy: a value-based analysis. J Am Coll Surg 218:929–939

    Article  Google Scholar 

  31. Cauchy F, Fuks D, Nomi T, Dokmak S, Scatton O, Schwarz L, Barbier L, Belghiti J, Soubrane O, Gayet B (2016) Benefits of laparoscopy in elderly patients requiring major liver resection. J Am Coll Surg 222:174–184 e110

    Article  Google Scholar 

  32. Kawaguchi Y, Fuks D, Kokudo N, Gayet B (2018) Difficulty of laparoscopic liver resection: proposal for a new classification. Ann Surg 267:13–17

    Article  Google Scholar 

  33. Hanazaki K, Kajikawa S, Shimozawa N, Matsushita A, Machida T, Shimada K, Yazawa K, Koide N, Adachi W, Amano J (2005) Perioperative blood transfusion and survival following curative hepatic resection for hepatocellular carcinoma. Hepato-Gastroenterology 52:524–529

    PubMed  Google Scholar 

  34. Melendez J, Ferri E, Zwillman M, Fischer M, DeMatteo R, Leung D, Jarnagin W, Fong Y, Blumgart LH (2001) Extended hepatic resection: a 6-year retrospective study of risk factors for perioperative mortality. J Am Coll Surg 192:47–53

    Article  CAS  Google Scholar 

  35. Cherqui D, Alon R, Lauzet JY, Salvat A, De Salles De Hys C, Rotman N, Duvoux C, Julien M, Fagniez PL (1996) Limitation of blood transfusions during hepatectomies. Study of 150 consecutive hepatic resections on healthy and pathological livers. Gastroenterol Clin Biol 20:132–138

    CAS  PubMed  Google Scholar 

  36. Lang H, Sotiropoulos GC, Brokalaki EI, Radtke A, Frilling A, Molmenti EP, Malago M, Broelsch CE (2006) Left hepatic trisectionectomy for hepatobiliary malignancies. J Am Coll Surg 203:311–321

    Article  Google Scholar 

  37. Halazun KJ, Al-Mukhtar A, Aldouri A, Malik HZ, Attia MS, Prasad KR, Toogood GJ, Lodge JP (2007) Right hepatic trisectionectomy for hepatobiliary diseases: results and an appraisal of its current role. Ann Surg 246:1065–1074

    Article  Google Scholar 

  38. Nishio H, Hidalgo E, Hamady ZZ, Ravindra KV, Kotru A, Dasgupta D, Al-Mukhtar A, Prasad KR, Toogood GJ, Lodge JP (2005) Left hepatic trisectionectomy for hepatobiliary malignancy: results and an appraisal of its current role. Ann Surg 242:267–275

    Article  Google Scholar 

  39. Takahara T, Wakabayashi G, Konno H, Gotoh M, Yamaue H, Yanaga K, Fujimoto J, Kaneko H, Unno M, Endo I, Seto Y, Miyata H, Miyazaki M, Yamamoto M (2016) Comparison of laparoscopic major hepatectomy with propensity score matched open cases from the National Clinical Database in Japan. J Hepato-Biliary-Pancreat Sci 23:721–734

    Article  Google Scholar 

  40. Otsubo T, Takasaki K, Yamamoto M, Katsuragawa H, Katagiri S, Yoshitoshi K, Hamano M, Ariizumi S, Kotera Y (2004) Bleeding during hepatectomy can be reduced by clamping the inferior vena cava below the liver. Surgery 135:67–73

    Article  Google Scholar 

  41. Nomi T, Fuks D, Agrawal A, Govindasamy M, Araki K, Gayet B (2015) Modified Pringle maneuver for laparoscopic liver resection. Ann Surg Oncol 22:852

    Article  Google Scholar 

  42. Kobayashi S, Honda G, Kurata M, Tadano S, Sakamoto K, Okuda Y, Abe K (2016) An experimental study on the relationship among airway pressure, pneumoperitoneum pressure, and central venous pressure in pure laparoscopic hepatectomy. Ann Surg 263:1159–1163

    Article  Google Scholar 

  43. Nagino M, Kamiya J, Arai T, Nishio H, Ebata T, Nimura Y (2006) “Anatomic” right hepatic trisectionectomy (extended right hepatectomy) with caudate lobectomy for hilar cholangiocarcinoma. Ann Surg 243:28–32

    Article  Google Scholar 

  44. Farid SG, White A, Khan N, Toogood GJ, Prasad KR, Lodge JP (2016) Clinical outcomes of left hepatic trisectionectomy for hepatobiliary malignancy. Br J Surg 103:249–256

    Article  CAS  Google Scholar 

  45. Vauthey JN, Pawlik TM, Abdalla EK, Arens JF, Nemr RA, Wei SH, Kennamer DL, Ellis LM, Curley SA (2004) Is extended hepatectomy for hepatobiliary malignancy justified? Ann Surg 239:722–730; discussion 730–722

    Article  Google Scholar 

  46. Esaki M, Shimada K, Nara S, Kishi Y, Sakamoto Y, Kosuge T, Sano T (2013) Left hepatic trisectionectomy for advanced perihilar cholangiocarcinoma. Br J Surg 100:801–807

    Article  CAS  Google Scholar 

  47. Hong J, Zhang X, Luo R, Cai X (2016) The clinical risk factors associated with postoperative bile leakage after hepatectomy: a meta-analysis. Minerva Medica 107:39–53

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France

    Daniel Pietrasz, David Fuks, Daren Subar, Gianfranco Donatelli, Carlotta Ferretti, Luca Portigliotti, Marc Ward, Jane Cowan, Takeo Nomi & Brice Gayet

  2. Department of General and HPB Surgery, Royal Blackburn Hospital, Haslingden Road, Lancashire, BB2 3HH, UK

    Daren Subar

  3. Department of Intensive Care Unit – Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France

    Christian Lamer

  4. Department of Anesthesiology – Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France

    Marc Beaussier

Authors
  1. Daniel Pietrasz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Fuks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daren Subar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gianfranco Donatelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carlotta Ferretti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christian Lamer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luca Portigliotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marc Ward
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jane Cowan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takeo Nomi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Marc Beaussier
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Brice Gayet
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel Pietrasz.

Ethics declarations

Disclosures

Dr. Daniel Pietrasz, Pr. David Fuks, Drs. Daren Subar, Gianfranco Donatelli, Carlotta Ferretti, Christian Lamer, Luca Portigliotti, Marc Ward, Jane Cowan, Takeo Nomi, and Prs. Marc Beaussier, and Brice Gayet have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pietrasz, D., Fuks, D., Subar, D. et al. Laparoscopic extended liver resection: are postoperative outcomes different?. Surg Endosc 32, 4833–4840 (2018). https://doi.org/10.1007/s00464-018-6234-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6234-9

Keywords

Search

Navigation