Pure abdominal laparoscopic approach versus thoraco-abdominal laparoscopic approach: What is the best technique for liver resection in segment 7 and segment 8? An answer from the Institut Mutualiste Montsouris experience with short- and long-term outcome evaluation.

Autor: Mazzotta AD; Department of Digestive, Oncological, and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France., Carneiro AC; Department of Digestive, Oncological, and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France., Tribillon E; Department of Digestive, Oncological, and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France., Kawaguchi Y; Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan., Gayet B; Department of Digestive, Oncological, and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France., Soubrane O; Department of Digestive, Oncological, and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2023 May; Vol. 173 (5), pp. 1176-1183. Date of Electronic Publication: 2023 Jan 18.
DOI: 10.1016/j.surg.2022.12.007
Abstrakt: Background: Lesions in segments 7 and 8 are a challenge during standard laparoscopic liver resection. The addition of transthoracic trocars could be useful in the standard abdominal approach for laparoscopic liver resection. We report our experience with a thoraco-abdominal laparoscopic combined approach for liver resection with the aim of comparing short- and long-term outcomes.
Methods: We reviewed 1,003 laparoscopic liver resections in a prospectively maintained, single-institution database. We compared patient outcomes intraoperatively and postoperatively. We analyzed the long-term outcomes of the colorectal liver metastasis subgroup. Propensity score matching 1:1 was performed based on the following variables: age, American Society of Anesthesiologists, body mass index, previous abdominal surgery, multiple or single liver resection, lesion >50 mm or <50 mm, presence of solitary or multiple lesions, T stage, and N stage.
Results: The standard abdominal approach was used in 110 laparoscopic liver resections, and the thoraco-abdominal laparoscopic combined approach was used in 62 laparoscopic liver resections. The thoraco-abdominal laparoscopic combined approach was associated with better intraoperative results (less blood loss and no need for conversion to open surgery). The R1s rate for segmentectomy 7 and 8 was lower in the thoraco-abdominal laparoscopic combined approach in the entire group and in the colorectal liver metastasis subgroup. In the colorectal liver metastasis subgroup, the 3- and 5-year overall survival was 90% and 80% in the thoraco-abdominal laparoscopic combined approach group and 76% and 52% in the standard abdominal approach group, respectively (P = .02). In univariate and multivariate analysis, the thoraco-abdominal laparoscopic combined approach was a significant factor that positively affected disease-free survival and overall survival.
Conclusion: The thoraco-abdominal laparoscopic combined approach in laparoscopic liver resection in segments 7 and 8 is safe and feasible, and it has demonstrated better oncologic outcomes than the pure abdominal approach, especially in segmentectomy.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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