Laparoscopic extended liver resection: are postoperative outcomes different?
| Autor: | Takeo Nomi, Marc Beaussier, Brice Gayet, Luca Portigliotti, Daren Subar, Carlotta Ferretti, Christian Lamer, Gianfranco Donatelli, David Fuks, Marc A. Ward, Daniel Pietrasz, Jane Cowan |
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| Přispěvatelé: | Pietrasz, D, Fuks, D, Subar, D, Donatelli, G, Ferretti, C, Lamer, C, Portigliotti, L, Ward, M, Cowan, J, Nomi, T, Beaussier, M, Gayet, B. |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Blood Loss Surgical 030230 surgery Resection 03 medical and health sciences Young Adult 0302 clinical medicine Postoperative Complications Blood loss Internal medicine medicine Hepatectomy Humans Aged Retrospective Studies Aged 80 and over business.industry Liver Neoplasms Perioperative Hepatology Length of Stay Middle Aged Surgery Postoperative mortality 030220 oncology & carcinogenesis Female Laparoscopy business Major hepatectomy Abdominal surgery |
| Zdroj: | Surgical endoscopy. 32(12) |
| ISSN: | 1432-2218 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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