scholarly journals Differences in Outcome of Laparoscopic Liver Surgery between Nationwide Daily Practice and High-volume Centers

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S39-S40
Author(s):  
B. Gorgec ◽  
R. Fichtinger ◽  
D. Agayhan ◽  
F. Ratti ◽  
B. Edwin ◽  
...  
Keyword(s):  
Liver Surgery ◽  
High Volume ◽  
Daily Practice ◽  
Laparoscopic Liver Surgery

scholarly journals Evolution of laparoscopic liver surgery: 20-year experience of a Norwegian high-volume referral center

2021 ◽  
Author(s):  
Davit L. Aghayan ◽  
Airazat M. Kazaryan ◽  
Åsmund Avdem Fretland ◽  
Bård Røsok ◽  
Leonid Barkhatov ◽  
...  
Keyword(s):  
Blood Loss ◽  
Liver Surgery ◽  
Liver Tumors ◽  
Early Period ◽  
High Volume ◽  
Perioperative Outcomes ◽  
Laparoscopic Liver Surgery ◽  
Referral Center ◽  
Number Of Patients ◽  
Time Periods

Abstract Background Laparoscopic liver surgery has evolved to become a standard surgical approach in many specialized centers worldwide. In this study we present the evolution of laparoscopic liver surgery at a single high-volume referral center since its introduction in 1998. Methods Patients who underwent laparoscopic liver resection (LLR) between August 1998 and December 2018 at the Oslo University Hospital were analyzed. Perioperative outcomes were compared between three time periods: early (1998 to 2004), middle (2005 to 2012) and recent (2013–2018). Results Up to December 2020, 1533 LLRs have been performed. A total of 1232 procedures were examined (early period, n = 62; middle period, n = 367 and recent period, n = 803). Colorectal liver metastasis was the main indication for surgery (68%). The rates of conversion to laparotomy and hand-assisted laparoscopy were 3.2% and 1.4%. The median operative time and blood loss were 130 min [interquartile range (IQR), 85–190] and 220 ml (IQR, 50–600), respectively. The total postoperative complications rate was 20.3% and the 30-day mortality was 0.3%. The median postoperative stay was two (IQR, 2–4) days. When comparing perioperative outcomes between the three time periods, shorter operation time (median, from 182 to 120 min, p < 0.001), less blood loss (median, from 550 to 200 ml, p = 0.023), decreased rate of conversions to laparotomy (from 8 to 3%) and shorter postoperative hospital stay (median, from 3 to 2 days, p < 0.001) was observed in the later periods, while the number of more complex liver resections had increased. Conclusion During the last two decades, the indications, the number of patients and the complexity of laparoscopic liver procedures have expanded significantly. Initially being an experimental approach, laparoscopic liver surgery is now safely implemented across our unit and has become the method of choice for surgical treatment of most liver tumors.

scholarly journals Operative Time, Age, and Serum Albumin Predict Surgical Morbidity After Laparoscopic Liver Surgery

2021 ◽  
pp. 155335062199122
Author(s):  
Daniel Heise ◽  
Jan Bednarsch ◽  
Andreas Kroh ◽  
Sandra Schipper ◽  
Roman Eickhoff ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Surgery ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Multivariable Analysis ◽  
Operation Time ◽  
Laparoscopic Liver Surgery ◽  
Surgical Morbidity ◽  
Perioperative Morbidity ◽  
Preoperative Albumin

Background. Laparoscopic liver resection (LLR) has emerged as a considerable alternative to conventional liver surgery. However, the increasing complexity of liver resection raises the incidence of postoperative complications. The aim of this study was to identify risk factors for postoperative morbidity in a monocentric cohort of patients undergoing LLR. Methods. All consecutive patients who underwent LLR between 2015 and 2019 at our institution were analyzed for associations between complications with demographics and clinical and operative characteristics by multivariable logistic regression analyses. Results. Our cohort comprised 156 patients who underwent LLR with a mean age of 60.0 ± 14.4 years. General complications and major perioperative morbidity were observed in 19.9% and 9.6% of the patients, respectively. Multivariable analysis identified age>65 years (HR = 2.56; P = .028) and operation time>180 minutes (HR = 4.44; P = .001) as significant predictors of general complications (Clavien ≥1), while albumin<4.3 g/dl (HR = 3.66; P = .033) and also operative time (HR = 23.72; P = .003) were identified as predictors of major postoperative morbidity (Clavien ≥3). Conclusion. Surgical morbidity is based on patient- (age and preoperative albumin) and procedure-related (operative time) characteristics. Careful patient selection is key to improve postoperative outcomes after LLR.

scholarly journals Indications for open left lateral sectionectomy in the Era of laparoscopic liver surgery

HPB ◽  
2018 ◽  
Vol 20 ◽  
pp. S333
Author(s):  
A. Chan ◽  
S. Jamdar ◽  
A. Sheen ◽  
A. Siriwardena
Keyword(s):  
Liver Surgery ◽  
Laparoscopic Liver Surgery ◽  
Left Lateral Sectionectomy ◽  
Lateral Sectionectomy

scholarly journals Adherence to the modified Barcelona Clinic Liver Cancer guidelines: Results from a high-volume liver surgery center in East Asias

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0249194
Author(s):  
Yi-Hao Yen ◽  
Yu-Fan Cheng ◽  
Jing-Houng Wang ◽  
Chih-Che Lin ◽  
Chien-Hung Chen ◽  
...  
Keyword(s):  
Liver Cancer ◽  
Liver Surgery ◽  
De Novo ◽  
Staging System ◽  
High Volume ◽  
Barcelona Clinic Liver Cancer ◽  
Treatment Modalities ◽  
Bclc Staging ◽  
Surgery Center ◽  
Stage D

Background and aims The Barcelona Clinic Liver Cancer (BCLC) staging system is the most widely applied staging system for hepatocellular carcinoma (HCC) and is recommended for treatment allocation and prognostic prediction. The BCLC guidelines were modified in 2018 to indicate that Child-Pugh A without any ascites is essential for all stages except stage D. This study sought to provide a description of patients with HCC treated at a high-volume liver surgery center in Taiwan where referral is not needed and all treatment modalities are available and reimbursed by the National Health Insurance program. As such, certain variables that could modulate treatment decisions in clinical practice, including financial constraints, the availability of treatment procedures, and the expertise of the hospital, could be excluded. The study further sought to evaluate the adherence to the modified BCLC guidelines. Methods This was a retrospective study with prospectively collected data. 1801 consecutive patients with de novo HCC were enrolled through our institution from 2011–2017. Results There were 302 patients with stage 0, 783 with stage A, 242 with stage B, 358 with stage C, and 116 with stage D HCC. Treatment adhering to the modified BCLC guidelines recommendations was provided to 259 (85.8%) stage 0 patients, 606 (77.4%) stage A patients, 120 (49.6%) stage B patients, 93 (26.0%) stage C patients, and 83 (71.6%) stage D patients. Conclusions We reported treatment adhering to the modified BCLC guidelines at a high-volume liver surgery center in Taiwan. We found that non-adherence to the modified BCLC staging system was common in treating stage B and C patients.

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