IS CONSERVATIVE AND MINIMALLY INVASIVE LIVER SURGERY SAFE IN THE APPROACH TO HEPATOCARCINOMA? ANALYSIS OF THE RESULTS IN OUR CENTER

Abstract INTRODUCTION We present the results of liver resection surgery for hepatocarcinoma (HCC), comparing morbidity, mortality, and survival data based on the type of surgical approach (open vs. laparoscopic) and the type of liver resection (anatomical vs. limited). MATERIAL AND METHODS Descriptive, prospective, and comparative study of 49 patients who underwent liver resection for HCC during the period 2013-2018 in our centre. RESULTS 16 laparoscopic resections were performed (32.7%) compared to 33 open surgeries (67.3%). Morbidity and mortality results according to the Clavien-Dindo classification (I 38 (77.6%); II 9 (18.4%), III 1 (2%), IV 1 (2%). Among the risk factors, the relationship between the preoperative Apri Index and the observed survival has been studied in our population, without observing statistically significant differences (p = 0.915). No statistically significant differences have been found between the laparoscopic versus the open approach (p = 0.78) or in anatomical surgery versus limited resections (p = 0.26) in terms of time to tumor recurrence. In our series, no significant differences in survival were found depending on the type of surgery (open vs laparoscopic, p = 0.57). CONCLUSIONS In our study, we have not been able to demonstrate the greater oncological safety of performing limited versus anatomic resections. The results of the laparoscopic approach are comparable, in terms of overall survival and time to recurrence, to the results of open surgery.

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Liver Surgery for Hepatocellular Carcinoma: Laparoscopic versus Open Approach

International Journal of Hepatology ◽

10.4061/2011/596792 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 34

Author(s):

C. G. Ker ◽

J. S. Chen ◽

K. K. Kuo ◽

S. C. Chuang ◽

S. J. Wang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Average Length ◽

Survival Rates ◽

Laparoscopic Approach ◽

Operation Time ◽

Open Approach ◽

Full Diet ◽

Or Groups ◽

Significant Difference

In this study, we try to compare the benefit of laparoscopic versus open operative procedures.Patients and Methods. One hundred and sixteen patients underwent laparoscopic liver resection (LR) and another 208 patients went for open liver resection (OR) for hepatocellular carcinoma (HCC). Patients' selection for open or laparoscopic approach was not randomized.Results. The CLIP score for LR and OR was 0.59 ± 0.75 and 0.86 ± 1.04, respectively, (). The operation time was 156.3 ± 308.2 and 190.9 ± 79.2 min for LR and OR groups, respectively. The necessity for blood transfusion was found in 8 patients (6.9%) and 106 patients (50.9%) for LR and OR groups. Patients resumed full diet on the 2nd and 3rd postoperative day, and the average length of hospital stay was 6 days and 12 days for LR and OR groups. The complication rate and mortality rate were 0% and 6.0%, 2.9% and 30.2% for LR and OR groups, respectively. The 1-yr, 3-yr, and 5-yr survival rate was 87.0%, 70.4%, 62.2% and 83.2%, 76.0%, 71.8% for LR and OR group, respectively, of non-significant difference. From these results, HCC patients accepted laparoscopic or open approach were of no significant differences between their survival rates.

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Laparoscopic vs open surgery during the COVID-19 pandemic: what are the risks?

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.7067 ◽

2021 ◽

Author(s):

C Hadjittofi ◽

SS Seraj ◽

A Uddin ◽

ZJ Ali ◽

PL Antonas ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Hospital Stay ◽

Survival Data ◽

Open Surgery ◽

Virus Transmission ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

Staff Members ◽

Significant Difference ◽

The Uk

Introduction The initial intercollegiate surgical guidance from the UK during the COVID-19 pandemic resulted in significant changes to practice. Avoidance of laparoscopy was recommended, to reduce aerosol generation and risk of virus transmission. Evidence on the safety profile of laparoscopy during the pandemic is lacking. This study compares patient outcomes and risk to staff from laparoscopic and open gastrointestinal operations during the COVID-19 pandemic. Methods Single-centre retrospective study of gastrointestinal operations performed during the peak of the COVID-19 pandemic. Demographic, comorbidity, perioperative and survival data were collected from electronic medical records and supplemented with patient symptoms reported at telephone follow up. Outcomes assessed were: patient mortality, illness among staff, patient COVID-19 rates, length of hospital stay and postdischarge symptomatology. Results A total of 73 patients with median age of 56 years were included; 55 (75%) and 18 (25%) underwent laparoscopic and open surgery, respectively. All-cause mortality was 5% (4/73), was related to COVID-19 in all cases, with no mortality after laparoscopic surgery. A total of 14 staff members developed COVID-19 symptoms within 2 weeks, with no significant difference between laparoscopic and open surgery (10 vs 4; p=0.331). Median length of stay was shorter in the laparoscopic versus the open group (4.5 vs 9.9 days; p=0.011), and postdischarge symptomatology across 15 symptoms was similar between groups (p=0.135–0.814). Conclusions With appropriate protective measures, laparoscopic surgery is safe for patients and staff during the COVID-19 pandemic. The laparoscopic approach maintains an advantage of shorter length of hospital stay compared with open surgery.

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Role for colorectal teams to support non-colorectal teams to improve clinical outcomes and adherence to ERAS guidelines for segmental colectomy: a cohort study

BMC Surgery ◽

10.1186/s12893-021-01149-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Simonette R. Mallard ◽

◽

Kari A. Clifford ◽

R. Park ◽

Kim Cousins ◽

...

Keyword(s):

Enhanced Recovery ◽

Multivariable Analysis ◽

Laparoscopic Approach ◽

Open Approach ◽

Surgical Team ◽

Univariable Analysis ◽

Indwelling Catheters ◽

Patient Demographics ◽

Segmental Colectomy ◽

The Relationship

Abstract Background To identify whether compliance with Enhanced Recovery After Surgery (ERAS) Society recommendations is associated with length of stay (LOS) in a New Zealand hospital for patients undergoing segmental colectomy in mixed acute and elective general surgery wards. Methods Consecutive elective colorectal surgeries (n = 770) between October 2012 and February 2019 were audited. Patients with non-segmental colectomies, multi-organ surgeries, LOS > 14 days, and those who died were excluded. Logistic regression was used to determine the relationship between patient demographics, compliance with ERAS guidelines, and suboptimal LOS (> 4 days). Results Analysis included 376 patients. Age, surgery prior to 2014, surgical approach, non-colorectal surgical team, operation type, and complications were significantly associated with suboptimal LOS. Non-compliance with ERAS recommendations for laparoscopy [OR 8.9, 95% CI (4.52, 19.67)], removal of indwelling catheters (IDC) [OR 3.14, 95% CI (1.85, 5.51)], use of abdominal drains [OR 4.27, 95% CI (0.99, 18.35)], and removal of PCA [OR 8.71, 95% CI (1.78, 157.27)], were associated with suboptimal LOS (univariable analysis). Multivariable analysis showed that age, surgical team, late removal of IDC, and open approach were independent predictors of suboptimal LOS. Conclusions Non-compliance with ERAS guidelines for laparoscopic approach and early removal of IDC was higher among procedures performed by non-colorectal surgery teams, and was also associated with adverse postoperative events and suboptimal LOS. This study demonstrates the importance of the surgical team’s expertise in affecting surgical outcomes, and did not find significant independent associations between most individual ERAS guidelines and suboptimal LOS once adjusting for other factors.

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Laparoscopic versus Open Surgery for Acute Adhesive Small-Bowel Obstruction: A Propensity Score–Matched Analysis

Scandinavian Journal of Surgery ◽

10.1177/1457496916641341 ◽

2016 ◽

Vol 106 (1) ◽

pp. 28-33 ◽

Cited By ~ 19

Author(s):

T. Hackenberg ◽

P. Mentula ◽

A. Leppäniemi ◽

V. Sallinen

Keyword(s):

Small Bowel ◽

Propensity Score ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Open Surgery ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

Adhesive Small Bowel Obstruction ◽

Open Approach ◽

Laparoscopic Adhesiolysis

Background and Aims: The laparoscopic approach has been increasingly used to treat adhesive small-bowel obstruction. The aim of this study was to compare the outcomes of a laparoscopic versus an open approach for adhesive small-bowel obstruction. Material and Methods: Data were retrospectively collected on patients who had surgery for adhesive small-bowel obstruction at a single academic center between January 2010 and December 2012. Patients with a contraindication for the laparoscopic approach were excluded. A propensity score was used to match patients in the laparoscopic and open surgery groups based on their preoperative parameters. Results: A total of 25 patients underwent laparoscopic adhesiolysis and 67 patients open adhesiolysis. The open adhesiolysis group had more suspected bowel strangulations and more previous abdominal surgeries than the laparoscopic adhesiolysis group. Severe complication rate (Clavien–Dindo 3 or higher) was 0% in the laparoscopic adhesiolysis group versus 14% in the open adhesiolysis group ( p = 0.052). Twenty-five propensity score–matched patients from the open adhesiolysis group were similar to laparoscopic adhesiolysis group patients with regard to their preoperative parameters. Length of hospital stay was shorter in the laparoscopic adhesiolysis group compared to the propensity score–matched open adhesiolysis group (6.0 vs 10.0 days, p = 0.037), but no differences were found in severe complications between the laparoscopic adhesiolysis and propensity score–matched open adhesiolysis groups (0% vs 4%, p = 0.31). Conclusion: Patients selected to be operated by the open approach had higher preoperative morbidity than the ones selected for the laparoscopic approach. After matching for this disparity, the laparoscopic approach was associated with a shorter length of hospital stay without differences in complications. The laparoscopic approach may be a preferable approach in selected patients.

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One hand is better than two: conversion from pure laparoscopic to the hand-assisted approach during difficult nephrectomy

Annals of The Royal College of Surgeons of England ◽

10.1308/003588411x563970 ◽

2011 ◽

Vol 93 (3) ◽

pp. 229-231 ◽

Cited By ~ 2

Author(s):

Nishanthan Mahesan ◽

Sirazum M Choudhury ◽

M Shamim Khan ◽

Declan G Murphy ◽

Prokar Dasgupta

Keyword(s):

Renal Cell Carcinoma ◽

Minimally Invasive Surgery ◽

Open Surgery ◽

Malignant Disease ◽

Laparoscopic Approach ◽

Open Approach ◽

Open Procedure ◽

Better Than ◽

Prospective Database ◽

Failure To Progress

INTRODUCTION The incidence of conversion from a laparoscopic to an open approach during nephrectomy is reported at 6-8%. 1 Conversion to an open procedure may be necessary to control haemorrhage or allow progress in dissection but the well established benefits of minimally invasive surgery (MIS) are obviously lost. Hand-assisted laparoscopy (HAL) also offers the benefits to the patient of MIS. We have used HAL to convert from the pure laparoscopic approach during difficult nephrectomies, rather than converting to traditional open surgery. MATERIALS AND METHODS A review of our prospective database was carried out to identify any conversions from the pure laparoscopic approach during nephrectomy or nephroureterectomy for benign or malignant disease. RESULTS A total of 87 laparoscopic nephrectomies (LNs) were identified over a 3-year period. There were five conversions to the HAL approach (5.7%) and no conversions to open surgery. The reason for conversion was failure to progress in all five cases. Operative times averaged 190 minutes with blood loss of 180ml. Histology revealed xanthogranulomatous pyelonephritis in four cases and renal cell carcinoma in one case. The median postoperative stay was 4 days. CONCLUSIONS Conversion to HAL during LN maintains the benefits of MIS in difficult nephrectomy and should be considered prior to converting to open surgery.

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Comparison of Oncologic Outcomes in Laparoscopic versus Open Surgery for Non-Metastatic Colorectal Cancer: Personal Experience in a Single Institution

Journal of Clinical Medicine ◽

10.3390/jcm8060875 ◽

2019 ◽

Vol 8 (6) ◽

pp. 875 ◽

Cited By ~ 1

Author(s):

Chong-Chi Chiu ◽

Wen-Li Lin ◽

Hon-Yi Shi ◽

Chien-Cheng Huang ◽

Jyh-Jou Chen ◽

...

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Blood Loss ◽

Metastatic Colorectal Cancer ◽

Surgical Complications ◽

Open Surgery ◽

Tumor Recurrence ◽

Laparoscopic Approach ◽

Open Approach ◽

Significant Difference

The oncologic merits of the laparoscopic technique for colorectal cancer surgery remain debatable. Eligible patients with non-metastatic colorectal cancer who were scheduled for an elective resection by one surgeon in a medical institution were randomized to either laparoscopic or open surgery. During this period, a total of 188 patients received laparoscopic surgery and the other 163 patients received the open approach. The primary endpoint was cancer-free five-year survival after operative treatment, and the secondary endpoint was the tumor recurrence incidence. Besides, surgical complications were also compared. There was no statistically significant difference between open and laparoscopic groups regarding the average number of lymph nodes dissected, ileus, anastomosis leakage, overall mortality rate, cancer recurrence rate, or cancer-free five-year survival. Even though performing a laparoscopic approach used a significantly longer operation time, this technique was more effective for colorectal cancer treatment in terms of shorter hospital stay and less blood loss. Meanwhile, fewer patients receiving the laparoscopic approach developed postoperative urinary tract infection, wound infection, or pneumonia, which reached statistical significance. For non-metastatic colorectal cancer patients, laparoscopic surgery resulted in better short-term outcomes, whether in several surgical complications and intra-operative blood loss. Though there was no significant statistical difference in terms of cancer-free five-year survival and tumor recurrence, it is strongly recommended that patients undergo laparoscopic surgery if not contraindicated.

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Parameters of radical resection in laparoscopic and open colon and rectal cancer surgery

Vojnosanitetski pregled ◽

10.2298/vsp180607127k ◽

2020 ◽

Vol 77 (5) ◽

pp. 532-538

Author(s):

Igor Krdzic ◽

Marko Kenic ◽

Milena Scepanovic ◽

Ivan Soldatovic ◽

Jelena Ilic-Zivojinovic ◽

...

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Lymph Nodes ◽

Open Surgery ◽

Rectal Surgery ◽

Laparoscopic Approach ◽

Resection Margins ◽

Rectal Cancer Surgery ◽

Open Approach ◽

Colon And Rectal Cancer

Background/Aim. In colon and rectal cancer surgery, resection is considered radical when circumferential, proximal and distal resection margins are without the presence of tumor cells. Concept of total mesorectal excision in rectal surgery involves complete removal of the tumor with mesorectal fascia which surrounds lymph nodes, lymphatics and blood vessels. The aim of this study was to determine whether laparoscopic approach provides all parameters of oncological radicality as open surgery of colorectal cancer. Methods. The study included 122 patients with carcinoma of colon and rectum, divided into two equal groups: patients operated on by laparoscopic and those operated on by open approach. In colon surgery we analyzed proximal and distal resection margins, and the number of removed lymph nodes, and in rectal surgery: proximal, distal and circumferential resection margins, and the number of removed lymph nodes. Results. Both groups were comparable in age, sex, American Society of Anesthesiologists (ASA) score, tumor localization, tumor size, and type of surgical operation performed. According to localization of the tumor, the most commonly performed operation was anterior resection of the rectum (60.7% vs. 59%). There was no case of the tumor involvement of the distal margin. Average proximal distance from the tumor on the fixed specimen was 100 vs. 120 mm with statistical significance (p < 0.001). Distal margins were not significantly different, 40 mm in both groups (p = 0.143). In two cases we had circumferential resection margin (CRM) of 1 mm (7.7%) in the laparoscopic group, and in three cases operated conventionally CRM was 1 mm (8.8%). The average number of removed lymph nodes was 15 vs. 16, respectively. Length of hospital stay for patients assigned to the laparoscopic surgery was significantly shorter than for patients operated on by the open approach. Concerning postoperative complications, no significant difference was found between groups. The overall postoperative morbidity was 18% vs. 21.3%, respectively. Conclusion. With laparoscopic approach it is possible to provide all parameters of oncological radicality similarly to the open surgery of colorectal cancer.

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Recurrence after Curative Resection for Intrahepatic Cholangiocarcinoma: How to Predict the Chance of Repeat Hepatectomy?

Journal of Clinical Medicine ◽

10.3390/jcm10132820 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2820

Author(s):

Serena Langella ◽

Nadia Russolillo ◽

Paolo Ossola ◽

Andrea-Pierre Luzzi ◽

Michele Casella ◽

...

Keyword(s):

Liver Resection ◽

Intrahepatic Cholangiocarcinoma ◽

Major Hepatectomy ◽

Multivariable Analysis ◽

Study Data ◽

Good Survival ◽

Lower Probability ◽

Factors Affecting ◽

Time To Recurrence ◽

Second Resection

(1) Background: Tumor recurrence after liver resection (LR) for intrahepatic cholangiocarcinoma (ICC) is common. Repeat liver resection (RLR) for recurrent ICC results in good survival outcomes in selected patients. The aim of this study was to investigate factors affecting the chance of resectability of recurrent ICC. (2) Methods: LR for ICC performed between January 2001 and December 2020 were retrospectively reviewed. Patients who had undergone first LR were considered for the study. Data on recurrences were analyzed. A logistic regression model was used for multivariable analysis of factors related to RLR rate. (3) Results: In total, 140 patients underwent LR for ICC. Major/extended hepatectomies were required in 105 (75%) cases. The 90-day mortality was 5.7%, Clavien–Dindo grade 3, 4 complications were 9.3%, N+ disease was observed in 32.5%, and the median OS was 38.3 months. Recurrence occurred in 91 patients (65%). The site of relapse was the liver in 53 patients (58.2%). RLR was performed in 21 (39.6%) patients. Factors that negatively affected RLR were time to recurrence ≤12 months (OR 7.4, 95% CI 1.68–33.16, p = 0.008) and major hepatectomy (OR 16.7, 95% CI 3.8–73.78, p < 0.001) at first treatment. Survival after recurrence was better in patients who underwent RLR as compared with not resected patients (31 vs. 13.2 months, p = 0.02). (4) Conclusions: Patients with ICC treated at first resection with major hepatectomy and those who recurred in ≤12 months had significantly lower probability to receive a second resection for recurrence.

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Laparoscopic versus Open Liver Resection: Differences in Intraoperative and Early Postoperative Outcome among Cirrhotic Patients with Hepatocellular Carcinoma—A Retrospective Observational Study

HPB Surgery ◽

10.1155/2014/871251 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 14

Author(s):

Antonio Siniscalchi ◽

Giorgio Ercolani ◽

Giulia Tarozzi ◽

Lorenzo Gamberini ◽

Lucia Cipolat ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Liver Function ◽

Hospital Stay ◽

Perioperative Complications ◽

Laparoscopic Approach ◽

Postoperative Outcome ◽

Laparoscopic Technique ◽

Surgical Trauma ◽

Cirrhotic Patients

Introduction. Laparoscopic liver resection is considered risky in cirrhotic patients, even if minor surgical trauma of laparoscopy could be useful to prevent deterioration of a compromised liver function. This study aimed to identify the differences in terms of perioperative complications and early outcome in cirrhotic patients undergoing minor hepatic resection for hepatocellular carcinoma with open or laparoscopic technique. Methods. In this retrospective study, 156 cirrhotic patients undergoing liver resection for hepatocellular carcinoma were divided into two groups according to type of surgical approach: laparoscopy (LS group: 23 patients) or laparotomy (LT group: 133 patients). Perioperative data, mortality, and length of hospital stay were recorded. Results. Groups were matched for type of resection, median number of nodules, and median diameter of largest lesions. Groups were also homogeneous for preoperative liver and renal function tests. Intraoperative haemoglobin decrease and transfusions of red blood cells and fresh frozen plasma were significantly lower in LS group. MELD score lasted stable after laparoscopic resection, while it increased in laparotomic group. Postoperative liver and renal failure and mortality were all lower in LS group. Conclusions. Lower morbidity and mortality, maintenance of liver function, and shorter hospital stay suggest the safety and benefit of laparoscopic approach.

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