Laparoscopic Major Hepatectomy Research Articles

Robotic major hepatectomy and laparoscopic major hepatectomy：is there no difference in the rate of intraoperative blood transfusion?

Robotic major hepatectomy and laparoscopic major hepatectomy：is there no difference in the rate of intraoperative blood transfusion?

Short-term outcomes of laparoscopic extended hepatectomy versus major hepatectomy: a single-center experience

IntroductionLaparoscopic major hepatectomy (LMH) remains restricted to a few specialized centers and poses a challenge to surgeons performing laparoscopic resections. Laparoscopic extended resections are even more complex and rarely conducted. MethodsFrom a single-institution database, we compared the short-term outcomes of patients who underwent major and extended laparoscopic resections, stratifying the entire retrospective cohort into four groups: right hepatectomy, left hepatectomy, right extended hepatectomy, and left extended hepatectomy. Patient demographics, tumor characteristics, operative variables, and especially postoperative outcomes were evaluated. Results250 patients underwent major and extended laparoscopic liver resections, including 160 right, 31 right extended, 36 left, and 23 left extended laparoscopic hepatectomies. The most common indication for resection was colorectal liver metastases (64%). Laparoscopic extended hepatectomy (LEH) showed significantly longer operative time, more blood loss, need for Pringle maneuver, conversion to open surgery, higher rates of liver failure, postoperative ascites, and intra-abdominal hemorrhage, R1 margins and length of stay when compared with the LMH group. Mortality rates were similar between groups. Multivariate analysis revealed intraoperative blood transfusion (OR = 5.1[CI-95%: 1.15–6.79]; p = 0.02) as an independent predictor for major complications. ConclusionsLEH showed to be feasible, however with higher blood loss and significantly associated to major complications.

A commentary on 'Comparison of safety and effectiveness between robotic and laparoscopic major hepatectomy: A systematic review and meta-analysis'.

A commentary on 'Comparison of safety and effectiveness between robotic and laparoscopic major hepatectomy: A systematic review and meta-analysis'.

Comparison of perioperative outcomes of open (CUSA) versus laparoscopic (LOTUS) major hepatectomy – revisited. first evaluation of efficacy and safety of AEONTM stapler

Comparison of perioperative outcomes of open (CUSA) versus laparoscopic (LOTUS) major hepatectomy – revisited. first evaluation of efficacy and safety of AEONTM stapler

Comparison of safety and effectiveness between robotic and laparoscopic major hepatectomy: a systematic review and meta-analysis.

Robotic platform has been increasingly applied in major hepatectomy. However, the role or advantage of robotic approach comparing with laparoscopic approach in major hepatectomy remains controversial. This meta-analysis compares perioperative outcomes of robotic major hepatectomy (RMH) to laparoscopic major hepatectomy (LMH) for hepatic neoplasms. PubMed, Web of Science, EMBASE, and Cochrane Library were searched to identify comparative studies compared RMH versus LMH for hepatic neoplasms. The search timeframe was set before May 2023. Main outcomes were mortality, overall morbidities, serious complications, and conversion to open surgery. Secondary outcomes were operative time, intraoperative blood loss, blood transfusion, postoperative length of hospital stay, R0 resection, reoperation, and readmission. Studies were evaluated for quality by Cochrane risk of bias tool or Newcastle-Ottawa scale. Data were pooled as odds ratio (OR) or mean difference (MD). This study was registered at PROSPERO (CRD42023410951). Twelve retrospective cohort studies concerning total 1657 patients (796 RMH, 861 LMH) were included. Meta-analyses showed no significant differences in mortality (OR=1.23, 95% CI=0.50-2.98, P =0.65), overall postoperative complications (OR=0.83, 95% CI=0.65-1.06, P =0.14), operative time (MD=6.47, 95% CI=-14.72 to 27.65, P =0.55), blood transfusion (OR=0.77, 95% CI=0.55-1.08, P =0.13), R0 resection (OR=1.45, 95% CI=0.91-2.31, P =0.12), reoperation (OR=0.76, 95% CI=0.31-1.88, P =0.56), and readmission (OR=0.63, 95% CI=0.28-1.44, P =0.27) between RMH and LMH. Incidence of serious complications (OR=0.60, 95% CI=0.40-0.90, P =0.01), conversion to open surgery (OR=0.41, 95% CI=0.27-0.63, P <0.0001), blood loss (MD=-91.42, 95% CI=-142.18 to -40.66, P =0.0004), and postoperative hospital stay (MD=-0.64, 95% CI=-0.78 to -0.49, P <0.00001) were reduced for RMH versus LMH. RMH is associated with comparable short-term surgical outcomes and oncologic adequacy compared to LMH when performed by experienced surgeons at large centres. RMH may result in reduced major morbidities, conversion rate, blood loss, and hospital stay, but these results were volatile. Further randomized studies should address the potential advantages of RMH over LMH.

Impact of Tumor Size on the Difficulty of Laparoscopic Major Hepatectomies: An International Multicenter Study.

Although tumor size (TS) is known to affect surgical outcomes in laparoscopic liver resection (LLR), its impact on laparoscopic major hepatectomy (L-MH) is not well studied. The objectives of this study were to investigate the impact of TS on the perioperative outcomes of L-MH and to elucidate the optimal TS cutoff for stratifying the difficulty of L-MH. This was a post-hoc analysis of 3008 patients who underwent L-MH at 48 international centers. A total 1396 patients met study criteria and were included. The impact of TS cutoffs was investigated by stratifying TS at each 10-mm interval. The optimal cutoffs were determined taking into consideration the number of endpoints which showed a statistically significant split around the cut-points of interest and the magnitude of relative risk after correction for multiple risk factors. We identified 2 optimal TS cutoffs, 50mm and 100mm, which segregated L-MH into 3 groups. An increasing TS across these 3 groups (≤ 50mm, 51-100mm, > 100mm), was significantly associated with a higher open conversion rate (11.2%, 14.7%, 23.0%, P < 0.001), longer operating time (median, 340 min, 346min, 365min, P = 0.025), increased blood loss (median, 300ml, ml, 400ml, P = 0.002) and higher rate of intraoperative blood transfusion (13.1%, 15.9%, 27.6%, P < 0.001). Postoperative outcomes such as overall morbidity, major morbidity, and length of stay were comparable across the three groups. Increasing TS was associated with poorer intraoperative but not postoperative outcomes after L-MH. We determined 2 TS cutoffs (50mm and 10mm) which could optimally stratify the surgical difficulty of L-MH.

Long-term outcomes of laparoscopic liver resection versus open liver resection for hepatocellular carcinoma: A single-center 10-year experience.

Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) has increased. However, the long-term outcomes of LLR for HCCs should be validated further. Besides, the validity of laparoscopic minor liver resection in difficult segments (1, 4a, 7, 8) (LMLR-DS) and laparoscopic major hepatectomy (LMH) for HCCs need to be studied. A total of 1773 HCC patients were collected: 683 received LLR and 1090 received OLR. Propensity score matching (PSM) with 1:1 ratio was used to eliminate the selection bias. Short-term and long-term outcomes were compared. In subgroup analyses, the validity of LMLR-DS or LMH for HCCs was studied. After PSM, 567 patients were in LLR or OLR group. LLR had lower intraoperative blood-loss and shorter postoperative hospital-stays than OLR. The postoperative complications were lower in LLR group (23.8% vs. 32.8%, P=0.001). The Overall survival (OS) and disease-free survival (DFS) had no significant difference between LLR and OLR groups (P=0.973, P=0.812). The cumulative 1-, 3-, and 5-year OR rates were 87.9%, 68.9%, and 57.7% for LLR group, and 85.9%, 68.8%, 58.8% for OLR group. The cumulative 1-, 3-, and 5-year DFS rates were 73.0%, 51.5%, 40.6% for LLR group, and 70.3%, 49.0%, 42.4% for OLR group. In subgroup analyses, 178 patients were in LMLR-DS or open surgery (OMLR-DS) group after PSM. LMLR-DS had lower intraoperative blood-loss and shorter postoperative hospital-stays than OMLR-DS. The postoperative complications were lower in LMLR-DS group. The OS and DFS had no difference between LMLR-DS and OMLR-DS groups. The cumulative 5-year OR and DFS rates were 61.6%, 43.9% for LMLR-DS group, and 66.5%, 47.7% for OMLR-DS group. In another subgroup analyses, 115 patients were in LMH or open major hepatectomy (OMH) group. LMH had lower blood-loss and shorter postoperative hospital-stays than OMH. The complications, OS and DFS had no significantly differences between two groups. The cumulative 5-year OR and DFS rates were 44.3%, 29.9% for LMH group, and 44.7%, 33.2% for OMH group. LLR for HCCs showed better short-term outcomes and comparable long-term outcomes with OLR, even for patients who received LMLR-DS or LMH. LLR could be reliable and recommended for HCC treatment.

Perioperative and Long-Term Oncologic Outcomes of Laparoscopic Right Hepatectomy Versus Open Right Hepatectomy for Hepatocellular Carcinoma: A Propensity Score–Matching Analysis

Objective To evaluate the efficacy and safety of laparoscopic major hepatectomy for hepatocellular carcinoma patients. Summary of background data Despite the popularity of laparoscopic hepatectomy, it is still in need of further evidence to assess its safety and efficacy for the treatment of hepatocellular carcinoma. Methods From 2008 to 2017, 149 patients (laparoscopic right hepatectomy [LRH], 28 patients; open right hepatectomy [ORH], 121 patients) were included. Baseline characteristics, including tumor characteristics, perioperative outcomes, and survival outcomes, were compared between the 2 groups. For group comparisons, one-to-one propensity score matching was used to minimize selection biases. Results After one-to-one propensity score matching, 25 LRHs were compared to 25 ORHs. Operative time was significantly shorter for the ORH group than for the LRH group (mean, 322.5 versus 379.5 minutes; P = 0.015), whereas the LRH group showed less intraoperative blood loss (P = 0.02) and lower intraoperative transfusion (P = 0.02). Postoperative hospital stays were significantly shorter for the LRH group (mean, 14.5 days versus 20.2 days; P = 0.004). Overall morbidities were significantly lower in the LRH group (1:13, P = 0.00). The cumulative 1-, 3-, and 5-year overall survival rates were 100%, 92.0%, and 92.0%, respectively, for the LRH group, and 84.0%, 80.0%, and 64.0%, respectively, for the ORH group. Furthermore, the cumulative 1-, 3-, and 5-year disease-free survival rates were 96.0%, 80.0%, and 75.3%, respectively, for the LRH group, and 72.0%, 48.0%, and 40.0%, respectively, for the ORH group. The LRH group showed significantly longer disease-free survival (P = 0.009) and overall survival (P = 0.028) than the ORH group. Conclusion LRH can be safely performed for hepatocellular carcinoma. LRH was associated with more favorable oncologic outcomes.

Robotic versus laparoscopic major hepatectomy for hepatocellular carcinoma: short-term outcomes from a single institution

BackgroundCurrently, an increasing number of robotic major hepatectomies for hepatocellular carcinoma (HCC) are being performed. Despite the advantages of robotic surgery over laparoscopic procedures, studies comparing robotic with laparoscopic major hepatectomy in terms of short-term results remain scarce. This study was performed to compare robotic major hepatectomy and laparoscopic major hepatectomy in terms of their intraoperative and postoperative results.MethodsData regarding demographics and intraoperative and postoperative results of 131 patients undergoing robotic or laparoscopic major hepatectomy between January 2017 and March 2022 were retrieved from their medical records and compared between the two types of surgery.ResultsBetween January 2017 and March 2022, 44 robotic major hepatectomies and 87 laparoscopic major hepatectomies were performed at the Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People’s Hospital. Patients undergoing robotic major hepatectomy were not significantly different from those undergoing laparoscopic major hepatectomy in terms of age (P = 0.397), sex (P = 0.624), body mass index (BMI) (P = 0.118), alpha-fetoprotein (AFP) (P = 0.09), tumor size (P = 0.176), cirrhosis (P = 0.384), fatty liver (P = 0.162), preoperative antiviral treatment (P = 0.934), hepatitis B virus (HBV) DNA (P = 0.646) and operation type (P = 0.054). Robotic major hepatectomy was associated with a longer operation time (median: 255.5 versus 206.8 min; P < 0.001) and less estimated blood loss (median: 118.9 versus 197.0 ml; P = 0.002) than laparoscopic major hepatectomy. However, robotic major hepatectomy was not significantly different from laparoscopic major hepatectomy regarding length of postoperative hospital stay (P = 0.849), open conversion (P = 0.077), ICU stay (P = 0.866), postoperative massive abdominal bleeding (P = 1.00), portal vein thrombosis (P = 1.00), abdominal infection (P = 1.00), pulmonary infection (P = 1.00), pulmonary embolism (P = 1.00), cardiac complications (P = 1.00), liver failure (P = 1.00), kidney failure (P = 1.00), biliary leak (P = 1.00), positive resection margin (P = 1.00), 30-day mortality (P = 1.00) and 90-day mortality (P = 1.00).ConclusionsRobotic major hepatectomy was as effective as laparoscopic surgery in terms of intraoperative and postoperative results but took longer and could more efficiently control intraoperative blood loss.

Enhanced recovery after surgery in laparoscopic major liver resection: A propensity score matching analysis

ObjectiveEven though enhanced recovery after surgery (ERAS) has been applied to liver resection worldwide, there is a lack of evidence covering its feasibility in laparoscopic major hepatectomy. This study aimed to preliminarily evaluate the superiority of ERAS in major liver resection. MethodsThe data were collected from patients who underwent laparoscopic major hepatectomy from July 2014 to November 2020 in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. The baseline characteristics, pathological features, surgical outcomes, medical costs, and postoperative pain scores were compared before and after propensity score matching (PSM). The patients were divided into the ERAS group and the routine group based on the treatment protocols. ResultsEighty-one patients who underwent laparoscopic major hepatectomy were retrospectively enrolled in the study. Before PSM, there were differences in pathology (p = 0.037) and surgical extent (p = 0.011) between the ERAS group (n = 42) and routine group (n = 39). After PSM, 26 patients from each group were matched. For surgical outcomes, patients in the ERAS group had a significantly lower postoperative complication incidence than patients in the routine group (28.6% vs. 53.8%, RR: 0.531 [0.303, 0.929], p = 0.021) before PSM. However, after PSM, superiority was not observed in the ERAS group (30.8% vs. 53.8%, RR: 0.571 [0.290, 1.13], p = 0.092). The duration of abdominal tube retention (before PSM: 5.0 d vs. 10.0 d, p < 0.001; after PSM: 6.0 d vs. 9.0 d, p = 0.001), the duration of urinary tube retention (before PSM: 1.0 d vs. 2.0 d, p < 0.001; after PSM: 1.0 d vs. 2.0 d, p = 0.002), and hospital stay (before PSM: 6.0 d vs. 11.0 d, p < 0.001; after PSM: 7.0 d vs. 11.5 d, p < 0.001) was significantly shorter in the ERAS group than in the routine group. A significant benefit on postoperative day 3 (2 vs. 3, p = 0.038) was observed with respect to the alleviation of pain after PSM. ConclusionsOur preliminary study revealed the superiority of ERAS in the setting of major liver resection, although further investigations in a large number of patients from multiple institutions are needed to evaluate the feasibility of ERAS.

Laparoscopic right hemihepatectomy following a novel optimized portal vein embolization: a video case report

BackgroundThis article is the first report of laparoscopic major hepatectomy of Hepatocellular carcinoma (HCC) following optimized portal vein embolization (oPVE).Case presentationThe patient was diagnosed with a single 3 × 3.5 cm HCC located in segment 5 and 8 detected by enhanced computed tomography and magnetic resonance imaging. The lesion was adjacent to the right anterior and posterior portal veins, making it difficult to confirm the adequate liver functional remnant volume, surgical margin and R0 resection. In addition, the liver cirrhosis induced by a long history of chronic hepatitis B virus increased the potential risk of postoperative liver failure and refractory ascites. Therefore, we conducted a laparoscopic surgery following oPVE, by which the safe tumor margin was ensured and the outcome of the surgery was improved. The patient was discharged on the seventh day after the surgery. The AFP gradually decreased to a normal level during the 90-day follow-up.ConclusionThis case report demonstrates that, in experienced hands for selected patients, laparoscopic hepatectomy after portal vein embolization is feasible and may be an alternative to open liver resection.

Impact of Three-Dimensional (3D) Visualization on Laparoscopic Hepatectomy for Hepatocellular Carcinoma.

The impact of three-dimensional (3D) visualization on laparoscopic hepatectomy for hepatocellular carcinoma is largely unknown. A retrospective review with propensity-score matched analysis of 3D and two-dimensional (2D) laparoscopic hepatectomy performed in a tertiary hepatobiliary surgery center. Since the availability of 3D laparoscopy, the proportion of laparoscopic major hepatectomies has significantly expanded (1.7% vs. 24.0%, p<0.0001) and the percentage of difficult resections among patients who underwent laparoscopic hepatectomy has also increased (12.6% vs. 40.0%, p=0.0001). A total of 305 patients (92 in the 3D group and 213 in the 2D group) underwent laparoscopic hepatectomy between 2002 and 2019. The 3D group had better liver function, larger tumors at more difficult locations, more major resections, and more difficult surgeries. After propensity score matching, 144 patients were analyzed (72 in both the 3D and 2D groups). Patients were comparable in terms of liver status, tumor status, and complexity of liver surgery. Operative time (218 vs. 218 mins, p=0.50) and blood loss (0.2 vs. 0.2L, p=0.49) were comparable between the two groups, however overall complications were higher in the 2D group (1.4 vs. 11.1%, p=0.03). Patients who underwent 3D laparoscopic major hepatectomy had a shorter hospital stay than their comparable counterparts operated through an open approach (7 vs. 6 days, p=0.003). 3D visualization enhanced the feasibility of laparoscopic major hepatectomy and difficult laparoscopic liver resection. 3D resection was potentially associated with fewer operative morbidities and the 3D laparoscopic approach did not jeopardize the outcome of major hepatectomy.

Is laparoscopic major hepatectomy feasible and safe in Swiss cantonal hospitals?

The number of laparoscopic liver resections is increasing worldwide, including in Switzerland. However, laparoscopy is mostly used for minor resections. Little is known about indications for and outcomes of major liver resections performed laparoscopically. The aim of this study was to compare the clinical outcome of open and laparoscopic major liver resection cohorts in two Swiss centres. Patients undergoing open or laparoscopic major hepatectomy (>3 segments) in two cantonal hospitals from January 2015 to December 2019 were analysed. All disease types except perihilar cholangiocarcinomas, rare malignancies and resections with biliary reconstruction were included. The primary outcome was the number of complications incurred. Operation time, blood loss, hospital stay and 90-day mortality were secondary outcomes investigated. A separate analysis was performed for colorectal liver metastases, the most common indication. Potential risk factors for major complications were evaluated in a multivariate analysis. A total of 88 patients were identified. Among those, 34 patients underwent laparoscopic major hepatectomy (LAPH) and 54 patients open major hepatectomy (OH). The two groups did not differ in demographics. The most common indication was malignancy (LAPH 94% vs OH 98%), mainly colorectal liver metastases (LAPH 53% vs OH 59%). There was no significant difference in major complications (21% vs 15%, p = 0.565). Median operation time (LAPH 433 minutes, interquartile range [IQR 351-482 vs OH 397 minutes, IQR 296-446; p = 0.222), blood loss (325 ml, IQR 200-575 vs 475 ml, IQR 300-800; p = 0.150) and hospital stay (9 days, IQR 8-14 vs 11 days, IQR 9-14; p = 0.441) were comparable between the two cohorts. There was no significant difference in 90-day mortality (3% vs 7%, p = 0.881). The laparoscopic technique was not identified as a risk factor for major complications in a multivariate analysis. This first report from Switzerland evaluating outcomes of laparoscopic major hepatectomies showed no difference in complications and clinical non-inferiority compared with open major hepatectomy.

Pure laparoscopic major hepatectomy facilitated with an application of GelportTM: a single-center case series

Pure laparoscopic major hepatectomy facilitated with an application of GelportTM: a single-center case series

Laparoscopic versus open major liver resection for hepatocellular carcinoma: A case-matched analysis of short- and long-term outcomes.

BackgroundThe feasibility and safety of laparoscopic major hepatectomy (LMH) are still uncertain. The purpose of the present study is to compare the short- and long-term outcomes of LMH with those of open major hepatectomy (OMH) for hepatocellular carcinoma (HCC).MethodBetween January 2012 and December 2018, a total of 26 patients received laparoscopic major hepatectomy in our center. To minimize any confounding factors, a 1:3 case-matched analysis was conducted based on the demographics and extent of liver resection. Data of demographics, perioperative outcomes, and long-term oncologic outcomes were reviewed.ResultsIntraoperative blood loss (P = 0.007) was significantly lower in the LMH group. In addition, the LMH group exhibited a lower overall complication rate (P = 0.039) and shorter postoperative hospital stay (P = 0.024). However, no statistically significant difference was found between LMH and OMH regarding operation time (P = 0.215) and operative cost (P = 0.860). Two laparoscopic cases were converted to open liver resection. In regard to long-term outcomes, there was no significant difference between LMH and OMH regarding disease-free survival (DFS) (P = 0.079) and overall survival (OS) (P = 0.172).ConclusionLMH can be an effective and safe alternative to OMH for selected patients with liver cancer in short- and long-term outcomes.

Impact of three-dimensional (3D) visualization on laparoscopic hepatectomy for hepatocellular carcinoma

To assess the impact of three-dimensional (3D) visualization on laparoscopic hepatectomy for hepatocellular carcinoma. A retrospective review with propensity-score matched analysis of 3D and two-dimensional (2D) laparoscopic hepatectomy performed in a tertiary hepatobiliary surgery centre. Since 3D laparoscopy was available, the proportion of laparoscopic major hepatectomy has significantly expanded (1.7% vs. 24.0%, p < 0.0001). The percentage of difficult resection among laparoscopic hepatectomy also increased (12.6% vs. 40.0%, p = 0.0001). A total of 305 patients (3D group: 92 patients; 2D group: 213 patients) underwent laparoscopic hepatectomy between 2002 and 2019. The 3D group had better liver function, larger tumours at more difficult locations, more major resections, and more difficult surgeries. After propensity score matching 144 patients were analysed (3D group: 72 patients; 2D group: 72 patients). They were comparable in terms of liver status, tumour status and complexity of liver surgery. The operative time (218 vs. 218 min, p = 0.50) and blood loss (0.2 vs. 0.2 L, p = 0.49) were comparable between two groups. Overall complications were higher in 2D group (1.4 vs. 11.1%, p = 0.03). Patients who underwent 3D laparoscopic major hepatectomy had a shorter hospital stay than their comparable counterparts operated through an open approach (7 vs. 6 days, p = 0.003). 3D visualization enhanced feasibility to laparoscopic major hepatectomy and difficult laparoscopic liver resection. 3D resection was potentially associated with fewer operative morbidities. 3D laparoscopic approach did not jeopardize the outcome of major hepatectomy.

Laparoscopic major hepatectomy using dorsal approach to the major hepatic veins

Dorsal approach of right and middle hepatic veins lets their exposure from root to periphery, minimizing venous bleeding. Usefulness of this approach is shown to tradiitional major hepatectomies (right and left hemihepatectomies) as well as tecchnicaly major hepatectomies (anterior and posterior sectionectomies).

Initial experience of laparoscopic liver resection in a community hospital: A case-series

Laparoscopic major and anatomical hepatectomy is emerging as a preferred method to perform liver resection in recent decades. However, the role of laparoscopy remains a matter of development and has to be further evaluated. In Hong Kong, laparoscopic major and anatomical monosegmentectomy has been performing in tertiary centers with convincing outcomes. Aim of this study is to evaluate the feasibility and efficacy of laparoscopic major and anatomical liver resection to be established in a community hospital. It is a retrospective case series between Jan 2019-Dec 2020, 20 patients underwent laparoscopic major or anatomical liver resection in Yan Chai Hospital for various indications. There are 13 cases of hepatocellular carcinoma, 6 cases of intrahepatic choledocholithiasis, 1 case of colorectal liver metastasis. hemihepatectomy was performed in 11 cases with hilar dissection; while anatomical monosegmentectomy was performed in 9 cases with Glissonean pedicle approach. There was no 30 days mortality reported in our series. 3 cases required open conversions for difficult haemostasis by laparoscopic means. The average blood loss is 723 mL +/- 221 mL and 4 cases required intraoperative blood transfusion. The mean operative time was 325 minutes +/- 120 minutes. There are 7 cases of post-operative collection and 1 case requiring IR-guided drainage. The average length of stay was 10.35 days. Laparoscopic major and anatomical liver resection is safe and feasible in both tertiary and community center. Laparoscopic liver resection should be considered as an option whenever possible.

Open and/or laparoscopic one-stage resections of primary colorectal cancer and synchronous liver metastases: An observational study.

One-stage resections of primary colorectal cancer and liver metastases have been reported to be feasible and safe. Minimally invasive approaches have become more common for both colorectal and hepatic surgeries. This study aimed to investigate outcomes of these combined surgical procedures among different approaches.We retrospectively analyzed patients diagnosed as having primary colorectal cancer with synchronous liver metastases and who underwent 1-stage primary resection and hepatectomy with curative intent in our hospital. According to the surgical approach for the primary tumor and hepatic lesions, namely open laparotomy (Op) or laparoscopic approach (Lap), patients were classified into Op-Op, Lap-Op (laparoscopic colorectal resection plus open hepatectomy), and Lap-Lap groups, respectively. Clinicopathological factors were reviewed, and short- and long-term outcomes were compared among the groups.The Op-Op, Lap-Op, and Lap-Lap groups comprised 36, 18, and 17 patients, respectively. The superior/posterior hepatic segments were more frequently resected via an open approach. There was no laparoscopic major hepatectomy. The median volume of intraoperative blood loss was smaller in the Lap-Lap and Lap-Op groups (290 and 270 mL) than in the Op-Op group (575 mL, P = .008). The hospital stay after surgery was shorter in the Lap-Lap and Lap-Op groups (median: 17 days and 15 days, vs 19 days for the Op-Op group, P = .033). The postoperative complication rates and survivals were similar among the groups.Application of laparoscopy to 1-stage resections of primary colorectal cancer and liver metastases may offer advantages of enhanced recovery from surgical treatment, given appropriate patient selection.

Establishing a New Program of Laparoscopic Major (>2 Segments) Hepatectomy in Greece.

Background: Despite gaining traction around the world, laparoscopic approach to major hepatectomy, defined as resection of at least two neighboring hepatic segments, has not been adopted in Greece. We sought to describe our own experience with a new program that was launched in the last year.