Background
This study analyzed the feasibility of laparoscopic living donor hepatectomy compared to open surgery.
Methods
Donors who underwent living donor right from May 2013 to October 2017 were ...included. Comparisons between laparoscopy and open surgery were performed using Student's t‐test, Mann–Whitney test, χ2 test, Fisher's exact test, and linear‐by‐linear association.
Results
Among 305 donors, 100 and 205 underwent laparoscopy and open surgery, respectively. The laparoscopy group had more type I (95.0%) bile ducts than the open group (59.5%, P < 0.001) and had longer operation time (378.2 ± 93.5 min vs. 329.1 ± 68.0 min, P < 0.001), while estimated blood loss was smaller (298.3 ± 162.9 ml vs. 344.3 ± 149.9 ml, P = 0.015). Although Clavien‐Dindo grade IIIb complication was higher in the laparoscopy (n = 4, 4.0%) compared to the open group (0.0%, P = 0.011), it was only significant in the initial 25 cases (8.0%, P = 0.011), and became comparable afterwards. Furthermore, grade IIIb complication was comparable when type I bile duct donors were selected (P = 0.072).
Conclusions
Laparoscopic living donor hepatectomy can cause significant complication in the initial stage. Therefore, careful donor selection and well‐established training program are required for introducing the laparoscopic donor program.
Although laparoscopic living donor hepatectomy can be beneficial in terms of donor recovery, it is prone to significant complications in the initial stage. Rhu and colleagues suggested careful donor selection and a well‐established training course for introducing a laparoscopic donor program based on their data of 100 laparoscopic donor cases.
Even after 2 decades of experience in laparoscopic hepatectomy, data on purely laparoscopic approach for donor hepatectomy in adult living donor liver transplantation (LDLT) are limited. We report ...our initial experience of a purely laparoscopic approach for donor hepatectomy for adult recipients to explore its potential application in the management of donors. We did a retrospective data analysis of 54 consecutive patients operated on between May 2013 and February 2015. There were 41 right, 10 extended right, and 3 left hepatectomies. The median operative time was 436 minutes (range 294‐684 minutes), and warm ischemia time was 6 minutes (2‐12 minutes). Estimated blood loss was 300 mL (10‐850 mL), and none of the patients required intraoperative transfusion. Four cases were converted to open laparotomy. The major complication rate was 16.7%, and biliary complication was the most frequent cause. Patients with normal anatomy had a major complication rate of 9.3% as compared with 45.5% in patients with anatomic variations. All patients recovered, and there was no mortality. In conclusion, a purely laparoscopic donor hepatectomy for adult LDLT recipients seems to be a feasible option; with careful patient selection and when performed by experienced surgeons, it may afford results comparable to the open method.
This study was designed to review laparoscopic living donor liver transplantations (LDLTs) at a single center that achieved complete transition from open surgery to laparoscopy. LDLTs performed from ...January 2013 to July 2021 were reviewed. Comparisons between open and laparoscopic surgeries were performed according to periods divided into initial, transition, and complete transition periods. A total of 775 LDLTs, 506 laparoscopic and 269 open cases, were performed. Complete transition was achieved in 2020. Bile duct variations were significantly abundant in the open group both in the initial period (30.2% vs. 8.1%; p < 0.001) and transition period (48.1% vs. 24.3%; p < 0.001). Portal vein variation was more abundant in the open group only in the initial period (13.0% vs. 4.1%; p = 0.03). Although the donor reoperation rate (0.0% vs. 4.1%; p = 0.02) and Grade III or higher complication rate (5.6% vs. 13.5%; p = 0.03) were significantly higher in the laparoscopy group in the initial period, there were no differences during the transition period as well as in overall cases. Median number of opioids required by the donor (three times interquartile range, IQR, 1–6 vs. 1 time IQR, 0–3; p < 0.001) was lower, and the median hospital stay (10 days IQR, 8–12 vs. 8 days IQR, 7–9; p < 0.001) was shorter in the laparoscopy group. Overall recipient bile leakage rate (23.8% vs. 12.8%; p < 0.001) and overall Grade III or higher complication rate (44.6% vs. 37.2%; p = 0.009) were significantly lower in the laparoscopy group. Complete transition to laparoscopic living donor hepatectomy was possible after accumulating a significant amount of experience. Because donor morbidity can be higher in the initial period, donor selection for favorable anatomy is required for both the donor and recipient.
This study is designed to analyze the feasibility of laparoscopic living donor right hemihepatectomy in living donors with portal vein variation. Living donor liver transplantation cases using a ...right liver graft during the period of January 2014 to September 2019 were included. Computed tomographic angiographies of the donor were 3‐dimensionally reconstructed, and the anatomical variation of the portal vein was classified. To reduce selection bias, a 1:1 ratio propensity score–matched analysis between the laparoscopy group and the open group was performed. Surgical and recovery‐related outcomes as well as portal vein complication‐free survival, graft survival, and overall survival rates were analyzed. After matching, 171 cases in each group from 444 original cases were compared. The laparoscopy group had a shorter operation time (P < 0.001), a smaller number of additional opioids required by the donor (P < 0.001), and a shorter hospital stay (P < 0.001). There were no differences in the portal vein complication‐free survival (P = 0.16), graft survival (P = 0.26), or overall survival rates (P = 0.53). Although portal vein complication‐free survival was inferior in portal veins other than type I (P = 0.01), the laparoscopy group showed similar portal vein complication‐free survival regardless of the anatomical variation of portal vein (P = 0.35 in type I and P = 0.30 in other types). Laparoscopic living donor right hemihepatectomy can be performed as safely as open surgery regardless of the anatomical variation of the portal vein.
https://www.wileyhealthlearning.com/Activity2/7395821/Activity.aspx
Background
While minimal invasive surgery is becoming popular in liver resection, right posterior sectionectomy (RPS) is still considered as a difficult procedure. We summarize the clinical data and ...investigate the feasibility of laparoscopic right posterior sectionectomy (LRPS) in hepatocellular carcinoma (HCC) by comparing its outcomes with those of open right posterior sectionectomy (ORPS).
Methods
We retrospectively reviewed 191 patients who underwent RPS for HCC during January 2009 to August 2016 at Samsung Medical Center. After 1:2 propensity score matching, 53 patients in LRPS group were matched to 97 patients in ORPS group.
Results
There was no statistical difference in preoperative data. While operation time was significantly longer in LRPS group (381.1 ± 118.7 vs. 234.4 ± 63.7 min,
P
< 0.001), transfusion rate (13.2 vs. 2.1%,
P
= 0.061) and complication rate (9.4 vs. 8.3%,
P
= 0.709) were not statistically different between groups. Clustered Cox proportional hazards regression analysis for matched paired data showed no difference in both disease-free survival (
P
= 0.607) and overall survival (
P
= 0.858).
Conclusions
In HCC, LRPS can be performed safely compared to ORPS, regarding the operative outcome, patient recovery, and oncological outcomes.
Background
This study was designed to analyze the risk of extra‐anatomical portal vein reconstruction during liver transplantation (LT) in patient with portal vein thrombosis (PVT).
Methods
Patients ...who underwent LT between 2008 and 2018 were reviewed. PVT was graded according to the Yerdel system. Risk factor for portal vein complication‐free, graft and overall survival were analyzed with multivariate Cox regression.
Results
Seventy out of 1180 patients had PVT. Number of patients who underwent extra‐anatomical reconstruction were three (13.0%), three (15.0%), and six (50.0%) with grade II, III and IV thrombosis, respectively. Grade III patients with extra‐anatomical reconstruction (HR 10.212, CI 2.475‐42.133, P = .001), grade IV with both anatomical (HR 16.991, CI 5.224‐54.740, P < .001) and extra‐anatomical reconstruction (HR 12.262, CI 2.698‐50.666, P = .001) were risk factors for portal vein complication‐free survival. Grade IV thrombosis with both anatomical (HR 4.296, CI 1.059‐17.430, P = .041) and extra‐anatomical reconstruction (HR 7.777, CI 2.461‐24.571, P < .001) were risk factors for graft failure. Extra‐anatomical reconstruction for both grade I to III (HR 3.638, CI 1.155‐11.453, P = .027) and grade IV thrombosis (HR 4.798, CI 1.773‐12.982, P = .002) were risk factors for survival.
Conclusion
Grade IV thrombosis and extra‐anatomical reconstruction were related to poor prognosis. Therefore, thorough evaluation and planning is required for these patients to improve the outcome.
Highlight
Rhu and colleagues analyzed the outcomes of liver transplantation in patients with portal vein thrombosis, which was previously considered a contraindication. Although advancements in surgical technique have led to improved outcomes, portal vein thrombosis which requires extra‐anatomical reconstruction of the portal vein is associated with poor prognosis and demands further improvement.
Background
Early recurrence after liver resection of hepatocellular carcinoma (HCC) has a great effect on the survival of patients. The aims of this study were to identify risk factors for early ...recurrence and to clarify whether early recurrence is related to patient survival rate.
Methods
We identified a total of 1010 patients with HCC recurrence after hepatic resection between 2009 and 2014 in Samsung Medical Center and Seoul National University Hospital. Inclusion criteria were preoperative solitary tumor Child-Pugh class A and curative hepatectomy. Early recurrence was defined as HCC recurrence < 1 year after surgery.
Results
A total of 628 patients were included in this study: 302 with early recurrence and 326 with late recurrence. Multivariate analysis showed that HCC grade 3 or 4, tumor size > 3 cm, and microvascular invasion were closely associated with early recurrence after liver resection for solitary HCC. When HCC recurred, the early recurrence group had large tumor size, increased tumor numbers and AFP levels, and high incidence of diffuse intrahepatic recurrence compared with the late recurrence group. The overall survival curve for the early recurrence group was lower than that for the late recurrence group (
P
< 0.001). Multivariate analysis demonstrated early recurrence was closely associated with patient survival.
Conclusions
Patients with early recurrence had different characteristics compared to patients with late recurrence after hepatic resection in solitary HCC. Early detection of recurrence is necessary through active postoperative surveillance in hepatectomy patients with poor prognostic factors.
Prognostic stratification of patients with colorectal cancer liver metastasis based solely on tumor-related factors has only moderate discriminatory ability. We hypothesized that the inclusion of ...nontumor related factors can improve prediction of long-term prognosis of patients with colorectal cancer liver metastasis.
Nontumor related laboratory markers were assessed utilizing a training cohort from 2 U.S. institutions (n = 1,205). Factors independently associated with prognosis were used to develop a nontumor related prognostic score. The discriminatory ability, assessed by Harrell’s C-statistics (C-index) and net reclassification improvement, was validated and compared with 3 commonly used tumor-related clinical risk scores: Fong clinical risk scores, m-clinical risk scores, and Genetic and Morphological Evaluation (GAME) score in an external validation cohort from 5 Asian (n = 1,307) and 3 European (n = 1,058) institutions. The discriminatory ability of nontumor related prognostic score combined with each of these 3 tumor-related prognostic scores was also estimated.
Alkaline phosphatase (hazard ratio 1.43; 95% confidence interval, 1.11–1.84), albumin (hazard ratio 0.71; 95% confidence interval, 0.57–0.89), and mean corpuscular volume (hazard ratio 19.0, per log unit; 95% confidence interval, 4.79–75.0) were each independently associated with increased risk of death after resection of colorectal cancer liver metastasis (all P < .05). In turn, alkaline phosphatase, albumin, and mean corpuscular volume were combined to form a nontumor related prognostic score (2.942 × mean corpuscular volume + 0.399 × alkaline phosphatase-0.339 × albumin-12) × 10 (median, 16; range, 1–30). The nontumor related prognostic score had good-to-modest discriminatory ability in the external cohort (C-index = 0.58), which was comparable to the 3 established tumor-related prognostic scores (C-index: Fong clinical risk scores, 0.53, m-clinical risk scores, 0.55, GAME, 0.58). The addition of the nontumor related prognostic score to the tumor-related prognostic scores enhanced the discriminatory ability in the entire study cohort (C-index: nontumor related score+Fong, 0.60, nontumor related score+m-clinical risk scores, 0.61, nontumor related score+GAME, 0.64), as well reclassification improvement (42.5, 42.7%, and 21.2%, respectively).
Nontumor related prognostic information may help improve the prognostic stratification of patients after resection of colorectal cancer liver metastasis. The nontumor related prognostic score may be combined with tumor-related prognostic tools to enhance prognostic stratification of patients with colorectal cancer liver metastasis.
Pure laparoscopic donor right hepatectomy (PLDRH) is not a standard procedure for living donor liver transplantation but is safe and reproducible in the hands of experienced surgeons. However, the ...perioperative outcomes of PLDRH have not been fully evaluated yet. We used propensity score matching to compare the perioperative complications and postoperative short-term outcomes of donors undergoing PLDRH and open donor right hepatectomy (ODRH). A total of 325 consecutive donors who underwent elective, adult-to-adult right hepatectomy were initially screened. After propensity score matching, all patients were divided into two groups: PLDRH (n = 123) and ODRH (n = 123) groups. Perioperative complications and postoperative outcomes were compared between the two groups. Postoperative pulmonary complications were significantly more common in the ODRH than in the PLDRH group (54.5 vs. 31.7%, P < 0.001). The biliary complications (leak and stricture) were higher in PLDRH group than in the ODRH group (8% vs. 3%), but it failed to reach statistical significance (P = 0.167). Overall, surgical complication rates were similar between the two groups (P = 0.730). The opioid requirement during the first 7 postoperative days was higher in the ODRH group (686 vs. 568 mg, P < 0.001). The hospital stay and time to the first meal were shorter in the PLDRH than in the ODRH group (P = 0.003 and P < 0.001, respectively). PLDRH reduced the incidence of postoperative pulmonary complications and afforded better short-term postoperative outcomes compared to ODRH. However, surgical complication rates were similar in both groups.
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