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World Journal of Surgery

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01-12-2014 | Original Scientific Report

Laparoscopic Major Hepatectomies: Clinical Outcomes and Classification

Authors: Francesco Di Fabio, Morsal Samim, Paolo Di Gioia, Rosemary Godeseth, Neil W. Pearce, Mohammed Abu Hilal

Published in: World Journal of Surgery | Issue 12/2014

Abstract

Background

According to the Louisville Statement, laparoscopic major hepatectomy is a heterogeneous category that includes “traditional” trisectionectomies/hemi-hepatectomies and the technically challenging resection of segments 4a, 7, and 8. The aims of this study were to assess differences in clinical outcomes between laparoscopic “traditional” major hepatectomy and resection of “difficult-to-access” posterosuperior segments and to define whether the current classification is clinically valid or needs revision.

Methods

We reviewed a prospectively collected single-center database of 390 patients undergoing pure laparoscopic liver resection. A total of 156 patients who had undergone laparoscopic major hepatectomy according to the Louisville Statement were divided into two subcategories: laparoscopic “traditional” major hepatectomy (LTMH), including hemi-hepatectomies and trisegmentectomies, and laparoscopic “posterosuperior” major hepatectomy (LPMH), including resection of posterosuperior segments 4a, 7, and 8. LTMH and LPMH subgroups were compared with respect to demographics, intraoperative variables, and postoperative outcomes.

Results

LTMH was performed in 127 patients (81 %) and LPMH in 29 (19 %). Operation time was a median 330 min for LTMH and 210 min for LPMH (p < 0.0001). Blood loss was a median 500 ml for LTMH and 300 ml for LPMH (p = 0.005). Conversion rate was 9 % for LTMH and nil for LPMH (p = 0.219). In all, 28 patients (22 %) developed postoperative complications after LTMH and 5 (17 %) after LPMH (p = 0.801). Mortality rate was 1.6 % after LTMH and nil after LPMH. Hospital stay was a median 5 days after LTMH and 4 days after LPMH (p = 0.026).

Conclusions

The creation of two subcategories of laparoscopic major hepatectomy seems appropriate to reflect differences in intraoperative and postoperative outcomes between LTMH and LPMH.

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Title: Laparoscopic Major Hepatectomies: Clinical Outcomes and Classification
Authors: Francesco Di Fabio
Morsal Samim
Paolo Di Gioia
Rosemary Godeseth
Neil W. Pearce
Mohammed Abu Hilal
Publication date: 01-12-2014
Publisher: Springer US
Published in: World Journal of Surgery / Issue 12/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-014-2724-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Laparoscopic Major Hepatectomies: Clinical Outcomes and Classification

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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