Laparoscopic parenchymal-sparing resections for nonperipheral liver lesions, the diamond technique: technical aspects, clinical outcomes, and oncologic efficiency
Laparoscopic parenchymal-sparing resections for nonperipheral liver lesions, the diamond technique: technical aspects, clinical outcomes, and oncologic efficiency
Background
Surgical management of liver lesions has moved toward “parenchymal-sparing” strategies. Although open parenchymal-sparing liver resections are supported by encouraging results, the applicability of the laparoscopic approach for nonperipheral tumors is still questionable. Our aim was to assess the feasibility, safety, and oncologic adequacy of laparoscopic parenchymal-sparing liver resection for nonperipheral lesions with a description of the technique adopted in this setting.
Study Design
A prospectively collected single-center database of 517 laparoscopic liver resections was reviewed. Laparoscopic nonperipheral parenchymal-sparing liver resections (LapPSLRs), that is, entirely intraparenchymal limited resections performed on nonperipheral lesions, were selected. Intra- and perioperative outcomes were analyzed along with 3-year actuarial survival for patients with colorectal liver metastases.
Results
The group comprised 49 LapPSLRs. Colorectal liver metastases were the most frequent diagnosis (n = 24 patients). Lesions were located in segments 8, 7, 4a, and 3 in 51%, 8.2%, 36.7%, and 4.1% of cases, respectively. Conversion occurred in 4 patients (8%). Intra- and postoperative short-term outcomes were calculated for the 24 isolated LapPSLR (not associated with any concurrent liver resection). Median operative time and blood loss were 215 minutes and 225 mL, respectively. Pringle maneuver was used in 75% of cases. Postoperative 90-day mortality was nil and morbidity rate was 12.5%. Median postoperative stay was 3 days. Median tumor-free margin was 4 mm and 100% R0 rate was achieved for all LapPSLRs with curative intent. Three-year overall, recurrence-free, and disease-free survival rates were 100%, 65.2%, and 69.6%, respectively.
Conclusions
Laparoscopic parenchymal-sparing liver resections for nonperipheral liver lesions are feasible and can be performed safely without compromising perioperative and oncological outcomes.
265-272
Cipriani, Federica
aca25573-d300-425d-ba9c-20be3190ce2e
Shelat, Vishal G
6ec4730c-124b-4a29-8cd3-db472027b5ec
Rawashdeh, Majd
16176f99-a7b6-426b-8fe6-e1adb68d3726
Francone, Elisa
6451da27-c5fe-4efb-b0e6-7ea516333c3b
Aldrighetti, Luca
bab36581-c535-4f90-970d-0a982fe7a244
Takhar, Arjun
e2f77012-0993-42e6-af95-597a73b6ce45
Armstrong, Thomas
3b87df01-cd08-4048-91c4-7390c73a5960
Pearce, Neil W
bbd2fe84-c835-4c73-aa40-ba5fceefa690
Abu Hilal, Mohammad
384e1c60-8519-4eed-8e92-91775aad4c47
August 2015
Cipriani, Federica
aca25573-d300-425d-ba9c-20be3190ce2e
Shelat, Vishal G
6ec4730c-124b-4a29-8cd3-db472027b5ec
Rawashdeh, Majd
16176f99-a7b6-426b-8fe6-e1adb68d3726
Francone, Elisa
6451da27-c5fe-4efb-b0e6-7ea516333c3b
Aldrighetti, Luca
bab36581-c535-4f90-970d-0a982fe7a244
Takhar, Arjun
e2f77012-0993-42e6-af95-597a73b6ce45
Armstrong, Thomas
3b87df01-cd08-4048-91c4-7390c73a5960
Pearce, Neil W
bbd2fe84-c835-4c73-aa40-ba5fceefa690
Abu Hilal, Mohammad
384e1c60-8519-4eed-8e92-91775aad4c47
Cipriani, Federica, Shelat, Vishal G, Rawashdeh, Majd, Francone, Elisa, Aldrighetti, Luca, Takhar, Arjun, Armstrong, Thomas, Pearce, Neil W and Abu Hilal, Mohammad
(2015)
Laparoscopic parenchymal-sparing resections for nonperipheral liver lesions, the diamond technique: technical aspects, clinical outcomes, and oncologic efficiency.
Journal of the American College of Surgeons, 221 (2), .
(doi:10.1016/j.jamcollsurg.2015.03.029).
(PMID:25899733)
Abstract
Background
Surgical management of liver lesions has moved toward “parenchymal-sparing” strategies. Although open parenchymal-sparing liver resections are supported by encouraging results, the applicability of the laparoscopic approach for nonperipheral tumors is still questionable. Our aim was to assess the feasibility, safety, and oncologic adequacy of laparoscopic parenchymal-sparing liver resection for nonperipheral lesions with a description of the technique adopted in this setting.
Study Design
A prospectively collected single-center database of 517 laparoscopic liver resections was reviewed. Laparoscopic nonperipheral parenchymal-sparing liver resections (LapPSLRs), that is, entirely intraparenchymal limited resections performed on nonperipheral lesions, were selected. Intra- and perioperative outcomes were analyzed along with 3-year actuarial survival for patients with colorectal liver metastases.
Results
The group comprised 49 LapPSLRs. Colorectal liver metastases were the most frequent diagnosis (n = 24 patients). Lesions were located in segments 8, 7, 4a, and 3 in 51%, 8.2%, 36.7%, and 4.1% of cases, respectively. Conversion occurred in 4 patients (8%). Intra- and postoperative short-term outcomes were calculated for the 24 isolated LapPSLR (not associated with any concurrent liver resection). Median operative time and blood loss were 215 minutes and 225 mL, respectively. Pringle maneuver was used in 75% of cases. Postoperative 90-day mortality was nil and morbidity rate was 12.5%. Median postoperative stay was 3 days. Median tumor-free margin was 4 mm and 100% R0 rate was achieved for all LapPSLRs with curative intent. Three-year overall, recurrence-free, and disease-free survival rates were 100%, 65.2%, and 69.6%, respectively.
Conclusions
Laparoscopic parenchymal-sparing liver resections for nonperipheral liver lesions are feasible and can be performed safely without compromising perioperative and oncological outcomes.
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More information
Accepted/In Press date: 17 March 2015
e-pub ahead of print date: 27 March 2015
Published date: August 2015
Organisations:
Cancer Sciences
Identifiers
Local EPrints ID: 400316
URI: http://eprints.soton.ac.uk/id/eprint/400316
PURE UUID: 75905381-be02-4e5e-aaf6-4f716c2d4e41
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Date deposited: 14 Sep 2016 11:03
Last modified: 15 Mar 2024 02:14
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Contributors
Author:
Federica Cipriani
Author:
Vishal G Shelat
Author:
Majd Rawashdeh
Author:
Elisa Francone
Author:
Luca Aldrighetti
Author:
Arjun Takhar
Author:
Thomas Armstrong
Author:
Neil W Pearce
Author:
Mohammad Abu Hilal
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