Safety of laparoscopic compared to open right hepatectomy after portal vein occlusion: results from a multicenter study
Safety of laparoscopic compared to open right hepatectomy after portal vein occlusion: results from a multicenter study
BACKGROUND: Concerns have been expressed about the feasibility of laparoscopic right hepatectomy (Lap-RH) after portal vein occlusion (PVO), because of its technical difficulty. The aim of this study is to assess the safety and feasibility of lap-RH after PVO.
METHODS: Retrospective analysis of prospectively collected data from high-volume HPB centers was performed. The peri-operative outcomes of lap-RH were compared to open-RH. Propensity score matching (PSM) was used to mitigate the influence of selection bias. Both one-stage and two-stage procedures were considered.
RESULTS: Between 01/2010 and 12/2020, 284 patients underwent RH or extended RH after PVO. The laparoscopic approach was used in 63 (22%) cases. Overall, surgeries were mainly performed for colorectal metastases (68.6%). Two-stage procedures were required in one-third of the cases for both groups. After PSM, 126 patients of the open-RH group were matched with 63 patients of the lap-RH group. In the lap-RH group, compared to open-RH, median FLR% post-PVO was larger (39.4% vs 38.5%, p = 0.037), median operation time was longer (360 vs 264 min, p < 0.001), pedicle clamping was used more frequently (79.4% vs 38.9%, p > 0.001), and median blood loss was higher (250 cc vs 200 cc, p = 0.024). Severe intraoperative incidents seldom occurred in both groups (6.3% lap-RH vs 1.6% open-RH, p = 0.208). The overall and severe complication rates were comparable. ISGLS liver failure grade B/C was rare in both groups (3.2% lap-RH vs 4.8% open-RH, p = 0.721). 90-day mortality was 1.6% following either lap-RH or open-RH. Lap-RH allowed a shorter median hospital stay (6 vs 8 days, p = 0.001). R1 resection rate was lower after lap-RH (3.2% vs 16%, p = 0.008).
CONCLUSION: Lap-RH after PVO is safe, although it is technically more demanding than open-RH. This study also suggests some potential benefits of the laparoscopic approach, in terms of a shorter hospital stay and increased rate of radical resections.
Laparoscopic hepatectomy, Major hepatectomy, Portal vein occlusion
1839-1847
Langella, Serena
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Nadia, Russolillo
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Sijberden, Jasper
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Fiorentini, Guido
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Guglielmo, Nicola
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Primrose, John
d85f3b28-24c6-475f-955b-ec457a3f9185
Modi, Sachin
caef086a-dda5-418a-ada8-fc042e6e0b18
Massella, Virginia
858093d2-a1be-4629-919b-d5b92480ac6b
Ettorre, Giuseppe Maria
b480f8d2-5fcc-4162-a2b0-35098a190da2
Aldrighetti, Luca
bab36581-c535-4f90-970d-0a982fe7a244
Hilal, Mohamed Abu
49de3083-f27e-4f69-ba0f-ee87d6b37cf5
Ferrero, Alessandro
0cb0b38c-30c5-44f9-996c-27e9ef37b62f
March 2025
Langella, Serena
7bb52936-5e41-4834-996d-9d71b5c762f7
Nadia, Russolillo
13830a0e-e818-4d71-ba86-7cab01ccd157
Sijberden, Jasper
a3423af5-8758-413a-b913-eead6095f8b8
Fiorentini, Guido
6b349cc7-d600-44b3-9e31-67e8d547845a
Guglielmo, Nicola
310e15c1-e386-48ed-a0fa-1c8b4614dabe
Primrose, John
d85f3b28-24c6-475f-955b-ec457a3f9185
Modi, Sachin
caef086a-dda5-418a-ada8-fc042e6e0b18
Massella, Virginia
858093d2-a1be-4629-919b-d5b92480ac6b
Ettorre, Giuseppe Maria
b480f8d2-5fcc-4162-a2b0-35098a190da2
Aldrighetti, Luca
bab36581-c535-4f90-970d-0a982fe7a244
Hilal, Mohamed Abu
49de3083-f27e-4f69-ba0f-ee87d6b37cf5
Ferrero, Alessandro
0cb0b38c-30c5-44f9-996c-27e9ef37b62f
Langella, Serena, Nadia, Russolillo, Sijberden, Jasper, Fiorentini, Guido, Guglielmo, Nicola, Primrose, John, Modi, Sachin, Massella, Virginia, Ettorre, Giuseppe Maria, Aldrighetti, Luca, Hilal, Mohamed Abu and Ferrero, Alessandro
(2025)
Safety of laparoscopic compared to open right hepatectomy after portal vein occlusion: results from a multicenter study.
Surgical Endoscopy, 39 (3), .
(doi:10.1007/s00464-025-11532-8).
Abstract
BACKGROUND: Concerns have been expressed about the feasibility of laparoscopic right hepatectomy (Lap-RH) after portal vein occlusion (PVO), because of its technical difficulty. The aim of this study is to assess the safety and feasibility of lap-RH after PVO.
METHODS: Retrospective analysis of prospectively collected data from high-volume HPB centers was performed. The peri-operative outcomes of lap-RH were compared to open-RH. Propensity score matching (PSM) was used to mitigate the influence of selection bias. Both one-stage and two-stage procedures were considered.
RESULTS: Between 01/2010 and 12/2020, 284 patients underwent RH or extended RH after PVO. The laparoscopic approach was used in 63 (22%) cases. Overall, surgeries were mainly performed for colorectal metastases (68.6%). Two-stage procedures were required in one-third of the cases for both groups. After PSM, 126 patients of the open-RH group were matched with 63 patients of the lap-RH group. In the lap-RH group, compared to open-RH, median FLR% post-PVO was larger (39.4% vs 38.5%, p = 0.037), median operation time was longer (360 vs 264 min, p < 0.001), pedicle clamping was used more frequently (79.4% vs 38.9%, p > 0.001), and median blood loss was higher (250 cc vs 200 cc, p = 0.024). Severe intraoperative incidents seldom occurred in both groups (6.3% lap-RH vs 1.6% open-RH, p = 0.208). The overall and severe complication rates were comparable. ISGLS liver failure grade B/C was rare in both groups (3.2% lap-RH vs 4.8% open-RH, p = 0.721). 90-day mortality was 1.6% following either lap-RH or open-RH. Lap-RH allowed a shorter median hospital stay (6 vs 8 days, p = 0.001). R1 resection rate was lower after lap-RH (3.2% vs 16%, p = 0.008).
CONCLUSION: Lap-RH after PVO is safe, although it is technically more demanding than open-RH. This study also suggests some potential benefits of the laparoscopic approach, in terms of a shorter hospital stay and increased rate of radical resections.
Text
Manuscript RH after PVO
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Restricted to Repository staff only until 2 January 2026.
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Accepted/In Press date: 2 January 2025
e-pub ahead of print date: 21 January 2025
Published date: March 2025
Additional Information:
© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Keywords:
Laparoscopic hepatectomy, Major hepatectomy, Portal vein occlusion
Identifiers
Local EPrints ID: 498714
URI: http://eprints.soton.ac.uk/id/eprint/498714
ISSN: 0930-2794
PURE UUID: 0476fbed-7d26-4159-b1cb-cdb298006d13
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Date deposited: 25 Feb 2025 18:09
Last modified: 15 May 2025 01:34
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Contributors
Author:
Serena Langella
Author:
Russolillo Nadia
Author:
Jasper Sijberden
Author:
Guido Fiorentini
Author:
Nicola Guglielmo
Author:
Sachin Modi
Author:
Virginia Massella
Author:
Giuseppe Maria Ettorre
Author:
Luca Aldrighetti
Author:
Mohamed Abu Hilal
Author:
Alessandro Ferrero
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