Lesions in segments 7 and 8 are a challenge during standard laparoscopic liver resection. The addition of transthoracic trocars could be useful in the standard abdominal approach for laparoscopic liver resection. We report our experience with a thoraco-abdominal laparoscopic combined approach for liver resection with the aim of comparing short- and long-term outcomes.
We reviewed 1,003 laparoscopic liver resections in a prospectively maintained, single-institution database. We compared patient outcomes intraoperatively and postoperatively. We analyzed the long-term outcomes of the colorectal liver metastasis subgroup. Propensity score matching 1:1 was performed based on the following variables: age, American Society of Anesthesiologists, body mass index, previous abdominal surgery, multiple or single liver resection, lesion >50 mm or <50 mm, presence of solitary or multiple lesions, T stage, and N stage.
The standard abdominal approach was used in 110 laparoscopic liver resections, and the thoraco-abdominal laparoscopic combined approach was used in 62 laparoscopic liver resections. The thoraco-abdominal laparoscopic combined approach was associated with better intraoperative results (less blood loss and no need for conversion to open surgery). The R1s rate for segmentectomy 7 and 8 was lower in the thoraco-abdominal laparoscopic combined approach in the entire group and in the colorectal liver metastasis subgroup. In the colorectal liver metastasis subgroup, the 3- and 5-year overall survival was 90% and 80% in the thoraco-abdominal laparoscopic combined approach group and 76% and 52% in the standard abdominal approach group, respectively (P = .02). In univariate and multivariate analysis, the thoraco-abdominal laparoscopic combined approach was a significant factor that positively affected disease-free survival and overall survival.
The thoraco-abdominal laparoscopic combined approach in laparoscopic liver resection in segments 7 and 8 is safe and feasible, and it has demonstrated better oncologic outcomes than the pure abdominal approach, especially in segmentectomy.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Laparoscopic liver resection of hepatocellular carcinoma located in segments 7 or 8.Surg Endosc. 2018; 32: 872-878
- Laparoscopic segmentectomy of the liver: from segment I to VIII.Ann Surg. 2012; 256: 959-964
- Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location.Surgery. 2008; 144: 32-38
- Intercostal and transthoracic trocars enable easier laparoscopic resection of dome liver lesions.HPB. 2015; 17: 299-303
- Laparoscopic and thoracoscopic approaches for the treatment of hepatocellular carcinoma.Am J Surg. 2005; 189: 474-478
- Surgical indications and procedures for resection of hepatic malignancies confined to segment VII.Ann Surg. 2016; 263: 529-537
- Thoracoscopic hepatectomy for malignant liver tumor.Surg Endosc. 2014; 28: 314
- Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases.J Gastrointest Surg. 2006; 10: 86-94
- Liver resection and liver transplantation in liver cell adenoma, hepatocellular carcinoma and fibrolamellar liver carcinoma. Article in German.Praxis (Bern 1994). 2001; 90: 7-13
- Laparoscopic and thoracoscopic partial hepatectomy for hepatocellular carcinoma.World J Surg. 2003; 27: 1131-1136
- A systematic review of minimally invasive trans-thoracic liver resection to examine intervention description, governance, and outcome reporting of an innovative technique.Ann Surg. 2021; 273: 882-889
- Laparoscopic surgery of postero-lateral segments: a comparison between transthoracic and abdominal approach.Updates Surg. 2015; 67: 141-145
- Laparoscopic transabdominal with transdiaphragmatic access improves resection of difficult posterosuperior liver lesions.Ann Surg. 2015; 262: 358-365
- Purposeful selection of variables in logistic regression.Source Code Biol Med. 2008; 3: 17
- Epidemiology of surgical-site infections diagnosed after hospital discharge: a prospective cohort study.Infect Control Hosp Epidemiol. 2001; 22: 24-30
- R1 vascular or parenchymal margins: what is the impact after resection of intrahepatic cholangiocarcinoma?.Cancers (Basel). 2022; 14: 5151
- Trans-thoracic minimally invasive liver resection guided by augmented reality.J Am Coll Surg. 2015; 220: e55-e60
- Transthoracic port placement increases safety of total laparoscopic posterior sectionectomy.Ann Surg Oncol. 2016; 23: 2167
- Role of intercostal trocars on laparoscopic liver resection for tumors in segments 7 and 8.J Hepatobiliary Pancreat Sci. 2014; 21: E65-E68
- Video-assisted thoracoscopic transdiaphragmatic liver resection for hepatocellular carcinoma.Surg Endosc. 2012; 26: 1772-1776
- Laparoscopic transthoracic liver resection.Arq Bras Cir Dig. 2014; 27: 288-290
- Transthoracic approach for liver tumors.J Visc Surg. 2012; 149: e11-e22
- Use of intercostal trocars for laparoscopic resection of subphrenic hepatic tumors.Surg Endosc. 2017; 31: 1280-1286
- World review of laparoscopic liver resection: 2804 patients.Ann Surg. 2009; 250: 831-841
- Laparoscopic liver resection.World J Surg. 2011; 35: 1478-1486
- Comprehensive complication index validates improved outcomes over time despite increased complexity in 3707 consecutive hepatectomies.Ann Surg. 2020; 271: 724-731
- Factors associated with and impact of open conversion on the outcomes of minimally invasive left lateral sectionectomies: an international multicenter study.Surgery. 2022; 172: 617-624
- Conditional cumulative incidence of postoperative complications stratified by complexity classification for laparoscopic liver resection: optimization of in-hospital observation e-pub ahead of print.Surgery. 2022; https://doi.org/10.1016/J.SURG.2022.07.026
- Conditional recurrence-free survival after resection of colorectal liver metastases: persistent deleterious association with RAS and TP53 co-mutation.J Am Coll Surg. 2019; 229: 286
- Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases.Ann Surg. 2005; 241: 715-724
- Effect of subcentimeter nonpositive resection margin on hepatic recurrence in patients undergoing hepatectomy for colorectal liver metastases: evidences from 663 liver resections.Ann Oncol. 2007; 18: 1190-1195
- Recurrence at surgical margin following hepatectomy for colorectal liver metastases is not associated with R1 resection and does not impact survival.Surgery. 2021; 169: 1061-1068
- Laparoscopic versus open liver resection for hepatocellular carcinoma in posterosuperior segments.Surg Endosc. 2015; 29: 2994-3001
- A case-matched analysis of laparoscopic liver resection for hepatocellular carcinoma located in posterosuperior segments of the liver according to adaption of developed techniques.Medicina (Kaunas). 2022; 85: 543
- Experiences of laparoscopic liver resection including lesions in the posterosuperior segments of the liver.Surg Endosc. 2008; 22: 2344-2349
- Laparoscopic liver resection for malignant and benign lesions: ten-year Norwegian single-center experience.Arch Surg. 2010; 145: 34-40
- Laparoscopic major hepatectomy: an evolution in standard of care.Ann Surg. 2009; 250: 856-860
- Laparoscopic hepatectomy for hepatocellular carcinoma: a European experience.J Am Coll Surg. 2010; 211: 16-23
- Comparison between the difficulty of laparoscopic limited liver resections of tumors located in segment 7 versus segment 8: an international multicenter propensity-score matched study e-pub ahead of print.J Hepatobiliary Pancreat Sci. 2022; https://doi.org/10.1002/JHBP. 1210
- Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines.Surg Endosc. 2009; 23: 1279-1285
Published online: January 18, 2023
Publication stageIn Press Corrected Proof
© 2022 Elsevier Inc. All rights reserved.