Advertisement

Pure abdominal laparoscopic approach versus thoraco-abdominal laparoscopic approach: What is the best technique for liver resection in segment 7 and segment 8? An answer from the Institut Mutualiste Montsouris experience with short- and long-term outcome evaluation

Published:January 18, 2023DOI:https://doi.org/10.1016/j.surg.2022.12.007

      Abstract

      Background

      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.

      Methods

      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.

      Results

      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.

      Conclusion

      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
      Institutional Access: Sign in to ScienceDirect

      References

        • Guro H.
        • Cho J.Y.
        • Han H.-S.
        • et al.
        Laparoscopic liver resection of hepatocellular carcinoma located in segments 7 or 8.
        Surg Endosc. 2018; 32: 872-878
        • Ishizawa T.
        • Gumbs A.A.
        • Kokudo N.
        • Gayet B.
        Laparoscopic segmentectomy of the liver: from segment I to VIII.
        Ann Surg. 2012; 256: 959-964
        • Cho J.Y.
        • Han H.S.
        • Yoon Y.S.
        • Shin S.H.
        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
        • Chiow A.K.H.
        • Lewin J.
        • Manoharan B.
        • et al.
        Intercostal and transthoracic trocars enable easier laparoscopic resection of dome liver lesions.
        HPB. 2015; 17: 299-303
        • Teramoto K.
        • Kawamura T.
        • Takamatsu S.
        • et al.
        Laparoscopic and thoracoscopic approaches for the treatment of hepatocellular carcinoma.
        Am J Surg. 2005; 189: 474-478
        • Lim C.
        • Ishizawa T.
        • Miyata A.
        • et al.
        Surgical indications and procedures for resection of hepatic malignancies confined to segment VII.
        Ann Surg. 2016; 263: 529-537
        • Aikawa M.
        • Miyazawa M.
        • Okamoto K.
        • et al.
        Thoracoscopic hepatectomy for malignant liver tumor.
        Surg Endosc. 2014; 28: 314
        • Zorzi D.
        • Mullen J.T.
        • Abdalla E.K.
        • et al.
        Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases.
        J Gastrointest Surg. 2006; 10: 86-94
        • Lang H.
        • Domland M.
        • Broelsch C.E.
        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
        • Teramoto K.
        • Kawamura T.
        • Takamatsu S.
        • et al.
        Laparoscopic and thoracoscopic partial hepatectomy for hepatocellular carcinoma.
        World J Surg. 2003; 27: 1131-1136
        • Pathak S.
        • Main B.G.
        • Blencowe N.S.
        • et al.
        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
        • Fuks D.
        • Gayet B.
        Laparoscopic surgery of postero-lateral segments: a comparison between transthoracic and abdominal approach.
        Updates Surg. 2015; 67: 141-145
        • Ogiso S.
        • Conrad C.
        • Araki K.
        • et al.
        Laparoscopic transabdominal with transdiaphragmatic access improves resection of difficult posterosuperior liver lesions.
        Ann Surg. 2015; 262: 358-365
        • Bursac Z.
        • Gauss C.H.
        • Williams D.K.
        • Hosmer D.W.
        Purposeful selection of variables in logistic regression.
        Source Code Biol Med. 2008; 3: 17
        • Delgado-Rodríguez M.
        • Gómez-Ortega A.
        • Sillero-Arenas M.
        • Llorca J.
        Epidemiology of surgical-site infections diagnosed after hospital discharge: a prospective cohort study.
        Infect Control Hosp Epidemiol. 2001; 22: 24-30
        • Mabilia A.
        • Mazzotta A.D.
        • Robin F.
        • et al.
        R1 vascular or parenchymal margins: what is the impact after resection of intrahepatic cholangiocarcinoma?.
        Cancers (Basel). 2022; 14: 5151
        • Hallet J.
        • Soler L.
        • Diana M.
        • et al.
        Trans-thoracic minimally invasive liver resection guided by augmented reality.
        J Am Coll Surg. 2015; 220: e55-e60
        • Schwarz L.
        • Aloia T.A.
        • Eng C.
        • et al.
        Transthoracic port placement increases safety of total laparoscopic posterior sectionectomy.
        Ann Surg Oncol. 2016; 23: 2167
        • Lee W.
        • Han H.-S.
        • Yoon Y.-S.
        • et al.
        Role of intercostal trocars on laparoscopic liver resection for tumors in segments 7 and 8.
        J Hepatobiliary Pancreat Sci. 2014; 21: E65-E68
        • Cloyd J.M.
        • Visser B.C.
        Video-assisted thoracoscopic transdiaphragmatic liver resection for hepatocellular carcinoma.
        Surg Endosc. 2012; 26: 1772-1776
        • Krüger J.A.P.
        • Coelho F.F.
        • Perini M.V.
        • Herman P.
        Laparoscopic transthoracic liver resection.
        Arq Bras Cir Dig. 2014; 27: 288-290
        • Golse N.
        • Ducerf C.
        • Rode A.
        • et al.
        Transthoracic approach for liver tumors.
        J Visc Surg. 2012; 149: e11-e22
        • Ichida H.
        • Ishizawa T.
        • Tanaka M.
        • et al.
        Use of intercostal trocars for laparoscopic resection of subphrenic hepatic tumors.
        Surg Endosc. 2017; 31: 1280-1286
        • Nguyen K.T.
        • Gamblin T.C.
        • Geller D.A.
        World review of laparoscopic liver resection: 2804 patients.
        Ann Surg. 2009; 250: 831-841
        • Reddy S.K.
        • Tsung A.
        • Geller D.A.
        Laparoscopic liver resection.
        World J Surg. 2011; 35: 1478-1486
        • Cloyd J.M.
        • Mizuno T.
        • Kawaguchi Y.
        • et al.
        Comprehensive complication index validates improved outcomes over time despite increased complexity in 3707 consecutive hepatectomies.
        Ann Surg. 2020; 271: 724-731
        • Wang H.P.
        • Yong C.C.
        • Wu A.G.R.
        • et al.
        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
        • Mazzotta A.D.
        • Kawaguchi Y.
        • Pantel L.
        • et al
        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
        • Kawaguchi Y.
        • Lillemoe H.S.
        • Panettieri E.
        • et al.
        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
        • Pawlik T.M.
        • Scoggins C.R.
        • Zorzi D.
        • et al.
        Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases.
        Ann Surg. 2005; 241: 715-724
        • Figueras J.
        • Burdio F.
        • Ramos E.
        • et al.
        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
        • Andreou A.
        • Knitter S.
        • Schmelzle M.
        • et al.
        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
        • Xiao L.
        • Xiang L.-J.
        • Li J.-W.
        • et al.
        Laparoscopic versus open liver resection for hepatocellular carcinoma in posterosuperior segments.
        Surg Endosc. 2015; 29: 2994-3001
        • Kwon Y.
        • Lee B.
        • Cho J.Y.
        • et al.
        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
        • Cho J.Y.
        • Han H.S.
        • Yoon Y.S.
        • Shin S.H.
        Experiences of laparoscopic liver resection including lesions in the posterosuperior segments of the liver.
        Surg Endosc. 2008; 22: 2344-2349
        • Kazaryan A.M.
        • Pavlik Marangos I.
        • Rosseland A.R.
        • et al.
        Laparoscopic liver resection for malignant and benign lesions: ten-year Norwegian single-center experience.
        Arch Surg. 2010; 145: 34-40
        • Dagher I.
        • O’Rourke N.
        • Geller D.A.
        • et al.
        Laparoscopic major hepatectomy: an evolution in standard of care.
        Ann Surg. 2009; 250: 856-860
        • Dagher I.
        • Belli G.
        • Fantini C.
        • et al.
        Laparoscopic hepatectomy for hepatocellular carcinoma: a European experience.
        J Am Coll Surg. 2010; 211: 16-23
        • Efanov M.
        • Salemgereeva D.
        • Alikhanov R.
        • et al.
        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
        • van Det M.J.
        • Meijerink W.J.H.J.
        • Hoff C.
        • Totté E.R.
        • Pierie J.P.E.N.
        Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines.
        Surg Endosc. 2009; 23: 1279-1285