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.
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Article info
Publication history
Published online: January 18, 2023
Publication stage
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