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Background <p>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.</p> Methods <p>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.</p> Results <p>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%, <i>p</i> = 0.037), median operation time was longer (360 vs 264&#xa0;min, <i>p</i> &lt; 0.001), pedicle clamping was used more frequently (79.4% vs 38.9%, <i>p</i> &gt; 0.001), and median blood loss was higher (250&#xa0;cc vs 200&#xa0;cc, <i>p</i> = 0.024). Severe intraoperative incidents seldom occurred in both groups (6.3% lap-RH vs 1.6% open-RH, <i>p</i> = 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, <i>p</i> = 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&#xa0;days, <i>p</i> = 0.001). R1 resection rate was lower after lap-RH (3.2% vs 16%, <i>p</i> = 0.008).</p> Conclusion <p>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.</p>

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Safety of laparoscopic compared to open right hepatectomy after portal vein occlusion: results from a multicenter study

  • 期刊论文

  • 发表日期：

    2025年1月21日

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  • Serena Langella,
  • Nadia Russolillo,
  • Jasper Sijberden,
  • Guido Fiorentini,
  • Nicola Guglielmo,
  • John Primrose,
  • Sachin Modi,
  • Virginia Massella,
  • Giuseppe Maria Ettorre,
  • Luca Aldrighetti,
  • Mohamed Abu Hilal,
  • Alessandro Ferrero

摘要

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.