Results of minor and major hepatectomies by laparoscopy
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Results of minor and major hepatectomies by laparoscopy. Brice Gayet, Vibert E, Kouider A. Department of digestive pathology Montsouris Institute, Paris, France. RISKS OF LAP’ HEPATECTOMY. Exploration in malignancy. Hemorrhage. Respect of abdominal wall. Poor exploration.

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Results of minor and major hepatectomies by laparoscopy

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Results of minor and major hepatectomies by laparoscopy

Results of minor and major hepatectomies by laparoscopy

Brice Gayet, Vibert E, Kouider A

Department of digestive pathology

Montsouris Institute, Paris, France


Benefice and controversial

RISKS OF LAP’ HEPATECTOMY

Exploration in malignancy

Hemorrhage

Respect of abdominal wall

Poor exploration

Post-operative adhesions

Gas embolism

Immunological benefice ?

Technologyand specific materials

Interface for computer

Progressive and specific learning

Benefice and controversial

Resection without reconstruction

Malignancy

Hepato-biliary surgeon

SURGERY OF THE LIVER


Technologies and experiences

Laparoscopic ultrasonography

Parenchymal section devices

Bipolar forceps

Voice-controlled robot for camera

131 Lap’ liver surgery

40 “easy” or resection < 3cm

53 Minor hepatectomies (≤ 2 segments)

38 Major hepatectomies (> 2 segments)

Technologies and experiences


Materials and methods

FNH 9

Others 7

19 diagnostic resections

Benign lesions

Adenoma 3

24

5 resections for symptoms

43 colo-rectal metastases (CRM)

Malignant lesions

16 hepatocellular carcinomas (HCC)

67

3 neuroendocrine metastases

5 non neuroendoc non crm

Materials and Methods

91 Hepatectomies in 86 patients (5 re-hepatectomies)

Sex Ratio : M/F 1.3 – Median Age : 55 years (23-85)


53 minor hepatectomies

28

Wedge resections in all segments

2

1

7

1

1

2

4

7

53 Minor Hepatectomies

25

Anatomical hepatectomies (All segments excepted IVa)


38 major hepatectomies

3

27

1

4

38 Major hepatectomies

Plus 3 trisegmentectomies (II+III+IVb, V+VI+VII, V+VI+IVb


Post operative results

7 Conversions (4 for hemorrhage)

Duration: 5.5 hours (180-515)

Mortality: 1 death at day 8 postop

Morbidity: 11/38 (28%)

38 Major resections

7 Major lap’ associated procedures

5 Conversions (0 for hemorrhage)

Duration: 2.5 hours (60-390)

Morbidity: 8/53 (15%)

53 Minor resections

Post-operative results

24 laparoscopic associated procedures

Morbidity : Abscess (n=2) - Biliary leak (reintervention) (n=1) - Hemorrhage (n=1†) – Hematoma (n=2) - Postoperative ileus (n=1) -Stroke (n=1) – Pleural effusion (n=2)

Morbidity : Biliary leak (reintervention) (n=2) – Hemorrhage (reintervention) (n=1) – Stump hematoma (n=2) – Liver abscess (n=1) – Abdominal abscess (n=2)

Transfusion: 8/91 patients (2 minor – 6 major)


Results of minor and major hepatectomies by laparoscopy

97%

8 RECURRENCES

3 intra-hepatic

74%

87%

51%

5 re-hepatectomies

Results in CRM (n=43 in 38 pat)

18 Metachronous / 19 Synchronous / 1 Recurrences

5 Lap’ re-hepatectomies: Two steps (n=2) / Recurrence (n=2)

Mean number: 2 (1-4) / Mean diameter: 3 cm (1-12)

Associated lap’ colorectal resection: 7 patients

100%

100%

80%

80%

60%

60%

40%

40%

Overall survival

DFS

20%

20%

0

10

20

30

40

50

60

0

10

20

30

40

50

60

Mean Follow-up: 30 months


Results of minor and major hepatectomies by laparoscopy

85%

76%

66%

68%

Results in HCC (n=16)

Cirrhotic liver (n=7)

Single nodule (n=14/15)

Mean diameter 6.5 cm (1-18)

100%

100%

80%

80%

60%

60%

40%

40%

Disease free survival

Overall survival

20%

20%

10

20

30

40

50

60

10

20

30

40

50

60

0

0

Mean Follow-up: 40 months


Conclusions

Conclusions

This study suggests :

  • Minor laparoscopic hepatectomies are feasible and safe for almost all hepatic segments

  • Major laparoscopic hepatectomies are feasible but remain a demanding procedure which require a long training

  • Prognosis of liver malignant tumors does not seem to be modified by laparoscopic approach


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