Cargando…
Safety and Perioperative Outcomes of Laparoscopic vs. Open Hepatectomy of Central-Located Liver Lesions: A Multicenter, Propensity Score-Matched, Retrospective Cohort Study
Background: Short-term outcomes of laparoscopic hepatectomy of central-located liver lesions (LHCL) compared with traditional open hepatectomy of central-located liver lesions (OHCL) remain unclear. The aim of this study was to explore the safety and efficacy of LHCL. Methods: A retrospective analys...
Autores principales: | , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10057074/ https://www.ncbi.nlm.nih.gov/pubmed/36983169 http://dx.doi.org/10.3390/jcm12062164 |
_version_ | 1785016274017845248 |
---|---|
author | Jin, Bao Yang, Muyi Wang, Yinhan Xu, Gang Wang, Yuxin Zhang, Yuke Liu, Yitong Niu, Xinming Liu, Xiao Wan, Xueshuai Yang, Huayu Lu, Xin Sang, Xinting Mao, Yilei Hong, Zhixian Du, Shunda |
author_facet | Jin, Bao Yang, Muyi Wang, Yinhan Xu, Gang Wang, Yuxin Zhang, Yuke Liu, Yitong Niu, Xinming Liu, Xiao Wan, Xueshuai Yang, Huayu Lu, Xin Sang, Xinting Mao, Yilei Hong, Zhixian Du, Shunda |
author_sort | Jin, Bao |
collection | PubMed |
description | Background: Short-term outcomes of laparoscopic hepatectomy of central-located liver lesions (LHCL) compared with traditional open hepatectomy of central-located liver lesions (OHCL) remain unclear. The aim of this study was to explore the safety and efficacy of LHCL. Methods: A retrospective analysis was performed on 262 patients who underwent hepatectomies involving resections of liver segment II, IV or VIII from January 2015 to June 2021 in two institutions. Patients in the LHCL group were matched in a 1:2 ratio to patients in the OHCL group. Results: After propensity score-matched (PSM) analysis, 61 patients remained in the LHCL group and 122 patients were in the OHCL group. What needs to be mentioned is that although not significant, patients in the OHCL group had increased lesion size (4.3 vs. 3.6 cm, p = 0.052), number (single/multiple, 84.8%/15.2% vs. 93.4%/6.6%, p = 0.097), and number of liver segments involved (one/two/three, 47.3%/42.0%/10.7% vs. 57.4%36.1%/10.7%, p = 0.393). To ensure surgical safety, fewer patients in the LHCL group underwent vascular exclusion than those in the OHCL group (p = 0.004). In addition, LHCL was associated with lower blood loss (p = 0.001) and transfusion requirement (p = 0.004). In terms of short-term outcomes, the LHCL group had significantly lower levels of peak ALT (p < 0.001), peak DBIL (p = 0.042), peak PT (p = 0.012), and higher levels of bottom ALB (p = 0.049). Moreover, the LHCL group demonstrated quicker postoperative recovery, which was represented by shorter time to first flatus, time to oral intake, time to drain off, and hospital stay (all p < 0.001). Importantly, the LHCL group had a significantly reduced occurrence of postoperative complications (p < 0.001) and similar R0 resection rates (p = 0.678) when compared to the OHCL group. Conclusion: LHCL is associated with increased safety and better perioperative outcomes and thus could be recommended for patients with central space-occupying liver lesions when appropriately selecting the surgical procedure according to the total tumor burden and carefully handled by experienced surgeons. From the experience of our center, LHCL could be performed to solitary lesion involving liver segment IV/V/VIII, <5 cm, with good safety and feasibility. |
format | Online Article Text |
id | pubmed-10057074 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-100570742023-03-30 Safety and Perioperative Outcomes of Laparoscopic vs. Open Hepatectomy of Central-Located Liver Lesions: A Multicenter, Propensity Score-Matched, Retrospective Cohort Study Jin, Bao Yang, Muyi Wang, Yinhan Xu, Gang Wang, Yuxin Zhang, Yuke Liu, Yitong Niu, Xinming Liu, Xiao Wan, Xueshuai Yang, Huayu Lu, Xin Sang, Xinting Mao, Yilei Hong, Zhixian Du, Shunda J Clin Med Article Background: Short-term outcomes of laparoscopic hepatectomy of central-located liver lesions (LHCL) compared with traditional open hepatectomy of central-located liver lesions (OHCL) remain unclear. The aim of this study was to explore the safety and efficacy of LHCL. Methods: A retrospective analysis was performed on 262 patients who underwent hepatectomies involving resections of liver segment II, IV or VIII from January 2015 to June 2021 in two institutions. Patients in the LHCL group were matched in a 1:2 ratio to patients in the OHCL group. Results: After propensity score-matched (PSM) analysis, 61 patients remained in the LHCL group and 122 patients were in the OHCL group. What needs to be mentioned is that although not significant, patients in the OHCL group had increased lesion size (4.3 vs. 3.6 cm, p = 0.052), number (single/multiple, 84.8%/15.2% vs. 93.4%/6.6%, p = 0.097), and number of liver segments involved (one/two/three, 47.3%/42.0%/10.7% vs. 57.4%36.1%/10.7%, p = 0.393). To ensure surgical safety, fewer patients in the LHCL group underwent vascular exclusion than those in the OHCL group (p = 0.004). In addition, LHCL was associated with lower blood loss (p = 0.001) and transfusion requirement (p = 0.004). In terms of short-term outcomes, the LHCL group had significantly lower levels of peak ALT (p < 0.001), peak DBIL (p = 0.042), peak PT (p = 0.012), and higher levels of bottom ALB (p = 0.049). Moreover, the LHCL group demonstrated quicker postoperative recovery, which was represented by shorter time to first flatus, time to oral intake, time to drain off, and hospital stay (all p < 0.001). Importantly, the LHCL group had a significantly reduced occurrence of postoperative complications (p < 0.001) and similar R0 resection rates (p = 0.678) when compared to the OHCL group. Conclusion: LHCL is associated with increased safety and better perioperative outcomes and thus could be recommended for patients with central space-occupying liver lesions when appropriately selecting the surgical procedure according to the total tumor burden and carefully handled by experienced surgeons. From the experience of our center, LHCL could be performed to solitary lesion involving liver segment IV/V/VIII, <5 cm, with good safety and feasibility. MDPI 2023-03-10 /pmc/articles/PMC10057074/ /pubmed/36983169 http://dx.doi.org/10.3390/jcm12062164 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Jin, Bao Yang, Muyi Wang, Yinhan Xu, Gang Wang, Yuxin Zhang, Yuke Liu, Yitong Niu, Xinming Liu, Xiao Wan, Xueshuai Yang, Huayu Lu, Xin Sang, Xinting Mao, Yilei Hong, Zhixian Du, Shunda Safety and Perioperative Outcomes of Laparoscopic vs. Open Hepatectomy of Central-Located Liver Lesions: A Multicenter, Propensity Score-Matched, Retrospective Cohort Study |
title | Safety and Perioperative Outcomes of Laparoscopic vs. Open Hepatectomy of Central-Located Liver Lesions: A Multicenter, Propensity Score-Matched, Retrospective Cohort Study |
title_full | Safety and Perioperative Outcomes of Laparoscopic vs. Open Hepatectomy of Central-Located Liver Lesions: A Multicenter, Propensity Score-Matched, Retrospective Cohort Study |
title_fullStr | Safety and Perioperative Outcomes of Laparoscopic vs. Open Hepatectomy of Central-Located Liver Lesions: A Multicenter, Propensity Score-Matched, Retrospective Cohort Study |
title_full_unstemmed | Safety and Perioperative Outcomes of Laparoscopic vs. Open Hepatectomy of Central-Located Liver Lesions: A Multicenter, Propensity Score-Matched, Retrospective Cohort Study |
title_short | Safety and Perioperative Outcomes of Laparoscopic vs. Open Hepatectomy of Central-Located Liver Lesions: A Multicenter, Propensity Score-Matched, Retrospective Cohort Study |
title_sort | safety and perioperative outcomes of laparoscopic vs. open hepatectomy of central-located liver lesions: a multicenter, propensity score-matched, retrospective cohort study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10057074/ https://www.ncbi.nlm.nih.gov/pubmed/36983169 http://dx.doi.org/10.3390/jcm12062164 |
work_keys_str_mv | AT jinbao safetyandperioperativeoutcomesoflaparoscopicvsopenhepatectomyofcentrallocatedliverlesionsamulticenterpropensityscorematchedretrospectivecohortstudy AT yangmuyi safetyandperioperativeoutcomesoflaparoscopicvsopenhepatectomyofcentrallocatedliverlesionsamulticenterpropensityscorematchedretrospectivecohortstudy AT wangyinhan safetyandperioperativeoutcomesoflaparoscopicvsopenhepatectomyofcentrallocatedliverlesionsamulticenterpropensityscorematchedretrospectivecohortstudy AT xugang safetyandperioperativeoutcomesoflaparoscopicvsopenhepatectomyofcentrallocatedliverlesionsamulticenterpropensityscorematchedretrospectivecohortstudy AT wangyuxin safetyandperioperativeoutcomesoflaparoscopicvsopenhepatectomyofcentrallocatedliverlesionsamulticenterpropensityscorematchedretrospectivecohortstudy AT zhangyuke safetyandperioperativeoutcomesoflaparoscopicvsopenhepatectomyofcentrallocatedliverlesionsamulticenterpropensityscorematchedretrospectivecohortstudy AT liuyitong safetyandperioperativeoutcomesoflaparoscopicvsopenhepatectomyofcentrallocatedliverlesionsamulticenterpropensityscorematchedretrospectivecohortstudy AT niuxinming safetyandperioperativeoutcomesoflaparoscopicvsopenhepatectomyofcentrallocatedliverlesionsamulticenterpropensityscorematchedretrospectivecohortstudy AT liuxiao safetyandperioperativeoutcomesoflaparoscopicvsopenhepatectomyofcentrallocatedliverlesionsamulticenterpropensityscorematchedretrospectivecohortstudy AT wanxueshuai safetyandperioperativeoutcomesoflaparoscopicvsopenhepatectomyofcentrallocatedliverlesionsamulticenterpropensityscorematchedretrospectivecohortstudy AT yanghuayu safetyandperioperativeoutcomesoflaparoscopicvsopenhepatectomyofcentrallocatedliverlesionsamulticenterpropensityscorematchedretrospectivecohortstudy AT luxin safetyandperioperativeoutcomesoflaparoscopicvsopenhepatectomyofcentrallocatedliverlesionsamulticenterpropensityscorematchedretrospectivecohortstudy AT sangxinting safetyandperioperativeoutcomesoflaparoscopicvsopenhepatectomyofcentrallocatedliverlesionsamulticenterpropensityscorematchedretrospectivecohortstudy AT maoyilei safetyandperioperativeoutcomesoflaparoscopicvsopenhepatectomyofcentrallocatedliverlesionsamulticenterpropensityscorematchedretrospectivecohortstudy AT hongzhixian safetyandperioperativeoutcomesoflaparoscopicvsopenhepatectomyofcentrallocatedliverlesionsamulticenterpropensityscorematchedretrospectivecohortstudy AT dushunda safetyandperioperativeoutcomesoflaparoscopicvsopenhepatectomyofcentrallocatedliverlesionsamulticenterpropensityscorematchedretrospectivecohortstudy |