Liver Parenchyma Transection-First Approach for Laparoscopic Left Hemihepatectomy: A Propensity Score Matching Analysis
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ORIGINAL SCIENTIFIC REPORT
Liver Parenchyma Transection-First Approach for Laparoscopic Left Hemihepatectomy: A Propensity Score Matching Analysis Qinqin Liu1 • Jing Li1 • Ledu Zhou2 • Huiying Gu1 • Ke Wu1 • Nan You1 • Zheng Wang1 Liang Wang1 • Yinan Zhu1 • Hui Gan3 • Lu Zheng1
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Accepted: 11 October 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Laparoscopic major liver resection, such as laparoscopic left hemihepatectomy (LLH), is still perceived as a complicated procedure due to technical difficulties and slow learning curve. The study introduced an optimized procedure using the liver parenchyma transection-first approach and investigated its advantages on surgical outcomes by comparison with the conventional hilar dissection approach for LLH. Methods Between January 2015 and May 2019, 96 patients who underwent laparoscopic left hemihepatectomy for hepatocellular carcinoma (HCC) were enrolled in the study. Among these, 41 patients underwent the liver parenchyma transection-first approach (LP-first group) and the other 55 underwent the conventional hilar dissection approach (conventional group). A 1:1 propensity score matching (PSM) was performed to compare the perioperative and long-term oncological outcomes of the two groups. Results After 1:1 PSM, 37 patients in each group were selected for further analysis. The LP-first group was associated with shorter median operative time (210 vs 235 min, P = 0.035) and less blood loss (200 vs 300 mL, P = 0.410). In addition, no statistical differences were found in overall complications between the two groups (8.1% vs 24.3%, P = 0.058). There were no significant differences between the two groups in terms of 1-year and 3-year disease-free survival (DFS, P = 0.608) and overall survival (OS, P = 0.414). Conclusion The prior liver parenchyma approach for LLH is safe and reproducible in selected patients, which showed improved perioperative outcomes and comparable long-term oncological outcomes compared with the conventional approach.
Introduction
& Lu Zheng [email protected] 1
Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Army Medical University, No. 183 Xinqiao High Street, Shapingba District, Chongqing 400037, China
2
Department of Liver Surgery, Xiangya Hospital, Central South University, Changsha, China
3
Department of Radiology, The Second Affiliated Hospital of Army Medical University, Chongqing, China
Laparoscopic liver resection has gained worldwide acceptance with reported less complications, shorter hospitalization, quicker postoperative recovery and reduced surgical trauma in comparison with open liver resection since it was first introduced in the 1990s [1, 2]. Nowadays, an increasing number of reports have confirmed the feasibility and safety of laparoscopic minor hepatectomy in selected patients [3, 4]. However, laparoscopic major hepatectomy is still in the exploration phase and confined to experienced surgeons in a small number of institutions concerning technical difficulties and harmful learning
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