Objective To evaluate the short-term effectiveness and safety of laparoscopic versus conventional open left hepatectomy. Methods Databases including CENTRAL (Issue 1, 2012), MEDLINE/PubMed (1978 to 2012), EMbase (1966 to 2012), CBM (1978 to 2012), CNKI (1979 to 2012) and the Chinese Medical Association Figures Journal Systems (1990 to 2012) were searched to collect clinical trials on laparoscopic versus conventional open left hepatectomy. Relevant proceedings and references of the included studies were also retrieved manually. According to the inclusion criteria, two reviewers independently screened literature, extracted data and assessed quality. Then meta-analysis was conducted using RevMan5.0 software. Results No randomized controlled trials were collected, and a total of 5 clinical concurrent controlled trials involving 319 patients were included finally. The results of meta-analysis showed that, compared with the conventional open group, the laparoscopic group was longer in the operation time (WMD=40.89, 95%CI 29.39 to 55.38, Plt;0.000 01), and was lower in the intraoperative blood loss (WMD=−107.84, 95%CI −208.96 to −6.73, Plt;0.04); but there was no significant difference between the two groups in terms of hospital stays (WMD=−3.78, 95%CI −9.60 to 2.04, P=0.20) or postoperative complications (WMD=0.69, 95%CI 0.37 to 1.29, P=0.25). Conclusion As a minimally invasive technique, laparoscopic left hepatectomy has advantages of small abdominal incision and less intraoperative blood loss, and it is helpful to improve the quality of life for patients. Due to the limitation of quantity and quality of the included studies, it is hard to estimate the impact of bias on the reliability of this conclusion. We advise to perform more high quality, large scale and multicenter studies with adequate follow-up in the future.
Objective To systematically evaluate the effectiveness and safety of laparoscopic hepatectomy (LH) versus open hepatectomy (OH) for hepatocellular carcinoma (HCC). Methods Databases including PubMed, EMbase, MEDLINE, SCI, CNKI, CBM, WanFang Data and The Cochrane Library (Issue 3, 2012) were searched to collect the randomized controlled trails (RCTs) and non-RCTs about LH versus OH for HCC. The retrieval time was from inception to August 2012. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. Then the meta-analysis was conducted using RevMan 5.1 software. Results A total of 13 non-RCTs involving 701 patients were included. The results of meta-analysis showed that: Compared with OH, LH had lesser amount of intraoperative bleeding (MD=?144.09, 95%CI ?194.25 to ?93.94, Plt;0.000 01), shorter hospital stay (MD=?5.48, 95%CI ?7.10 to ?3.85, Plt;0.000 01), and lower postoperative complications (OR=0.43, 95%CI 0.27 to 0.66, P=0.000 1). But there were no differences between the 2 groups in operation time (MD=?0.64, 95%CI ?22.95 to 21.68, P=0.96), perioperative death rate, 3-5 year survival rate, and tumor free survival rate. Conclusion LH is superior to OH in treating HCC for it is associated with smaller wound, lesser operative blood loss, shorter hospital stay, and lower postoperative complications. And it is similar as OH in operation time, perioperative death rate and 3-5 year survival rate. So LH is safe and feasible for treating HCC when its indications are strictly controlled. However, for the quantity and quality limitation of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for HCC patients according to an integrative disease assessment.
Objective To evaluate the efficiency and safety of laparoscopic hepatectomy (LH) and conventional open hepatectomy (OH) in patients with hepatocellular carcinoma (HCC). Methods We searched The Cochrane Library, MEDLINE (1966~2008.3), EMBASE (1966~2008.3), CBM (1979~2008.3), we also handsearched some Chinese journals. Using a defined search strategy, randomized controlled trails and controlled clinical trials of comparing OH with LH for hepatocellular carcinoma were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trails was evaluated by Deeks JJ’s evaluation criterion. Meta–analysis was done using the Cochrane collaboration’s Revman 4.2.10. Results Seven controlled clinical trials (309 patients) were included, The meta–analysis showed that: (1) Four studies (n=198) reported mortality, the mortality rate of the LH group was not significantly different from that of the OH group [OR=1.14, 95%Cl (0.15, 8.65), P=0.90]; (2) Two studies (n=91) reported blood transfusion. There were no significant differences between the two treatment groups in terms of the blood transfusion [OR=0.20, 95%Cl (0.03, 1.19), P=0.08]; (3) Four studies (n=165) reported operation time. There were significant differences in operating time between the two groups [SMD=1.05, 95%CI (0.72, 1.38), Plt;0.000 01]; (4) Four studies (n=165) reported intraoperative blood loss. There were significant differences in intraoperative blood loss between the two groups [SMD= – 1.56, 95%Cl (– 2.39, – 0.73), P=0.000 2]; (5) Five studies (n=210) reported the duration of hospital stay. There were significant differences in duration of hospital stay between the two groups [WMD= – 3.89, 95%CI (– 5.54, – 2.23), Plt;0.000 01]; (6) Two studies (n=248) reported complications. There were significant differences in complications between the two groups [OR=0.31, 95%Cl (0.13, 0.72), P=0.006]; (7) Two studies (n=97) reported ALT. There were significant differences in ALT between the two groups [SMD= – 1.54, 95%Cl (– 207, – 1.01), Plt;0.000 01]. Conclusion LH is associated with less postoperative complications, operative blood loss, duration of hospital stay and lower ALT, but longer operation time. However, the trails available for this systematic review are limited, so a prospective randomized controlled trial is warranted to fully investigate these and other outcome measures.
ObjectiveTo explore the curative effect of precise hepatectomy techniques in hepatolithus. MethodsTotally 132 patients underwent precise hepatectomy and 52 patients underwent irregular hepatectomy were retrospectively analyzed, and the intraoperative and postoperative indexes such as operation time, blood loss, postoperative complications, hospitalization time, clearance rate of calculus, and cost of hospitalization were analyzed. ResultsCompared with the patients in irregular hepatectomy group, although the operative time was longer in precise hepatectomy group 〔(364.6±57.8) min vs. (292.9±44.7) min, Plt;0.001〕, but the patients in precise hepatectomy group had less blood loss 〔(558.3±90.6) ml vs. (726.7±88.7) ml, Plt;0.001〕, less postoperative complications (11.4% vs. 23.1%，P=0.004 3), and higher clearance rate of calculus (89.4% vs. 73.1%, P=0.005 5). Thus, the patients in precise hepatectomy group had shorter hospital stay 〔(22.9±4.4) d vs. (28.8±3.5) d, Plt;0.001〕 and less cost of hospitalization 〔(1.8±0.7)×104 yuan vs. (2.1±0.9)×104 yuan, P=0.016 5〕. Conclusion Precise hepatectomy is better than irregular hepatectomy in treatment for hepatolithus.
To evaluate the biological tolerance of the human liver to prolonged warm ischemia, 20 patients who underwent liver resections with hepatic inflow occlusion are reported. Biopsy of liver were performed during and after consecutive periods of hepatic ischemia, and speciments were observed under light and electron microscope. The results showed that hepatic vascular occlusion for ＜30 min, resulted in atotissular temporary but reversible pathologic and ultrastructural changes in liver, even patients with liver cirrhosis had better recovery from the operation when the hepatic ischemia was lengthen up to 40 min.
Thirty-six partial hepatectomies for patients with symptomatic intrahepatic stones is reported.Partial liver resection should be done when the liver containing strictrue(s),dilated ducts and stones.Meanwhile,additional procedures should be performed togather with partial hepatectomy,i,e,common duct exploration and drainage,cholangiotomy and cholangioplanty,and cholangeoenterostomy,according to the location of stones and ductal strictures.Postoperative long-term follow-up in this series showed that the results of 86.2% of patients were satiffactory.Partial hepatectomy can be considered as a better treatment of choice for the stones confined to one segment or lobe of liver or combined with multiple strictures of ducts.
Objective To systematically evaluate the efficiency of laparoscopic hepatectomy（LH） and conventionalopen hepatectomy （OH）in patients with hepatocellular carcinoma （HCC）. Methods The literatures about the therap-eutic effect of LH and OH on hepatocellular carcinoma were collected from PubMed， Chinese Journal Full-text Database （CJFD）， Wanfang Database， China Doctor/Master Dissertations Full-text Database （CDMD）， and China Proceedings of Conference Full-text Database （CPCD）from 2000 to 2011. RevMan 5.0 software was used for data analysis. Results Eleven controlled clinical trials were included in this analysis. These studies included a total of 781 patients：325 treated with LH and 456 treated with OH. The results of meta-analysis showed that LH group had shorter operation time〔WMD=-20.85， 95% CI （-29.54， -12.16）， P＜0.000 01〕， less operative blood loss 〔SMD=-0.42，95% CI（-0.65，-0.19）， P=0.000 4〕， a lower postoperative morbidity rate 〔OR=0.43，95% CI （0.28，0.65），P＜0.000 1〕， and shorter hospitalization days 〔WMD=-4.32，95％ CI （-6.29，-2.34），P＜0.000 1〕 than OH group. There was no significant difference in postoperative recurrence （P=0.80）， overall survival in 1-year （P=0.98）， 3-year （P=0.41）， and 5-year （P=0.12）， and in disease-free survival in 1-year （P=0.15）， 3-year （P=0.62）， and 5-year （P=0.99）between the two groups. Conclusions For the patients with hepatocellular carcinoma localized to the CouinaudⅡ，Ⅲ，Ⅳ，Ⅴ，and Ⅵ segments with a maximum lesion size of 5cm， as well as the tumor has no effect on the exposure of blood vessel of the first and second hepatic portal， and the liver functions are classified as Child B or A high grade， the laparoscopic liver resection is priority considered in the conditions allow.
Objective To approach whether the postoperative recovery processes of the living donors and hepaticpatients after right hepatectomy is similar. Methods The clinical data of consecutive cases from 2009 to 2010 in our liver transplantation center was retrospectively analyzed， including 40 cases who donated the right lobe without the middlehepatic vein （living donor liver transpalntation-donor group， abbreviated as LDLT-D group） and 80 hepatic patients forright hepatectomy， in which 40 cases were hepatic patients without cirrhosis （liver disease-noncirrhosis group， abbreviatedas LD-NC group） and 40 cases were hepatic patients with cirrhosis （liver disease-with cirrhosis group， abbreviated asLD-WC group）. Preoperative liver function and general clinical data， intraoperative blood loss and transfusion， postoper-ative liver function， and complications were statistically analyzed in this study. Results The preoperative parameters of three groups were comparable. LDLT-D group experienced more intraoperative bleeding than LD-NC group 〔（765±411） mL vs. （584±242） mL， P=0.008〕， and was similar to LD-WC group 〔（666±224） mL， P=0.136〕. However， the average amount of blood transfusion products was similar among the 3 groups （P=0.108）. The levels of total bilirubin and INR of LDLT-D group were higher than LD-NC group and LD-WC group on the first and third day after operation （P＜0.05）. The levels of ALT and AST of LD-WC group were higher than LDLT-D group and LD-NC group （P＜0.05）. The overall postoperative surgical morbidity incidence of LDLT-D group， LD-NC group， and LD-WC group were 30.0%（12/40）， 27.5% （11/40）， and 37.5% （15/40） respectively， and were not statistically significant （P=0.606）. However， the ClavienⅢcomplication rate of LD-WC group was higher than LDLT-D group and LD-NC group 〔27.5% （11/40） vs. 7.5%（3/40） and 10.0% （4/40）， P=0.024〕. Conclusions Liver function of living donors is injured more seriously during the early postoperative period. The total complication rates after right hepatectomy are similar among the living liver donation and hepatic patients with or without cirrhosis. However， the serious complication rate of cirrhotic liver recipients is higher than living donors and patients without cirrhosis.
Objective To explore the safety and feasibility of using modified Glisson pedicle transection methodin the precise hepatectomy of hepatocellular carcinoma （HCC）. Methods Sixty patients with HCC， which confirmed by postoperational pathology were admitted in the study. During the surgery of experimental group （Glisson group）， the segment pedicle were transected firstly using modified Glisson pedicle transection method. Then， the liver parenchyma was split follow the hepatic vein guided by intraoperative ultrasound. During the surgery of contrast group （Prigle group），the liver parenchyma was split using ultracision harmonic scalpel under intermittent pringle clamping of hilar. Results There were no significant difference in the amount of intraoperative bleeding， blood transfusion， as well as duration of surgery， serum alanine aminotransferase， total bilirubin， and length of hospital stay between the two groups （P＞0.05）. However， the incidence of postoperative complication was lower in Glisson group （23.3% vs. 50.0%， P＜0.05）. In addition， the length of tumor margin was more favorable in Glisson group 〔（2.3±0.7） cm vs. （1.5±0.6） cm， P＜0.05〕. The recurrence rate of Glisson group was lower than that Prigle group， but was not different significantly （P＞0.05）. Conclusions The modified Glisson pedicle transection method has the same safety as traditional method in the precise hepatectomy of HCC. And it has the advantages in lower postoperative complication and more favorable tumor margin， which may reduce the recurrence rate theoretically.
ObjectiveTo evaluate the feasibility and accuracy of a novel three dimensional (3D) preoperative simulation software in a clinical setting for patients undergoing precise hepatectomy. MethodsThe clinical data of 85 patients with hepatocellular carcinoma underwent precise hepatectomy were retrospectively studied. All the patients received CT screening and subsequent evaluation on the liver resection volume and margin and the percentage of resected tumor by 3D preoperative simulation software, which compared with the actual resection liver values. The operation plan was optimized by virtual hepatectomy. ResultsThe liver, tumor as well as blood vessel could be clearly showed and reconstructed by 3D preoperative simulation software. All the patients underwent precise hepatectomy. After operation ascites occurred in 3 patients on 2 d, moderate pleural effusion occurred in 2 patients on 2 d, and bile leakage appeared in 4 patients on 5 d, which were improved by conservative treatment. The length of stay in all patients ranged from 6 to 88 d (mean 23 d), and no recurrence and death occurred within 30 d of operation. The predicted resection liver volume was significantly correlated with the actual resection volume (r=0.960, Plt;0.001), and the difference between the mean volume of predicted and actual resection liver was not significant (896.7 ml vs. 819.1 ml， t=1.851, P=0.068). In addition, the predicted resection margin was also correlated with the actual resection margin (r=0.972, Plt;0.001), with the difference in the mean resection margin was not significant too (12.2 mm vs. 11.9 mm， t=1.143, P=0.256). No patients suffered from severe postoperative complications. ConclusionsThe 3D preoperative simulation software is able to evaluate and simulate liver resection accurately, which may contribute to a safe precise hepatectomy plan.