PMID- 25159116
OWN - NLM
STAT- MEDLINE
DCOM- 20150611
LR  - 20211021
IS  - 1432-2323 (Electronic)
IS  - 0364-2313 (Linking)
VI  - 38
IP  - 12
DP  - 2014 Dec
TI  - Laparoscopic major hepatectomies: clinical outcomes and classification.
PG  - 3169-74
LID - 10.1007/s00268-014-2724-7 [doi]
AB  - BACKGROUND: According to the Louisville Statement, laparoscopic major hepatectomy 
      is a heterogeneous category that includes "traditional" 
      trisectionectomies/hemi-hepatectomies and the technically challenging resection 
      of segments 4a, 7, and 8. The aims of this study were to assess differences in 
      clinical outcomes between laparoscopic "traditional" major hepatectomy and 
      resection of "difficult-to-access" posterosuperior segments and to define whether 
      the current classification is clinically valid or needs revision. METHODS: We 
      reviewed a prospectively collected single-center database of 390 patients 
      undergoing pure laparoscopic liver resection. A total of 156 patients who had 
      undergone laparoscopic major hepatectomy according to the Louisville Statement 
      were divided into two subcategories: laparoscopic "traditional" major hepatectomy 
      (LTMH), including hemi-hepatectomies and trisegmentectomies, and laparoscopic 
      "posterosuperior" major hepatectomy (LPMH), including resection of 
      posterosuperior segments 4a, 7, and 8. LTMH and LPMH subgroups were compared with 
      respect to demographics, intraoperative variables, and postoperative outcomes. 
      RESULTS: LTMH was performed in 127 patients (81 %) and LPMH in 29 (19 %). 
      Operation time was a median 330 min for LTMH and 210 min for LPMH (p < 0.0001). 
      Blood loss was a median 500 ml for LTMH and 300 ml for LPMH (p = 0.005). 
      Conversion rate was 9 % for LTMH and nil for LPMH (p = 0.219). In all, 28 
      patients (22 %) developed postoperative complications after LTMH and 5 (17 %) 
      after LPMH (p = 0.801). Mortality rate was 1.6 % after LTMH and nil after LPMH. 
      Hospital stay was a median 5 days after LTMH and 4 days after LPMH (p = 0.026). 
      CONCLUSIONS: The creation of two subcategories of laparoscopic major hepatectomy 
      seems appropriate to reflect differences in intraoperative and postoperative 
      outcomes between LTMH and LPMH.
FAU - Di Fabio, Francesco
AU  - Di Fabio F
AD  - Department of Hepato-Biliary and Pancreatic Surgery, University Hospital 
      Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK, 
      difabiof@hotmail.it.
FAU - Samim, Morsal
AU  - Samim M
FAU - Di Gioia, Paolo
AU  - Di Gioia P
FAU - Godeseth, Rosemary
AU  - Godeseth R
FAU - Pearce, Neil W
AU  - Pearce NW
FAU - Abu Hilal, Mohammed
AU  - Abu Hilal M
LA  - eng
PT  - Journal Article
PL  - United States
TA  - World J Surg
JT  - World journal of surgery
JID - 7704052
SB  - IM
MH  - Aged
MH  - Blood Loss, Surgical
MH  - Conversion to Open Surgery
MH  - Databases, Factual
MH  - Female
MH  - Hepatectomy/adverse effects/*classification/mortality
MH  - Humans
MH  - Laparoscopy/adverse effects/*classification/mortality
MH  - Length of Stay
MH  - Liver Diseases/*surgery
MH  - Male
MH  - Middle Aged
MH  - Operative Time
MH  - Retrospective Studies
EDAT- 2014/08/28 06:00
MHDA- 2015/06/13 06:00
CRDT- 2014/08/28 06:00
PHST- 2014/08/28 06:00 [entrez]
PHST- 2014/08/28 06:00 [pubmed]
PHST- 2015/06/13 06:00 [medline]
AID - 10.1007/s00268-014-2724-7 [doi]
PST - ppublish
SO  - World J Surg. 2014 Dec;38(12):3169-74. doi: 10.1007/s00268-014-2724-7.