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Li W, Fang L, Huang Y. The safety and feasibility of laparoscopic anatomical left hemihepatectomy along the middle hepatic vein from the head side approach. Front Oncol 2024; 14:1368678. [PMID: 38854724 PMCID: PMC11157031 DOI: 10.3389/fonc.2024.1368678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/06/2024] [Indexed: 06/11/2024] Open
Abstract
Background Laparoscopic left hemihepatectomy (LLH) is commonly used for benign and malignant left liver lesions. We compared the benefits and drawbacks of LLH from the head side approach (LLHH) with those of conventional laparoscopic left hemihepatectomy (CLLH). This study was conducted to investigate the safety and feasibility of LLHH by comparing it with CLLH. Methods In this study, 94 patients with tumor or hepatolithiasis who underwent LLHH (n = 39) and CLLH (n = 55) between January 2016 and January 2023 were included. The preoperative features, intraoperative details, and postoperative outcomes were compared between the two groups. Results For hepatolithiasis, patients who underwent LLHH exhibited shorter operative time (p = 0.035) and less blood loss (p = 0.023) than those who underwent CLLH. However, for tumors, patients undergoing LLHH only showed shorter operative time (p = 0.046) than those undergoing CLLH. Moreover, no statistically significant differences in hospital stay, transfusion, hospital expenses, postoperative white blood cell (WBC) count, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were observed between the two groups (p > 0.05) for tumor or hepatolithiasis. For hepatocellular carcinoma (HCC), no differences in both overall survival (p = 0.532) and disease-free survival (p = 0.274) were observed between the two groups. Conclusion LLHH is a safe and feasible surgical procedure for tumors or hepatolithiasis of the left liver.
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Affiliation(s)
| | | | - Yong Huang
- Department of General Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
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You N, Wu K, Li Y, Zheng L. Intrahepatic Glisson Intrathecal Dissection via a Hepatic Parenchymal Transection-First Approach for Laparoscopic Anatomical Hemihepatectomy in Patients with Left/Right Glisson Pedicle Involvement. J Laparoendosc Adv Surg Tech A 2024; 34:257-262. [PMID: 38252558 DOI: 10.1089/lap.2023.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
Background: Because of lack of an appropriate surgical approach, laparoscopic surgery in patients with left/right Glisson pedicle involvement is still rarely conducted. This study aimed to discusses the methods of intrahepatic Glisson intrathecal dissection via a hepatic parenchymal transection-first approach for laparoscopic hemihepatectomy in patients with left/right Glisson pedicle involvement. Materials and Methods: We retrospectively analyzed the clinical data of 21 patients who underwent laparoscopic hepatectomy in the Second Affiliated Hospital, Third Military Medical University (Army Medical University) from March 2021 to May 2022. Results: The mean age of the patients was 53.1 ± 11.6 years; mean operation time, 191.9 ± 22.3 minutes; median intraoperative blood loss, 205 mL (160-300 mL); and median length of hospital stay, 8 days (7-9 days). None of the patients underwent conversion to open procedure. Thirteen patients had pathologically confirmed hepatocellular carcinoma (HCC) with portal tumor thrombi (PVTT), and 8 was confirmed hepatolithiasis. Intraoperative frozen pathology and final pathology showed tumor free surgical margins in HCC with PVTT patients. After conservative treatment, all the complications such as postoperative liver section effusion, pleural effusion, pneumonia, intra-abdomen bleeding, and bile leak were cured. During outpatient follow-up examination, no other abnormality was detected. All HCC with PVTT patients were treated with a tyrosine kinase inhibitor after the operation and survived tumor-free. Conclusions: Proposed here is a more safe and feasible method of laparoscopic hemihepatectomy in patients with left/right Glisson pedicle involvement, but many problems still needs further exploration.
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Affiliation(s)
- Nan You
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ke Wu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yongkun Li
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lu Zheng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Fan Y, Huang J, Xu L, Xu Q, Tang X, Zheng K, Hu W, Liu J, Wang J, Liu T, Liang B, Xiong H, Li W, Fu X, Fang L. Laparoscopic anatomical left hemihepatectomy guided by middle hepatic vein in the treatment of left hepatolithiasis with a history of upper abdominal surgery. Surg Endosc 2023; 37:9116-9124. [PMID: 37803187 DOI: 10.1007/s00464-023-10458-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/06/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND This study aimed to investigate the safety and efficacy of laparoscopic anatomical left hemihepatectomy guided by the middle hepatic vein (MHV) for the treatment of patients with hepatolithiasis who had a history of upper abdominal surgery. METHODS Retrospective data analysis was performed on patients who underwent laparoscopic left hepatectomy for hepatolithiasis and with previous upper abdominal surgery at the Second Affiliated Hospital of Nanchang University from January 2018 to April 2022. According to the different surgical approaches, patients were divided into laparoscopic anatomical left hepatectomy guided by the MHV group (MHV-AH group) and laparoscopic traditional anatomical left hepatectomy not guided by the MHV group (non-MHV-AH group). RESULTS This study included 81 patients, with 37 and 44 patients in the MHV-AH and non-MHV-AH groups, respectively. There was no significant difference in the basic information between the two groups. Five cases were converted to laparotomy, and the remaining were successfully completed under laparoscopy. Compared to the non-MHV-AH group, the MHV-AH group had a slightly longer operation time (319.30 min vs 273.93 min, P = 0.032), lower bile leakage rate (5.4% vs 20.5%, P = 0.047), stone residual rate (2.7% vs 20.5%, P = 0.015), stone recurrence rate (5.4% vs 22.7%, P = 0.028), and cholangitis recurrence rate (2.7% vs 22.7%, P = 0.008).There were no significant differences in the results of other observation indices between the groups. CONCLUSIONS Laparoscopic anatomical left hepatectomy guided by the MHV is safe and effective in the treatment of left hepatolithiasis with a history of upper abdominal surgery. It does not increase intraoperative bleeding and reduces the risk of postoperative bile leakage, residual stones, stone recurrence, and cholangitis recurrence.
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Affiliation(s)
- Yuting Fan
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Jian Huang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Liangzhi Xu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Qi Xu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Xinguo Tang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Kangpeng Zheng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Wei Hu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Jinghang Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Jiyang Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Tiande Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Bo Liang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Hu Xiong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Wen Li
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Xiaowei Fu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China.
| | - Lu Fang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China.
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Huang L, Lai J, Liao C, Wang D, Wang Y, Tian Y, Chen S. Classification of left-side hepatolithiasis for laparoscopic middle hepatic vein-guided anatomical hemihepatectomy combined with transhepatic duct lithotomy. Surg Endosc 2023:10.1007/s00464-023-10198-4. [PMID: 37340061 DOI: 10.1007/s00464-023-10198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/04/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Laparoscopic middle hepatic vein-guided anatomical hemihepatectomy combined with transhepatic duct lithotomy (MATL) is an approach that can substantially improve stone clearance rates while reducing the rate of postoperative biliary fistula formation, residual stone rates, and rates of recurrence. In this study, we classified left-side hepatolithiasis cases into four subtypes based upon the diseased stone-containing bile duct, the middle hepatic vein, and the right hepatic duct. We then investigated the risk associated with different subtypes and evaluated the safety and efficacy of the MATL procedure. METHODS In total, 372 patients who underwent left hemihepatectomy for left intrahepatic bile duct stones were enrolled. Based on the distribution of the stones, the cases could be divided into four types. The risk of surgical treatment was compared for the four types and the safety, short-term efficacy, and long-term efficacy of the MATL procedure in the four types of left intrahepatic bile duct stones were studied. RESULTS Type II was found to be the most likely to cause intraoperative bleeding while type III was likely to cause biliary tract damage and type IV was associated with the highest stone recurrence rate. The MATL procedure did not increase the risk of surgery and was found to reduce the rate of bile leakage, residual stones, and stone recurrence. CONCLUSION Left-side hepatolithiasis-associated risk classification is feasible and may represent a viable means of improving the safety and feasibility of the MATL procedure.
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Affiliation(s)
- Long Huang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Jianlin Lai
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Chengyu Liao
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Danfeng Wang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, China
- Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Yaodong Wang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Yifeng Tian
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, China.
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China.
| | - Shi Chen
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, China.
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China.
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