Laparoscopic isolated liver segmentectomy 8 (ILSeg8) using the extrahepatic Glissonian approach and hepatic vein root at first parenchymal dissection may be feasible, safe, and oncologically acceptable for patients with intrahepatic cholangiocarcinoma (CCA), hepatocellular carcinoma, and metastatic liver tumors, according to a propensity score–matched study.
The results showed that patients who underwent laparoscopic ILSeg8 had significantly less blood loss and lower bilirubin levels in the serum following the operation, and stayed for less time in the hospital compared to those who had open surgery.
“In ILSeg8 for malignancy, the laparoscopic approach potentially confers short-term advantages over the open approach with comparable long-term outcomes in select patients,” the researchers wrote.
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The results were published in the journal Langenbeck’s Archives of Surgery.
Cholangiocarcinoma is a group of rare malignant tumors originating from the cells of the biliary tree. It is the second most common primary malignancy of the liver, after hepatocellular carcinoma. Treatment typically involves surgery followed by adjuvant therapy.
Read more about cholangiocarcinoma
In the present study, a team of researchers led by Ichiro Uyama, MD, FACS, of the Fujita Health University, in Toyoake, Japan, evaluated the feasibility, safety, and oncologic validity of laparoscopic ILSeg8 compared to open surgery.
The researchers analyzed a total of 64 patients, 47 of whom had hepatocellular carcinoma, 16 who had metastatic liver tumors, and 1 who had intrahepatic CCA. Among this cohort, 35 patients had open surgery, while 29 patients underwent laparoscopic ILSeg8.
The researchers analyzed patients’ short- and long-term outcomes after ILSeg8 and compared them between open surgery and laparoscopy. The surgeries were based on the extrahepatic Glissonian pedicle control before hepatectomy and then cranial-to-caudal parenchymal dissection from the hepatic vein root side.
The overall survival rates were comparable, and the recurrence-free survival rates were similar, between the 2 groups. The researchers also identified laparoscopic surgery as an independent factor for favorable overall survival.
Larger studies are necessary to better understand the impact of laparoscopic ILSeg8 on oncologic outcomes, the researchers concluded.
Reference
Kato Y, Sugioka A, Kojima M, et al. Laparoscopic isolated liver segmentectomy 8 for malignant tumors: techniques and comparison of surgical results with the open approach using a propensity score-matched study. Langenbecks Arch Surg. Published online September 14, 2022. doi:10.1007/s00423-022-02673-8
