Jennifer A Kalil, MD, Erik Schadde, MD, FACS, FEBS. Rush University Medical Center
Introduction: Liver resection with preservation of as much liver parenchyma as possible is called parenchymal sparing hepatectomy (PSH). PSH has been shown to improve overall survival by increasing the re-resection rate in patients with colorectal liver metastases (CRLM) and recurrence. The caudal-cranial perspective in laparoscopy makes the cranial segments (2, 4a, 7, and 8) more difficult to access. The objective of this systematic review is to analyze feasibility, safety, morbidity, and oncologic outcomes of laparoscopic PSH.
Methods: A systematic review of the literature was performed. Medline/PubMed, Scopus, and Cochrane databases were searched. A search strategy was published with the PROSPERO registry. A systematic review was conducted on all cases reported, they were categorized by area of resection and quantitative meta-analysis of operative time, blood loss, length of hospital stay, complications, and R0 resection was performed.
Results: Of the 351 studies screened for relevance, 48 studies were selected. Because interventions or endpoints were noncontributory or reporting incomplete, 38 were excluded. Only 10 publications remained, reporting data from 579 patients who underwent laparoscopic PSH. The highest Oxford evidence level was 2b and selective reporting bias was common due to single center and non-controlled reports. Among them, 132 (21.5%) resections were in the cranial segments 2 (1.1%), 4a (5.2%), 7 (6%), and 8 (9.1%), which previously would have required laparoscopic hemi-hepatectomies or sectorectomies. The most common tumor type was CRLM (58%) and the second most common tumor type was hepatocellular carcinoma (16%). Feasibility of laparoscopic PSH was 93%, conversion rate was 7%, and complications were seen in 17% of cases. No perioperative mortality was reported. No standardized reporting format for complications was used across studies. Meta-analysis revealed a weighted average operating time of 385 minutes, estimated blood loss of 463 cc, and length of stay of 8 days. R0 resections were achieved in 91% of cases.
Conclusion: Laparoscopic PSH of difficult to reach liver tumors are feasible with acceptable conversion and complication rate, but relatively long operating times and relatively high blood loss. In future studies, data on long term survival and specific tumor type recurrence should be reported and bias reduced.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86327
Program Number: P537
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster