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Results of minor and major hepatectomies by laparoscopy

Results of minor and major hepatectomies by laparoscopy. Brice Gayet, Vibert E, Kouider A. Department of digestive pathology Montsouris Institute, Paris, France. RISKS OF LAP’ HEPATECTOMY. Exploration in malignancy. Hemorrhage. Respect of abdominal wall. Poor exploration.

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Results of minor and major hepatectomies by laparoscopy

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  1. Results of minor and major hepatectomies by laparoscopy Brice Gayet, Vibert E, Kouider A Department of digestive pathology Montsouris Institute, Paris, France

  2. RISKS OF LAP’ HEPATECTOMY Exploration in malignancy Hemorrhage Respect of abdominal wall Poor exploration Post-operative adhesions Gas embolism Immunological benefice ? Technologyand specific materials Interface for computer Progressive and specific learning Benefice and controversial Resection without reconstruction Malignancy Hepato-biliary surgeon SURGERY OF THE LIVER

  3. Laparoscopic ultrasonography Parenchymal section devices Bipolar forceps Voice-controlled robot for camera 131 Lap’ liver surgery 40 “easy” or resection < 3cm 53 Minor hepatectomies (≤ 2 segments) 38 Major hepatectomies (> 2 segments) Technologies and experiences

  4. FNH 9 Others 7 19 diagnostic resections Benign lesions Adenoma 3 24 5 resections for symptoms 43 colo-rectal metastases (CRM) Malignant lesions 16 hepatocellular carcinomas (HCC) 67 3 neuroendocrine metastases 5 non neuroendoc non crm Materials and Methods 91 Hepatectomies in 86 patients (5 re-hepatectomies) Sex Ratio : M/F 1.3 – Median Age : 55 years (23-85)

  5. 28 Wedge resections in all segments 2 1 7 1 1 2 4 7 53 Minor Hepatectomies 25 Anatomical hepatectomies (All segments excepted IVa)

  6. 3 27 1 4 38 Major hepatectomies Plus 3 trisegmentectomies (II+III+IVb, V+VI+VII, V+VI+IVb

  7. 7 Conversions (4 for hemorrhage) Duration: 5.5 hours (180-515) Mortality: 1 death at day 8 postop Morbidity: 11/38 (28%) 38 Major resections 7 Major lap’ associated procedures 5 Conversions (0 for hemorrhage) Duration: 2.5 hours (60-390) Morbidity: 8/53 (15%) 53 Minor resections Post-operative results 24 laparoscopic associated procedures Morbidity : Abscess (n=2) - Biliary leak (reintervention) (n=1) - Hemorrhage (n=1†) – Hematoma (n=2) - Postoperative ileus (n=1) -Stroke (n=1) – Pleural effusion (n=2) Morbidity : Biliary leak (reintervention) (n=2) – Hemorrhage (reintervention) (n=1) – Stump hematoma (n=2) – Liver abscess (n=1) – Abdominal abscess (n=2) Transfusion: 8/91 patients (2 minor – 6 major)

  8. 97% 8 RECURRENCES 3 intra-hepatic 74% 87% 51% 5 re-hepatectomies Results in CRM (n=43 in 38 pat) 18 Metachronous / 19 Synchronous / 1 Recurrences 5 Lap’ re-hepatectomies: Two steps (n=2) / Recurrence (n=2) Mean number: 2 (1-4) / Mean diameter: 3 cm (1-12) Associated lap’ colorectal resection: 7 patients 100% 100% 80% 80% 60% 60% 40% 40% Overall survival DFS 20% 20% 0 10 20 30 40 50 60 0 10 20 30 40 50 60 Mean Follow-up: 30 months

  9. 85% 76% 66% 68% Results in HCC (n=16) Cirrhotic liver (n=7) Single nodule (n=14/15) Mean diameter 6.5 cm (1-18) 100% 100% 80% 80% 60% 60% 40% 40% Disease free survival Overall survival 20% 20% 10 20 30 40 50 60 10 20 30 40 50 60 0 0 Mean Follow-up: 40 months

  10. Conclusions This study suggests : • Minor laparoscopic hepatectomies are feasible and safe for almost all hepatic segments • Major laparoscopic hepatectomies are feasible but remain a demanding procedure which require a long training • Prognosis of liver malignant tumors does not seem to be modified by laparoscopic approach

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