title: Laparoscopic left hemihepatectomy a consideration for acceptance as standard of care.
abstract: BACKGROUND
  Since the inception of laparoscopic liver surgery, the left-lateral sectionectomy has become the standard of care for resection of lesions located in segments II and III. However, few centers employee laparoscopic left hemihepatectomy on a routine basis. This study evaluated the safety and efficacy of the laparoscopic left hemihepatectomy as a standard of care.
  
  
  METHODS
  An international database of 1,620 laparoscopic liver resections was established and outcomes analyzed comparing the laparoscopic left lateral sectionectomy (L lat) to laparoscopic left hemihepatectomy (LH). All data are presented as mean ± standard deviation.
  
  
  RESULTS
  A total of 222 laparoscopic L lat and 82 LH were identified. The L lat group compared with LH group had a higher incidence of cirrhosis (27 vs. 21 %; p = 0.003) and cancer (48 vs. 35 %; p = 0.043). Tumors were larger in the LH group (7.09 ± 4.2 vs. 4.89 ± 3.1 cm; p = 0.001). Operating time for LH was longer than L lat (3.9 ± 2.3 vs. 2.9 ± 1.4 h; p < 0.001). Operative blood loss was higher in LH (306 vs. 198 cc; p = 0.003). Patient morbidity (20 vs. 18 %; p = 0.765) was equivalent with a longer length of stay (7.1 ± 5.1 vs. 2.5 ± 2.3 days; p < 0.001) for LH. Patient mortality and tumor recurrence were equivalent.
  
  
  CONCLUSIONS
  Laparoscopic left hemihepatectomy is a more technically challenging and often time-consuming procedure than a left-lateral sectionectomy. This international multi-institutional confirmed that intraoperative blood loss, complications, and conversions are more than acceptable for laparoscopic left hemihepatectomy in expert hands. Postoperative morbidity and mortality rates together with adequate surgical margins and long-term recurrence are not compromised by the laparoscopic approach.
authors: S. Maria Loreto Nuovo Hospital, General and Hepato-Pancreato-Biliary Surgery, Naples, Italy. chirurgia.loretonuovo@tin.it
authors: Giulio
authors: G
authors: Belli
authors: Brice
authors: B
authors: Gayet
authors: Ho-Seong
authors: HS
authors: Han
authors: Go
authors: G
authors: Wakabayashi
authors: Ki-Hun
authors: KH
authors: Kim
authors: Robert
authors: R
authors: Cannon
authors: Hironori
authors: H
authors: Kaneko
authors: Thomas
authors: T
authors: Gamblin
authors: Alan
authors: A
authors: Koffron
authors: Ibrahim
authors: I
authors: Dagher
authors: Joseph F
authors: JF
authors: Buell
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods* / Q000592:standards*; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000592:standards*; D008103:Liver Cirrhosis / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D059039:Standard of Care; D016896:Treatment Outcome