title: Clinical impact of laparoscopic hepatectomy: technical and oncological viewpoints.
abstract: The objective of this study was to assess the clinical impact of laparoscopic hepatectomy from technical and oncological viewpoints through the consecutive 5-year experience of an expert team. The subjects consisted of 491 consecutive hepatectomies performed over the course of 5 years. A total of 190 hepatectomies (38.6 %) were performed laparoscopically, and the remaining 301 (61.4 %) were open hepatectomies. Chronological trends of operative procedures and their indications were evaluated, and patients with hepatocellular carcinoma (HCC) were analyzed from an oncological viewpoint. The proportion of laparoscopic hepatectomies performed increased significantly during the study period (from 17.6 to 49.5 %). According to chronological trends, right hepatectomy was standardized using consecutive steps after minor hepatectomy, left lateral sectionectomy, and left hepatectomy were standardized. The proportion of laparoscopic hepatectomies performed for HCC increased from 21.4 to 71.0 %. No significant difference was observed in the proportion of major hepatectomies performed for HCC between the open and laparoscopy groups (50.6 vs. 48.6 %, p = 0.8053), whereas that of anatomical segmentectomy for HCC was significantly lower in the laparoscopy group (28.7 vs. 11.1 %, p = 0.0064). All laparoscopic anatomical segmentectomies were of segments 5 and 6, and there was no segmentectomy of posterosuperior lesions. The present study shows the consecutive technical developmental processes for minor hepatectomy, left lateral sectionectomy, left hepatectomy, and right hepatectomy without compromising oncological principles. Laparoscopic anatomical segmentectomy for posterosuperior lesions may be the most technically demanding procedure, requiring individualized standardization.
authors: Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
authors: Shohei
authors: S
authors: Komatsu
authors: Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
authors: Raffaele
authors: R
authors: Brustia
authors: Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
authors: Claire
authors: C
authors: Goumard
authors: Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Hopital Beaujon, Université Paris VII, Clichy Cedex, France.
authors: Ailton
authors: A
authors: Sepulveda
authors: Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
authors: Fabiano
authors: F
authors: Perdigao
authors: Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Hopital Beaujon, Université Paris VII, Clichy Cedex, France.
authors: Olivier
authors: O
authors: Soubrane
authors: Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. olivier.scatton@psl.aphp.fr.
authors: Olivier
authors: O
authors: Scatton
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000639:trends; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000379:methods / Q000639:trends; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anatomical segmentectomy; Hepatocellular carcinoma; Laparoscopic hepatectomy; Left lateral sectionectomy; Major hepatectomy; Standardization