Laparoscopic Parenchymal-Sparing Hepatectomy: the New Maximally Minimal Invasive Surgery of the Liver-a Systematic Review and Meta-Analysis.
BACKGROUND
Parenchymal-sparing hepatectomies (PSH) are liver resections with preservation of as much liver parenchyma as possible. PSH can be performed laparoscopically (LPSH), but access to the posterosuperior segments is difficult and they are challenging when there are multiple bilobar lesions; the procedure may require repositioning and may be long and cumbersome. The objective of this systematic review is to analyze the feasibility and limitations of laparoscopic PSH in the literature.


METHODS
A systematic review of the literature was performed by searching Medline/PubMed, Scopus, and Cochrane databases. Resections were categorized by segment(s), and data regarding operative time, blood loss, length of hospital stay, complications, and R0 resection were analyzed.


RESULTS
Of 351 studies screened for relevance, 48 studies were reviewed. Ten publications fulfilled inclusion criteria, reporting data from 579 patients undergoing LPSH. The most common indication was CRLM (58%) followed by hepatocellular carcinoma (16%). Only 92 patients were reported to have resections of more than one tumor; the maximum number of lesions resected was seven. Of resected lesions, 21.5% were located in the cranial segments. Mean operating time was 335.2 min, estimated blood loss was 462 cc, and hospital stay was 7.6 days. Conversion rate was 9.7%, and complications occurred in 19.4% of cases. No perioperative mortality was reported. R0 resections were achieved in 87.7% of cases.


CONCLUSION
Laparoscopic PSH is performed and reported, but the data quality is low so far. The main limitation of LPSH is the low number of lesions resected, especially for bilobar, metastatic disease. Prospective reports with tumor-specific oncological data are desirable.
['Kalil|Jennifer A|JA|0000-0001-6304-4690', 'Poirier|Jennifer|J|', 'Becker|Bjoern|B|', 'Van Dam|Robert|R|', 'Keutgen|Xavier|X|', 'Schadde|Erik|E|']
D016063:Blood Loss, Surgical D006528:Carcinoma, Hepatocellular D015179:Colorectal Neoplasms D061887:Conversion to Open Surgery D006498:Hepatectomy D006801:Humans D010535:Laparoscopy D007902:Length of Stay D008113:Liver Neoplasms D061646:Operative Time D059351:Organ Sparing Treatments D000072356:Parenchymal Tissue D011183:Postoperative Complications
Laparoscopic parenchymal-sparing hepatectomy Colorectal liver metastasis Parenchymal-sparing liver surgery