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Laparoscopic right hepatectomy combined with partial diaphragmatic resection for colorectal liver metastases: Is it feasible and reasonable?
E-HPBA: Poster Abstracts (25.0e29.9 kg/m2) and obese (30.0 kg/m2). These 3 groups were compared in terms of demographic data, intraoperative factors, and postoperative outcomes. Logistic regression was used to determine odd ratios with 95% confidence intervals and evaluate BMI as an independent risk factor for morbidity. Results: Among 228 selected patients, 83 (36.4%) patients were overweight and 32 (14.0%) were obese. Despite higher rates of diabetes mellitus, hypertension and ischemic heart disease with an increase of BMI, no significant difference in operative time, blood loss and conversion rate was observed in the 3 groups. There were no significant differences in postoperative mortality rate between the groups (0.9% vs. 1.2% vs. 0%). The rate of overall complications (31.0% vs. 31.3% vs. 40.6%) and major complications (14.2% vs. 9.6% vs. 18.8%) did not differ in the three groups. Major hepatectomy (HR: 6.810, CI; 1.437e 32.267, p = 0.016) and operative time >180 min (HR: 2.639, CI; 1.179e5.908, p = 0.018) were independently associated with postoperative complications. Conclusions: The present study demonstrated that BMI does not negatively affect the postoperative short-term outcomes. Therefore, obesity and overweight should not be a contraindication for LLR.
LIVER 0370 LAPAROSCOPIC RIGHT HEPATECTOMY COMBINED WITH PARTIAL DIAPHRAGMATIC RESECTION FOR COLORECTAL LIVER METASTASES: IS IT FEASIBLE AND REASONABLE? D. Fuks, P. Lainas, A. Camerlo, C. Conrad and B. Gayet Institut Mutualiste Montsouris, France Aims: The impact of diaphragmatic invasion in patients with colorectal liver metastases (CRLM) remains poorly evaluated. We aimed to evaluate feasibility and safety of laparoscopic right hepatectomy (LRH) with or without diaphragmatic resection for CRLM. Methods: From 2002 to 2012, 52 patients underwent LRH for CRLM. Of them, 7 patients had combined laparoscopic partial diaphragmatic resection (‘diaphragm’ group). Data were retrospectively collected and short and long-term outcomes analyzed. Results: Operative time was lower in the control group (272 vs. 345 min, p = 0.06). Six patients required conversion to open surgery. Blood loss and transfusion rate were similar. Portal triad clamping was used more frequently in the ‘diaphragm’ group (42.8% vs. 6.6%, p = 0.02). Maximum tumor size was significantly greater in the ‘diaphragm’ group (74.5 vs. 37.1 mm, p = 0.002). Resection margin was negative in all cases. Mortality was nil and general morbidity similar in the two groups. Specific liverrelated complications occurred in two patients in the ‘diaphragm’ group and 17 in the control group (p = 0.69). Mean hospital stay was similar (p = 0.56). Twenty-two (42.3%) patients experienced recurrence. One-, 3- and 5-year overall survival after surgery in ‘diaphragm’ and control groups were 69%, 34%, 34% and 97%, 83%, 59%, respectively (p = 0.103). One- and 3-year disease-free survival after surgery in ‘diaphragm’ and control groups were 57%, 47% and 75%, 54%, respectively (p = 0.310). HPB 2016, 18 (S2), e685ee738
e699
Conclusions: LRH with en-bloc diaphragmatic resection could be reasonably performed for selected patients in expert centers. Technical difficulties related to diaphragmatic invasion must be circumvented. Further experience must be gained to confirm our results.
LIVER 0371 3D VISUALIZATION REDUCES OPERATING TIME WHEN COMPARED TO HIGH-DEFINITION 2D IN LAPAROSCOPIC LIVER RESECTION: A CASE MATCHED STUDY D. Fuks, V. Velayutham, T. Nomi, Y. Kawaguchi and B. Gayet Institut Mutualiste Montsouris, France Aims: Major limitations of conventional laparoscopy are lack of depth perception and tactile feedback. Introduction of robotic technology, which employs 3D imaging, has removed only one of these technical obstacles. Despite the significant advantages claimed, 3D systems have not been widely accepted. The aim was to evaluate the effect of three-dimensional (3D) visualization on operative performance during elective laparoscopic liver resection (LLR). Methods: In this single institutional study, 20 patients undergoing LLR by high definition 3D laparoscope between April 2014 and August 2014 were matched to a retrospective control group of patients who underwent LLR by two-dimensional (2D) laparoscope. Results: The number of patients who underwent major liver resection was 5(25%) in the 3D group and 10(25%) in the 2D group. There was no significant difference in contralateral wedge resection, or combined resections between the 3D and 2D groups. There was no difference in the proportion of patients undergoing previous abdominal surgery (70 vs. 77%, p = 0.523) or previous hepatectomy (20 vs. 27.5%, p = 0.75). The operative time was significantly shorter in the 3D group when compared to 2D (225109 min vs. 28471 min, p = 0.03). The amount of blood loss in the 3D group was lesser than the 2D group though this did not attain statistical significance. (204 226 ml in 3D and 252 349 ml in 2D group, p = 0.29). The major complication rates were similar, 5% (1/20) and 7.5% (3/40) respectively (p 0.99). Conclusions: High definition (HD) 3D visualization reduces operating time when compared to 2D HD in laparoscopic Liver resection.
LIVER 0384 ASPECTS ON DETAILED VOLUMETRIC ANALYSIS AFTER PORTAL VEIN EMBOLIZATION E. Sparrelid, T. Brismar, L. Lundell and B. Isaksson Karolinska University Hospital, Sweden Aims: The primary aim of this study was to assess regional differences in hypertrophy of the liver after portal vein embolization (PVE). The secondary endpoint was to evaluate predictive factors for growth of future liver remnant (FLR) after PVE. Finally, this study compared different variables used to describe the size of FLR.
LIVER 0370 LAPAROSCOPIC RIGHT HEPATECTOMY COMBINED WITH PARTIAL DIAPHRAGMATIC RESECTION FOR COLORECTAL LIVER METASTASES: IS IT FEASIBLE AND REASONABLE? D. Fuks, P. Lainas, A. Camerlo, C. Conrad and B. Gayet Institut Mutualiste Montsouris, France Aims: The impact of diaphragmatic invasion in patients with colorectal liver metastases (CRLM) remains poorly evaluated. We aimed to evaluate feasibility and safety of laparoscopic right hepatectomy (LRH) with or without diaphragmatic resection for CRLM. Methods: From 2002 to 2012, 52 patients underwent LRH for CRLM. Of them, 7 patients had combined laparoscopic partial diaphragmatic resection (‘diaphragm’ group). Data were retrospectively collected and short and long-term outcomes analyzed. Results: Operative time was lower in the control group (272 vs. 345 min, p = 0.06). Six patients required conversion to open surgery. Blood loss and transfusion rate were similar. Portal triad clamping was used more frequently in the ‘diaphragm’ group (42.8% vs. 6.6%, p = 0.02). Maximum tumor size was significantly greater in the ‘diaphragm’ group (74.5 vs. 37.1 mm, p = 0.002). Resection margin was negative in all cases. Mortality was nil and general morbidity similar in the two groups. Specific liverrelated complications occurred in two patients in the ‘diaphragm’ group and 17 in the control group (p = 0.69). Mean hospital stay was similar (p = 0.56). Twenty-two (42.3%) patients experienced recurrence. One-, 3- and 5-year overall survival after surgery in ‘diaphragm’ and control groups were 69%, 34%, 34% and 97%, 83%, 59%, respectively (p = 0.103). One- and 3-year disease-free survival after surgery in ‘diaphragm’ and control groups were 57%, 47% and 75%, 54%, respectively (p = 0.310). HPB 2016, 18 (S2), e685ee738
e699
Conclusions: LRH with en-bloc diaphragmatic resection could be reasonably performed for selected patients in expert centers. Technical difficulties related to diaphragmatic invasion must be circumvented. Further experience must be gained to confirm our results.
LIVER 0371 3D VISUALIZATION REDUCES OPERATING TIME WHEN COMPARED TO HIGH-DEFINITION 2D IN LAPAROSCOPIC LIVER RESECTION: A CASE MATCHED STUDY D. Fuks, V. Velayutham, T. Nomi, Y. Kawaguchi and B. Gayet Institut Mutualiste Montsouris, France Aims: Major limitations of conventional laparoscopy are lack of depth perception and tactile feedback. Introduction of robotic technology, which employs 3D imaging, has removed only one of these technical obstacles. Despite the significant advantages claimed, 3D systems have not been widely accepted. The aim was to evaluate the effect of three-dimensional (3D) visualization on operative performance during elective laparoscopic liver resection (LLR). Methods: In this single institutional study, 20 patients undergoing LLR by high definition 3D laparoscope between April 2014 and August 2014 were matched to a retrospective control group of patients who underwent LLR by two-dimensional (2D) laparoscope. Results: The number of patients who underwent major liver resection was 5(25%) in the 3D group and 10(25%) in the 2D group. There was no significant difference in contralateral wedge resection, or combined resections between the 3D and 2D groups. There was no difference in the proportion of patients undergoing previous abdominal surgery (70 vs. 77%, p = 0.523) or previous hepatectomy (20 vs. 27.5%, p = 0.75). The operative time was significantly shorter in the 3D group when compared to 2D (225109 min vs. 28471 min, p = 0.03). The amount of blood loss in the 3D group was lesser than the 2D group though this did not attain statistical significance. (204 226 ml in 3D and 252 349 ml in 2D group, p = 0.29). The major complication rates were similar, 5% (1/20) and 7.5% (3/40) respectively (p 0.99). Conclusions: High definition (HD) 3D visualization reduces operating time when compared to 2D HD in laparoscopic Liver resection.
LIVER 0384 ASPECTS ON DETAILED VOLUMETRIC ANALYSIS AFTER PORTAL VEIN EMBOLIZATION E. Sparrelid, T. Brismar, L. Lundell and B. Isaksson Karolinska University Hospital, Sweden Aims: The primary aim of this study was to assess regional differences in hypertrophy of the liver after portal vein embolization (PVE). The secondary endpoint was to evaluate predictive factors for growth of future liver remnant (FLR) after PVE. Finally, this study compared different variables used to describe the size of FLR.