Safety and Feasibility of Laparoscopic Major Hepatectomy after Portal Vein Embolization

Abstract

Background and Aim: The operative safety and feasibility of laparoscopic major hepatectomy in patients after portal vein embolization is unknown, prompting our investigation of its safety and feasibility in patients at our center. Methods: Fifteen patients (male≤13, female≤2, with median age of 58 years), underwent laparoscopic major hepatectomy after portal vein embolization. Ten patients had hepatocellular carcinoma, two had combined hepatocellular carcinoma and cholangiocarcinoma, and 2 colorectal liver metastases, and 1 cholangiocarcinoma. Results: All patients were Child-Turcotte-Pugh score, 10 had liver fibrosis, and 10 had viral hepatitis. The median interval between portal vein embolization and laparoscopic major hepatectomy was 21 days. The median operative time was 324 min, estimated blood loss was 100 mL. White (2.5 mm) and blue (3.5 mm) cartridges were used in one patient each and Tri-Staple tan (2-3 mm) in 11 patients, and two patients required a combination of tan and purple cartridges (3-4 mm). There was one biliary leak and stricture after using a white cartridge, one transient hepatic insufficiency, and three minor complications. One patient died from a stroke on postoperative day 37. The mortality rate was 6.6% (1/15), and the morbidity rate was 33% (5/15). Conclusions: Laparoscopic major hepatectomy after portal vein embolization seems relatively safe and feasible. We advise against using a white cartridge and recommend a thicker cartridge for a more secure staple line.

References

1. 1.Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, JemalA. Global cancerstatistics2018:GLOBOCANestimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.‫‏‬
2. 2.Kim BH1, Park JW. Epidemiology of liver cancer in South Korea. Clin Mol Hepatol 2018;24:1-9.‫‏‬
3. 3.May BJ, Madoff DC. Portal vein embolization: rationale, technique, and current application. Semin Intervent Radiol 2012;29:81-89.‫‏‬
4. 4.Sarasin FP, Giostra E, Mentha G, Hadengue A. Partial hepatectomy or orthotopic liver transplantation for the treatment of resectable hepatocellular carcinoma? A cost-effectiveness perspective. Hepatology 1998;28:436-442.‫‏‬
5. 5.Belghiti J, Fuks D. Liver resection and transplantation in hepatocellular carcinoma. Liver cancer 2012;1:71-82.‫‏‬
6. 6.Rahbari NN, Garden OJ, Padbury R, Brooke-SmithM,CrawfordM,AdamR,et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 2011;149:713-724.‫‏‬
7. 7.Marengo A, Rosso C, Bugianesi E. Liver cancer: connections with obesity, fatty liver, and cirrhosis. Annu Rev Med 2016;67:103-117.‫‏‬
8. 8.Shoup M, Gonen M, D’Angelica M, Jarnagin WR, DeMatteo RP, Schwartz LH, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg 2003;7:325-330.‫‏‬
9. 9.Ribero D, Abdalla EK, Madoff DC, Donadon M, Loyer EM, Vauthey JN. Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg 2007;94:1386-1394.‫‏‬
10. 10.Makuuchi M, Thai BL, Takayasu K, Takayama T, Kosuge T, Gunvén P. Preoperative portal embolization to increase 14 Majmaah Journal of Health Sciences ,Vol. 9, Issue 1, January - 2021, Jumadi ulAwwal - 1442 Safety and Feasibility of Laparoscopic Major Hepatectomy after Portal Vein Embolization safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 1990;107:521-527.
11. 11.Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, et al. The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg 2009;250:825-830.
12. 12.Tranchart H, Di Giuro G, Lainas P, Roudie J, Agostini H, Franco D, et al. Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 2010;24:1170-1176.
13. 13.Fuks D, Cauchy F, Ftériche S, Nomi T, Schwarz L, Dokmak S, et al. Laparoscopy decreases pulmonary complications in patients undergoing major liver resection: a propensity score analysis.Ann Surg 2016;263:353-361.
14. 14.Orcutt ST, Kobayashi K, Sultenfuss M, Hailey BS, SparksA, Satpathy B, et al. Portal vein embolization as an oncosurgical strategy prior to major hepatic resection: anatomic, surgical, and technical considerations. Front Surg 2016;3:14.‫‏‬
15. 15.Vauthey JN, Chaoui A, Do KA, Bilimoria MM, Fenstermacher MJ, Charnsangavej C, et al. Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery 2000;127:512-519.
16. 16.Kishi Y, Abdalla EK, Chun YS, Zorzi D, Madoff DC, Wallace MJ, et al. Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Ann Surg 2009;250:540-548.
17. 17.Chekan, E., & Whelan, R. L. (2014). Surgical stapling device–tissue interactions: what surgeons need to know to improve patient outcomes. Medical Devices (Auckland, NZ), 7, 305
18. 18.Komatsu S, Brustia R, Goumard C, Perdigao F, Soubrane O, Scatton O. Laparoscopic versus open major hepatectomy for hepatocellular carcinoma: a matched pair analysis. Surg Endosc 2016;30:1965-1974.‫‏‬
19. 19.Yan Y, Cai X, Geller DA. Laparoscopic liver resection: a review of current status. J Laparoendosc Adv Surg Tech A 2017;27:481-486.‫‏‬
20. 20.Ratti F, Cipriani F, Ariotti R, Giannone F, Paganelli M, Aldrighetti L. Laparoscopic major hepatectomies: cur- Majmaah Journal of Health Sciences ,Vol. 9, Issue 1, January - 2021, Jumadi ulAwwal - 1442 15 Safety and Feasibility of Laparoscopic Major Hepatectomy after Portal Vein Embolization rent trends and indications. A comparison with the open technique. Updates Surgery 2015;67:157-167.‫‏‬
21. 21.Snyder RA, Ewing JA, Parikh AA. Preoperative portal vein embolization is notassociatedwithincreasedpostoperative complications after major hepatectomy: a study of the National Surgical Quality Improvement Database. J Gastrointest Surg 2019.‫‏‬ doi: 10.1007/s11605-019-04313-x. doi:10.1007/s11605-019-04313-x
22. 22.ChanA, Zhang WY, Chok K, Dai J, Ji R,KwanC,etal.ALPPSversusportalvein embolization for hepatitis-related hepatocellular carcinoma: a changing paradigm in modulation of future liver remnant before major hepatectomy. Ann Surg 2019. doi: 10.1097/SLA.0000000000003433.‫‏‬ doi:10.1097/SLA.0000000000003433.‫‏‬
23. 23.Esposito F, Lim C, Lahat E, Shwaartz C, Eshkenazy R, Salloum C, et al. Combined hepatic and portal vein embolization as preparation for major hepatectomy: a systematic review. HPB (Oxford) 2019;21:1099-1106.