BACKGROUND Radical resection offers the only hope for the long-term survival of patients with gallbladder carcinoma(GBC)above the T1b stage.However,whether it should be performed under laparoscopy for GBC is still con...BACKGROUND Radical resection offers the only hope for the long-term survival of patients with gallbladder carcinoma(GBC)above the T1b stage.However,whether it should be performed under laparoscopy for GBC is still controversial.AIM To compare laparoscopic radical resection(LRR)with traditional open radical resection(ORR)in managing GBC.METHODS A comprehensive search of online databases,including Medline(PubMed),Cochrane Library,and Web of Science,was conducted to identify comparative studies involving LRR and ORR in GBCs till March 2023.A meta-analysis was subsequently performed.RESULTS A total of 18 retrospective studies were identified.In the long-term prognosis,the LRR group was comparable with the ORR group in terms of overall survival and tumor-free survival(TFS).LRR showed superiority in terms of TFS in the T2/tumor-node-metastasis(TNM)Ⅱstage subgroup vs the ORR group(P=0.04).In the short-term prognosis,the LRR group had superiority over the ORR group in the postoperative length of stay(POLS)(P<0.001).The sensitivity analysis showed that all pooled results were robust.CONCLUSION The meta-analysis results show that LRR is not inferior to ORR in all measured outcomes and is even superior in the TFS of patients with stage T2/TNMⅡdisease and POLS.Surgeons with sufficient laparoscopic experience can perform LRR as an alternative surgical strategy to ORR.展开更多
Background： Laparoscopic liver resection has become an accepted treatment for liver tumors or intrahepatic bile duct stones, but its application in patients with previous upper abdominal surgery is controversial.The ...Background： Laparoscopic liver resection has become an accepted treatment for liver tumors or intrahepatic bile duct stones, but its application in patients with previous upper abdominal surgery is controversial.The aim of this study was to evaluate the feasibility and safety of laparoscopic hepatectomy in these patients.Methods： Three hundred and thirty-six patients who underwent laparoscopic hepatectomy at our hospital from March 2012 to June 2015 were enrolled in the retrospective study.They were divided into two groups： Those with previous upper abdominal surgery （PS group, n =42） and a control group with no previous upper abdominal surgery （NS group, n =294）.Short-term outcomes including operating time, blood loss, hospital stay, morbidity, and mortality were compared among the groups.Results： There was no significant difference in median operative duration between the PS group and the NS group （180 min vs.160 min, P =0.869）.Median intraoperative blood loss was same between the PS group and the control group （200 ml vs.200 ml, P =0.907）.The overall complication rate was significantly lower in the NS group than in the PS group （17.0% vs.31.0%, P =0.030）.Mortality and other short-term outcomes did not differ significantly between groups.Conclusions： Our study showed no significant difference between the PS group and NS group in term of short-term outcomes.Laparoscopic hepatectomy is a feasible and safe procedure for patients with previous upper abdominal surgery.展开更多
Objective： The liver hanging maneuver （LHM） is rarely applied in laparoscopic right hepatectomy （LRH） because of the difficulty encountered in retrohepatic tunnel （RT） dissection and tape positioning. Thus far ...Objective： The liver hanging maneuver （LHM） is rarely applied in laparoscopic right hepatectomy （LRH） because of the difficulty encountered in retrohepatic tunnel （RT） dissection and tape positioning. Thus far no report has detailed how to quickly and easily establish RT for laparoscopic LHM in LRH, nor has employment of the Goldfinger dissector to create a total RT been reported. This study＇s aim was to evaluate the safety and feasibility of establishing RT for laparoscopic LHM using the Goldfinger dissector in LRH. Methods： Between March 2015 and July 2015, five consecutive patients underwent LRH via the caudal approach with laparoscopic LHM. A five-step strategy using the Goldfinger dissector to establish RT for laparoscopic LHM was adopted. Perioperative data were analyzed. Results： The median age of patients was 58 （range, 51-65） years. Surgery was performed for one intrahepatic lithiasis and four hepatocellular carcinomas with a median size of 90 （40-150） mm. The median operative time was 320 （282-358） min with a median blood loss of 200 （200-600） ml. Laparoscopic LHM was achieved in a median of 31 （21-62） min, and the median postoperative hospital stay was 14 （9-16） d. No transfusion or conversion was required, and no severe liver-related morbidity or death was observed. Conclusions： The Goldfinger dissector is a useful instrument for the establishment of RT. A five-step strategy using the Goldfinger dissector can quickly and easily facilitate an RT for a laparoscopic LHM in LRH.展开更多
文摘BACKGROUND Radical resection offers the only hope for the long-term survival of patients with gallbladder carcinoma(GBC)above the T1b stage.However,whether it should be performed under laparoscopy for GBC is still controversial.AIM To compare laparoscopic radical resection(LRR)with traditional open radical resection(ORR)in managing GBC.METHODS A comprehensive search of online databases,including Medline(PubMed),Cochrane Library,and Web of Science,was conducted to identify comparative studies involving LRR and ORR in GBCs till March 2023.A meta-analysis was subsequently performed.RESULTS A total of 18 retrospective studies were identified.In the long-term prognosis,the LRR group was comparable with the ORR group in terms of overall survival and tumor-free survival(TFS).LRR showed superiority in terms of TFS in the T2/tumor-node-metastasis(TNM)Ⅱstage subgroup vs the ORR group(P=0.04).In the short-term prognosis,the LRR group had superiority over the ORR group in the postoperative length of stay(POLS)(P<0.001).The sensitivity analysis showed that all pooled results were robust.CONCLUSION The meta-analysis results show that LRR is not inferior to ORR in all measured outcomes and is even superior in the TFS of patients with stage T2/TNMⅡdisease and POLS.Surgeons with sufficient laparoscopic experience can perform LRR as an alternative surgical strategy to ORR.
文摘Background： Laparoscopic liver resection has become an accepted treatment for liver tumors or intrahepatic bile duct stones, but its application in patients with previous upper abdominal surgery is controversial.The aim of this study was to evaluate the feasibility and safety of laparoscopic hepatectomy in these patients.Methods： Three hundred and thirty-six patients who underwent laparoscopic hepatectomy at our hospital from March 2012 to June 2015 were enrolled in the retrospective study.They were divided into two groups： Those with previous upper abdominal surgery （PS group, n =42） and a control group with no previous upper abdominal surgery （NS group, n =294）.Short-term outcomes including operating time, blood loss, hospital stay, morbidity, and mortality were compared among the groups.Results： There was no significant difference in median operative duration between the PS group and the NS group （180 min vs.160 min, P =0.869）.Median intraoperative blood loss was same between the PS group and the control group （200 ml vs.200 ml, P =0.907）.The overall complication rate was significantly lower in the NS group than in the PS group （17.0% vs.31.0%, P =0.030）.Mortality and other short-term outcomes did not differ significantly between groups.Conclusions： Our study showed no significant difference between the PS group and NS group in term of short-term outcomes.Laparoscopic hepatectomy is a feasible and safe procedure for patients with previous upper abdominal surgery.
基金Project supported by the General Research Project of Medicine and Science of Zhejiang Province(Nos.2014KYB119 and 2015KYB221),China
文摘Objective： The liver hanging maneuver （LHM） is rarely applied in laparoscopic right hepatectomy （LRH） because of the difficulty encountered in retrohepatic tunnel （RT） dissection and tape positioning. Thus far no report has detailed how to quickly and easily establish RT for laparoscopic LHM in LRH, nor has employment of the Goldfinger dissector to create a total RT been reported. This study＇s aim was to evaluate the safety and feasibility of establishing RT for laparoscopic LHM using the Goldfinger dissector in LRH. Methods： Between March 2015 and July 2015, five consecutive patients underwent LRH via the caudal approach with laparoscopic LHM. A five-step strategy using the Goldfinger dissector to establish RT for laparoscopic LHM was adopted. Perioperative data were analyzed. Results： The median age of patients was 58 （range, 51-65） years. Surgery was performed for one intrahepatic lithiasis and four hepatocellular carcinomas with a median size of 90 （40-150） mm. The median operative time was 320 （282-358） min with a median blood loss of 200 （200-600） ml. Laparoscopic LHM was achieved in a median of 31 （21-62） min, and the median postoperative hospital stay was 14 （9-16） d. No transfusion or conversion was required, and no severe liver-related morbidity or death was observed. Conclusions： The Goldfinger dissector is a useful instrument for the establishment of RT. A five-step strategy using the Goldfinger dissector can quickly and easily facilitate an RT for a laparoscopic LHM in LRH.
