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Pure Laparoscopic Liver Resection for Large Malignant Tumors: Does Size Matter?

Background Laparoscopic liver resection (LLR) for large malignant tumors can be technically challenging. Data on this topic are scarce, and many question its feasibility, safety, and oncologic efficiency. This study aimed to assess outcomes of LLR for large (≥5 cm) and giant (≥10 cm) malignant liver...

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Published in:Annals of surgical oncology 2015-04, Vol.22 (4), p.1288-1293
Main Authors: Shelat, Vishal G., Cipriani, Federica, Basseres, Tiago, Armstrong, Thomas H., Takhar, Arjun S., Pearce, Neil W., AbuHilal, Mohammad
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container_title Annals of surgical oncology
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creator Shelat, Vishal G.
Cipriani, Federica
Basseres, Tiago
Armstrong, Thomas H.
Takhar, Arjun S.
Pearce, Neil W.
AbuHilal, Mohammad
description Background Laparoscopic liver resection (LLR) for large malignant tumors can be technically challenging. Data on this topic are scarce, and many question its feasibility, safety, and oncologic efficiency. This study aimed to assess outcomes of LLR for large (≥5 cm) and giant (≥10 cm) malignant liver tumors. Methods A prospectively collected database of 422 LLRs was reviewed from August 2003 to August 2013. The data for 52 patients undergoing LLR for large malignant tumors were analyzed. A subgroup analysis of giant tumors also is reported. Results During the period studied, 52 LLRs were performed (males, 53.8 %; mean age, 64.6 years) for large malignant tumors. Colorectal liver metastasis was the most common indication (42.3 %). The 52 LLRs included 32 major (61.5 %) and 20 minor (38.5 %) LLRs for tumors with a mean diameter of 83 mm. The median operative time was 240 min [interquartile range (IQR), 150–330 min], and the blood loss was 500 ml (IQR, 200–1,373 ml). Eight conversions (15.4 %) were performed. Six patients experienced complications (11.5 %). Among the 44 patients with successful LLRs, two patients (4.5 %) had an R1 resection. The median hospital stay was 5 days (range, 1–21 days), and no mortality occurred during a 90-day period. A subgroup analysis of patients with giant tumors showed greater blood loss ( p  = 0.002) and a longer operative time ( p  = 0.052) but no difference in terms of conversions ( p  = 0.64) or complications ( p  = 0.32). Conclusion The findings showed that LLR is feasible and safe for large malignant tumors and can be performed with acceptable morbidity and oncologic efficiency. When used for giant malignant tumors, LLR is associated with greater blood loss and a longer operative time but no increase in complications.
doi_str_mv 10.1245/s10434-014-4107-6
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Data on this topic are scarce, and many question its feasibility, safety, and oncologic efficiency. This study aimed to assess outcomes of LLR for large (≥5 cm) and giant (≥10 cm) malignant liver tumors. Methods A prospectively collected database of 422 LLRs was reviewed from August 2003 to August 2013. The data for 52 patients undergoing LLR for large malignant tumors were analyzed. A subgroup analysis of giant tumors also is reported. Results During the period studied, 52 LLRs were performed (males, 53.8 %; mean age, 64.6 years) for large malignant tumors. Colorectal liver metastasis was the most common indication (42.3 %). The 52 LLRs included 32 major (61.5 %) and 20 minor (38.5 %) LLRs for tumors with a mean diameter of 83 mm. The median operative time was 240 min [interquartile range (IQR), 150–330 min], and the blood loss was 500 ml (IQR, 200–1,373 ml). Eight conversions (15.4 %) were performed. Six patients experienced complications (11.5 %). Among the 44 patients with successful LLRs, two patients (4.5 %) had an R1 resection. The median hospital stay was 5 days (range, 1–21 days), and no mortality occurred during a 90-day period. A subgroup analysis of patients with giant tumors showed greater blood loss ( p  = 0.002) and a longer operative time ( p  = 0.052) but no difference in terms of conversions ( p  = 0.64) or complications ( p  = 0.32). Conclusion The findings showed that LLR is feasible and safe for large malignant tumors and can be performed with acceptable morbidity and oncologic efficiency. 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Data on this topic are scarce, and many question its feasibility, safety, and oncologic efficiency. This study aimed to assess outcomes of LLR for large (≥5 cm) and giant (≥10 cm) malignant liver tumors. Methods A prospectively collected database of 422 LLRs was reviewed from August 2003 to August 2013. The data for 52 patients undergoing LLR for large malignant tumors were analyzed. A subgroup analysis of giant tumors also is reported. Results During the period studied, 52 LLRs were performed (males, 53.8 %; mean age, 64.6 years) for large malignant tumors. Colorectal liver metastasis was the most common indication (42.3 %). The 52 LLRs included 32 major (61.5 %) and 20 minor (38.5 %) LLRs for tumors with a mean diameter of 83 mm. The median operative time was 240 min [interquartile range (IQR), 150–330 min], and the blood loss was 500 ml (IQR, 200–1,373 ml). Eight conversions (15.4 %) were performed. Six patients experienced complications (11.5 %). Among the 44 patients with successful LLRs, two patients (4.5 %) had an R1 resection. The median hospital stay was 5 days (range, 1–21 days), and no mortality occurred during a 90-day period. A subgroup analysis of patients with giant tumors showed greater blood loss ( p  = 0.002) and a longer operative time ( p  = 0.052) but no difference in terms of conversions ( p  = 0.64) or complications ( p  = 0.32). Conclusion The findings showed that LLR is feasible and safe for large malignant tumors and can be performed with acceptable morbidity and oncologic efficiency. 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Data on this topic are scarce, and many question its feasibility, safety, and oncologic efficiency. This study aimed to assess outcomes of LLR for large (≥5 cm) and giant (≥10 cm) malignant liver tumors. Methods A prospectively collected database of 422 LLRs was reviewed from August 2003 to August 2013. The data for 52 patients undergoing LLR for large malignant tumors were analyzed. A subgroup analysis of giant tumors also is reported. Results During the period studied, 52 LLRs were performed (males, 53.8 %; mean age, 64.6 years) for large malignant tumors. Colorectal liver metastasis was the most common indication (42.3 %). The 52 LLRs included 32 major (61.5 %) and 20 minor (38.5 %) LLRs for tumors with a mean diameter of 83 mm. The median operative time was 240 min [interquartile range (IQR), 150–330 min], and the blood loss was 500 ml (IQR, 200–1,373 ml). Eight conversions (15.4 %) were performed. Six patients experienced complications (11.5 %). Among the 44 patients with successful LLRs, two patients (4.5 %) had an R1 resection. The median hospital stay was 5 days (range, 1–21 days), and no mortality occurred during a 90-day period. A subgroup analysis of patients with giant tumors showed greater blood loss ( p  = 0.002) and a longer operative time ( p  = 0.052) but no difference in terms of conversions ( p  = 0.64) or complications ( p  = 0.32). Conclusion The findings showed that LLR is feasible and safe for large malignant tumors and can be performed with acceptable morbidity and oncologic efficiency. When used for giant malignant tumors, LLR is associated with greater blood loss and a longer operative time but no increase in complications.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>25256130</pmid><doi>10.1245/s10434-014-4107-6</doi><tpages>6</tpages></addata></record>
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subjects Adult
Aged
Aged, 80 and over
Blood Loss, Surgical
Carcinoma, Hepatocellular - secondary
Carcinoma, Hepatocellular - surgery
Colorectal Neoplasms - pathology
Colorectal Neoplasms - surgery
Female
Follow-Up Studies
Hepatectomy
Hepatobiliary Tumors
Humans
Laparoscopy
Liver Neoplasms - secondary
Liver Neoplasms - surgery
Male
Medicine
Medicine & Public Health
Middle Aged
Neoplasm Staging
Neuroendocrine Tumors - secondary
Neuroendocrine Tumors - surgery
Oncology
Prognosis
Prospective Studies
Surgery
Surgical Oncology
Young Adult
title Pure Laparoscopic Liver Resection for Large Malignant Tumors: Does Size Matter?
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