Fast track program in liver resection: a PRISMA-compliant systematic review and meta-analysis.
ABSTRACT: FT program (FT) is a multimodal approach used to enhance postoperative rehabilitation and accelerate recovery. It was 1st described in open heart surgery, then modified and applied successfully in colorectal surgery. FT program was described in liver resection for the 1st time in 2008. Although the program has become widely accepted, it has not yet been considered the standard of care in liver surgery.we performed this systematic review and meta-analysis to evaluate the impact of using the FT program compared to the traditional care (TC), on the main clinical and surgical outcomes for patients who underwent elective liver resection.PubMed/Medline, Scopus, and Cochran databases were searched to identify eligible articles that compared FT with TC in elective liver resection to be included in this study. Subgroup meta-analysis between laparoscopic and open surgical approaches to liver resection was also conducted. Quality assessment was performed for all the included studies. Odds ratios (ORs) and mean differences (MDs) were considered as a summary measure of evaluating the association in this meta-analysis for dichotomous and continuous data, respectively. A 95% confidence interval (CI) was reported for both measures. I was used to assess the heterogeneity across studies.From 2008 to 2015, 3 randomized controlled trials (RCTs) and 5 cohort studies were identified, including 394 and 416 patients in the FT and TC groups, respectively. The length of hospital stay (LoS) was markedly shortened in both the open and laparoscopic approaches within the FT program (P?
Project description:To compare surgical and oncological outcomes of laparoscopic versus open liver resection for colorectal liver metastases.A total of 14 retrospective studies with 1679 colorectal liver metastases patients were analyzed: 683 patients treated with laparoscopic liver resection and 996 patients with open liver resection. With respect to surgical outcomes, laparoscopic compared with open liver resection was associated with lower blood loss (MD, -216.7, 95% CI, -309.4 to -124.1; P < 0.00001), less requiring blood transfusion (OR, 0.36; 95% CI, 0.23 to 0.55; P < 0.00001), lower postoperative complication morbidity (OR, 0.61; 95% CI, 0.47 to 0.80; P = 0.003), and shorter hospitalization time (MD, -3.85, 95% CI, -5.00 to -2.71; P < 0.00001). However, operation time and postoperative mortality were no significant difference between the two approaches. With respect to oncological outcomes, laparoscopic liver resection group was prone to lower recurrence rate (OR, 0.78; 95% CI, 0.61-0.99; P = 0.04), but surgical margins R0, overall survival and disease-free survival were no significant difference.We performed a systematic search in MEDLINE, EMBASE, and CENTRAL for all relevant studies. All statistical analysis was performed using Review Manager version 5.3. Dichotomous data were calculated by odds ratio (OR) and continuous data were calculated by mean difference (MD) with 95% confidence intervals (CI).Laparoscopic and open liver resection for colorectal liver metastases have the same effect on oncological outcomes, but laparoscopic liver resection achieves better surgical outcomes.
Project description:<h4>Backgrounds/aims</h4>Colorectal cancer is found with liver metastases about 20-25% due to characteristics of cancer itself. Approximately 20% of liver metastases are found to be resectable. The objective of this study was to evaluate short-term outcomes of patients who received liver resection with colorectal cancer operation in our center by laparoscopic surgery or open surgery.<h4>Methods</h4>Short-term outcomes of laparoscopic surgery of liver resection (LSLR) group who underwent liver resection for colorectal liver metastases (CRLM) at a single institute from 2013 to 2016 were compared to those of open surgery of liver resection (OSLR) group.<h4>Results</h4>A total of 123 patients underwent liver resection for CRLM, including 101 (82.1%) patients in the OSLR group and 22 (17.9%) patients in the LSLR group. There were significant differences in tumor characteristics between the two groups, including synchronous and metachronous (<i>p</i>=0.004), tumor number (<i>p</i><0.001), and tumor margin (<i>p</i>=0.002). For postoperative outcomes, only the length of hospital stay (LOS) was significantly different between the two groups (8.5 days in LSLR vs. 11 days in OSLR, <i>p</i><0.001). There was no significant difference in overall rate of postoperative complications between the two groups (9.1% in LSLR vs. 23.8% in OSLR, <i>p</i>=0.158).<h4>Conclusions</h4>There are no significant differences in postoperative outcomes between LSLR and OSLR except LOS, liver metastasis number, and resection margin. LSLR may be favorable for highly selected patients with CRLM.
Project description:The effects of laparoscopic liver resection (LLR) and open liver resection (OLR) on oncological outcomes for colorectal cancer liver metastases (CCLM) remain inconclusive. Major databases were searched from January 1992 to October 2016. Effects of LLR vs OLR were determined. The primary endpoints were oncological outcomes. In total, 32 eligible non-randomized studies with 4697 patients (LLR: 1809, OLR: 2888) were analyzed. There were higher rates of clear surgical margins (OR: 1.64, 95%CI: 1.32 to 2.05, p?<?0.00001) in the LLR group, without significant differences in disease recurrence, 3- or 5-year overall survival(OS) and disease free survival(DFS) between the two approaches. LLR was associated with less intraoperative blood loss (WMD: -147.46 [-195.78 to -99.15] mL, P?<?0.00001) and fewer blood transfusions (OR: 0.41 [0.30-0.58], P?<?0.00001), but with longer operation time (WMD:14.44 [1.01 to 27.88] min, P?<?0.00001) compared to OLR. Less overall morbidity (OR: 0.64 [0.55 to 0.75], p?<?0.00001) and shorter postoperative hospital stay (WMD: -2.36 [-3.06 to -1.66] d, p?<?0.00001) were observed for patients undergoing LLR, while there was no statistical difference in mortality. LLR appears to be a safe and feasible alternative to OLR in the treatment of CCLM in selected patients.
Project description:Laparoscopic liver resection is used in specialized centers all over the world. However, laparoscopic liver resection has never been compared with open liver resection in a prospective, randomized trial.The Oslo-CoMet Study is a randomized trial into laparoscopic versus open liver resection for the surgical management of hepatic colorectal metastases. The primary outcome is 30-day perioperative morbidity. Secondary outcomes include 5-year survival (overall, disease-free and recurrence-free), resection margins, recurrence pattern, postoperative pain, health-related quality of life, and evaluation of the inflammatory response. A cost-utility analysis of replacing open surgery with laparoscopic surgery will also be performed. The study includes all resections for colorectal liver metastases, except formal hemihepatectomies, resections where reconstruction of vessels/bile ducts is necessary and resections that need to be combined with ablation. All patients will participate in an enhanced recovery after surgery program. A biobank of liver and tumor tissue will be established and molecular analysis will be performed.After 35 months of recruitment, 200 patients have been included in the trial. Molecular and immunology data are being analyzed. Results for primary and secondary outcome measures will be presented following the conclusion of the study (late 2015). The Oslo-CoMet Study will provide the first level 1 evidence on the benefits of laparoscopic liver resection for colorectal liver metastases.The trial was registered in ClinicalTrals.gov (NCT01516710) on 19 January 2012.
Project description:Introduction:There are limited data to date regarding laparoscopic liver resection (LLR) for spontaneously ruptured hepatocellular carcinoma (srHCC). We performed this study to determine the safety and feasibility of LLR for srHCC. Materials and Methods:We conducted a retrospective review of all patients who underwent liver resection for srHCC from 2000 to 2018. A total of five patients underwent LLR for srHCC, and they were matched to 10 patients who underwent open liver resection (OLR) for srHCC to perform a 1:2 comparison. A separate cohort of patients who underwent LLR for non-ruptured HCC (nrHCC) was also compared against the laparoscopic group. Results:The comparison between LLR versus OLR for srHCC demonstrated no significant differences in baseline characteristics between both groups. There was also no significant difference in perioperative outcomes such as median operating time, estimated blood loss (EBL), rate of blood transfusion, post-operative median length of stay (LOS), overall complication rates, major morbidity rates and 90-day mortality rates. Comparison between LLR for srHCC and LLR for nrHCC demonstrated no significant differences in baseline characteristics between both groups. There was also no significant difference in key perioperative outcomes such as median operating time, EBL, rate and volume of blood transfusion, median post-operative LOS, morbidity rates or mortality rates. Conclusion:LLR may be performed safely in selected cases of srHCC. These patients have comparable perioperative outcomes as those who undergo OLR for srHCC and LLR for nrHCC.
Project description:Enhanced recovery after surgery (ERAS) has shown effectiveness in terms of reducing the hospital stay and cost associated with open liver resection. However, the benefit of ERAS in patients undergoing laparoscopic liver resection is still unclear, and clinical studies on this topic are limited.The ERAS program for laparoscopic liver resection was used in a group of 80 patients (ERAS group). The results were compared with those in a control group of 107 patients. All patients underwent laparoscopic liver resection. The primary endpoints were the postoperative hospital stay, defined as the number of days from surgery to discharge, and the hospitalization expense. The secondary endpoints were resumption of oral intake, readmissions, and complications.The median postoperative hospital stay was 6.2?±?2.6 days in the ERAS group, which was significantly shorter than that in the control group (9.9?±?5.9 d; P?<?0.001). The hospitalization cost was $6871?±?2571 in the ERAS group and $7948?±?3630 in the control group (P?=?0.020). The morbidity rate was 22.5% (18 of 80 patients) in the ERAS group and 43.9% (47 of 107 patients) in the control group (P?=?0.002). There were no significant differences the in rate of readmission between the 2 groups.Enhanced recovery after surgery for laparoscopic liver resection is safe and effective. Patients in the ERPS group had a shorter hospital stay, fewer complications, and lower hospital costs.
Project description:Dramatic progresses had been made in the operation in the past 26 years. Procedure was extended to major liver resection, isolated resection of caudate lobe, living donor liver resection and associating liver partition with portal vein ligation for staged hepatectomy (ALPPS). Laparoscopic liver resection became a new group of HPB surgery and the international laparoscopic liver society was established in Paris followed by the first international congress of the society held in Paris in July 2017. This biannual congress would be top convention for surgeons specialized in laparoscopic liver surgery. The advantage of laparoscopic liver resection had been recognized by patients and surgeons and is gradually replacing conventional open liver resection in some experienced institutes worldwide. Most procedures, such as laparoscopic local resection and left lateral segmentectomy, could be routinely performed, but some procedures including laparoscopic hemihepatectomy still need to be further evaluated. For now, the establishment of a training system for laparoscopic liver surgeons became the most important issue for the popularization of laparoscopic liver resection.
Project description:BACKGROUND: To compare short-term and long-term results of colorectal patients undergoing laparoscopic and open hepatectomy. Moreover, outcomes of laparoscopic versus open procedures for simultaneous primary colorectal tumor and liver metastasis resection were compared. METHODS: A systematic search was conducted in the PubMed and EmBase databases (until Oct. 22. 2013) with no limits. Bibliographic citation management software (EndNote X6) was used for extracted literature management. Quality assessment was performed according to a modification of the Newcastle-Ottawa Scale. The data were analyzed using Review Manager (Version 5.1), and sensitivity analysis was performed by sequentially omitting each study. RESULTS: Finally, 14 studies, including a total of 975 CLM (colorectal liver metastasis) patients, compared laparoscopic with open hepatectomy. 3 studies of them, including a total of 107 CLM patients, compared laparoscopic with open procedures for synchronous hepatectomy and colectomy. Laparoscopic hepatectomy was associated with a significantly less blood loss, shorter hospitalization time, and less operative transfusion rate. In addition, lower hospital morbidity rate (OR=0.57, 95%CI:0.42-0.78, P=0.0005) and better R0 resection (OR=2.44, 95%CI:1.21-4.94, P=0.01) were observed in laparoscopic hepatectomy. For long-term outcomes, there were no significant differences between two surgical procedures on recurrence and overall survival. In comparison of synchronous hepatectomy and colectomy, laparoscopic procedure displayed shorter hospitalization (MD?=?-3.40, 95%CI:-4.37-2.44, P<0.00001) than open procedure. Other outcomes, including surgical time, estimated blood loss, hospital morbidity, and overall survival did not differ significantly in the comparison. CONCLUSIONS: Laparoscopic hepatectomy with or without synchronous colectomy are acceptable for selective CLM patients. We suggest standard inclusion criteria of CLM patients be formulated.
Project description:The inflammatory response has been shown to be a major contributor to acute kidney injury. Considering that laparoscopic surgery is beneficial in reducing the inflammatory response, we compared the incidence of postoperative acute kidney injury between laparoscopic liver resection and open liver resection. Among 1173 patients who underwent liver resection surgery, 222 of 926 patients who underwent open liver resection were matched with 222 of 247 patients who underwent laparoscopic liver resection, by using propensity score analysis. The incidence of postoperative acute kidney injury assessed according to the creatinine criteria of the Kidney Disease: Improving Global Outcomes definition was compared between those 1:1 matched groups. A total 77 (6.6%) cases of postoperative acute kidney injury occurred. Before matching, the incidence of acute kidney injury after laparoscopic liver resection was significantly lower than that after open liver resection [1.6% (4/247) vs. 7.9% (73/926), P < 0.001]. After 1:1 matching, the incidence of postoperative acute kidney injury was still significantly lower after laparoscopic liver resection than after open liver resection [1.8% (4/222) vs. 6.3% (14/222), P = 0.008; odds ratio 0.273, 95% confidence interval 0.088-0.842, P = 0.024]. The postoperative inflammatory marker was also lower in laparoscopic liver resection than in open liver resection in matched set data (white blood cell count 12.7 ± 4.0 × 103/?L vs. 14.9 ± 3.9 × 103/?L, P < 0.001). Our findings suggest that the laparoscopic technique, by decreasing the inflammatory response, may reduce the occurrence of postoperative acute kidney injury during liver resection surgery.
Project description:The use of lLaparoscopic liver resection in terms of time to functional recovery, length of hospital stay (LOS), long-term abdominal wall hernias, costs and quality of life (QOL) has never been studied in a randomised controlled trial. Therefore, this is the subject of the international multicentre randomised controlled ORANGE II trial.Patients eligible for left lateral sectionectomy (LLS) of the liver will be recruited and randomised at the outpatient clinic. All randomised patients will undergo surgery in the setting of an ERAS programme. The experimental design produces two randomised arms (open and laparoscopic LLS) and a prospective registry. The prospective registry will be based on patients that cannot be randomised because of the explicit treatment preference of the patient or surgeon, or because of ineligibility (not meeting the in- and exclusion criteria) for randomisation in this trial. Therefore, all non-randomised patients undergoing LLS will be approached to participate in the prospective registry, thereby allowing acquisition of an uninterrupted prospective series of patients. The primary endpoint of the ORANGE II trial is time to functional recovery. Secondary endpoints are postoperative LOS, percentage readmission, (liver-specific) morbidity, QOL, body image and cosmetic result, hospital and societal costs over 1 year, and long-term incidence of incisional hernias. It will be assumed that in patients undergoing laparoscopic LLS, length of hospital stay can be reduced by two days. A sample size of 55 patients in each randomisation arm has been calculated to detect a 2-day reduction in LOS (90% power and ? = 0.05 (two-tailed)).The ORANGE II trial is a multicenter randomised controlled trial that will provide evidence on the merits of laparoscopic surgery in patients undergoing LLS within an enhanced recovery ERAS programme.ClinicalTrials.gov NCT00874224.