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Title: OPTIMIZING LAPAROSCOPIC LIVER RESECTION TECHNIQUES FOR HEPATOCELLULAR CARCINOMA: A FOCUS ON TECHNICAL FEASIBILITY, COMPLICATION RATES AND PATIENT-CENTERED OUTCOMES
Authors: Raza Rehman, Misha Aslam, Syed Wasif Ali Naqvi, Anam Saleem, Zainab Rehman
Journal: The Research of Medical Science Review
| Category | From | To |
|---|---|---|
| Y | 2024-10-01 | 2025-12-31 |
Publisher: Innovative Education Research Institute
Country: Pakistan
Year: 2024
Volume: 2
Issue: 3
Language: English
Keywords: Hepatocellular carcinomaMinimally Invasive SurgeryLaparoscopic Liver ResectionOpen Liver ResectionPatient-Centered Outcomes
Hepatocellular carcinoma (HCC) is among the most common and difficult liver cancers, requiring accurate surgical intervention for optimal treatment. Liver transplantation represents the most conclusive treatment; nonetheless, restricted organ availability and exorbitant prices make surgical excision the primary approach for the majority of patients. The laparoscopic liver resection (LLR) technique has become a game-changer because it has the same long-term cancer results as open liver resection (OLR) but a much better short-term recovery due to less morbidity, less invasiveness, and faster rehabilitation. This study offers a thorough investigation of optimizing LLR approaches for HCC, concentrating on technical feasibility, complication rates, and patient-centered results. We examine evidence-based options for patient selection, acknowledging that the advantages of LLR are optimized just for suitably selected instances. The four principal difficulty-scoring systems for LLR are examined to inform surgical decision-making and improve procedural safety. We also look at the progress made in robotically assisted liver resection, focusing on how it can improve difficult surgical techniques and make minimally invasive liver surgery more useful in more situations. This study seeks to deliver actionable insights for enhancing outcomes in patients having laparoscopic liver resection for hepatocellular carcinoma by merging the newest advancements with surgical accuracy, thus establishing new standards of excellence in hepatobiliary surgery.
To conduct a thorough investigation of optimizing laparoscopic liver resection (LLR) approaches for hepatocellular carcinoma (HCC), concentrating on technical feasibility, complication rates, and patient-centered outcomes.
A literature search was conducted in MEDLINE using keywords "laparoscopy liver surgical removal" and "liver-specific carcinoma" up to May 2018. English-language works with human participants were selected. Studies with fewer than 15 patients and case reports were excluded. Eleven studies with at least 15 participants were selected for comparison and analysis of patient features, perioperative outcomes, and oncological findings.
graph TD;
A[Literature Search MEDLINE] --> B[Select English-language studies with human participants];
B --> C[Exclude studies with <15 patients and case reports];
C --> D[Identify 11 relevant studies];
D --> E[Analyze patient features, perioperative outcomes, oncological findings];
E --> F[Synthesize findings and draw conclusions];
LLR is presented as a viable and safe alternative to open liver resection for HCC, offering similar oncological outcomes with improved short-term recovery. The study highlights the importance of patient selection, the role of difficulty-scoring systems, and the potential of robotic assistance. While LLR shows promising results, the need for robust data from randomized controlled trials is emphasized to confirm oncological outcomes and establish its role as a standard strategy. The transition to open surgery during LLR should be viewed as a tactical modification for patient safety rather than a failure.
- Eleven studies involving 466 HCC patients who underwent LLR were analyzed.
- The average age of patients was sixty, with 62% having liver cirrhosis and 45% having hepatitis B infection.
- 7.7% of total cases required conversion to open resection due to inadequate margins, poor advancement, or bleeding.
- Postoperative complications included bleeding (3.2%), liver failure (4.8%), ascites (5.5%), and bile leakage (1.2%), comparable to open resections.
- The overall mortality rate was 0.41% (2 out of 482 patients).
- Disease-free survival rates at 1, 3, and 5 years ranged from 65-92%, 53-68%, and 33-52%, respectively.
- Overall survival rates at 1, 3, and 5 years ranged from 88-100%, 70-98%, and 55-96%, respectively.
- No port-site metastases were documented.
Laparoscopic liver resection is a feasible and safe intervention for HCC, even in patients with cirrhosis. Advancements in surgical equipment and methodologies are enabling LLR for tumors in complex anatomical regions. The technique demonstrates encouraging long-term survival outcomes, though its comparability to open surgery is still debated. Robotic surgery is expected to play a crucial role in the future of hepatobiliary surgery, offering enhanced accuracy and patient outcomes.
- The study analyzed data from 466 HCC patients who underwent laparoscopic liver resection.
- Postoperative bleeding occurred in 3.2% of patients.
- The overall mortality rate observed in the analysis of 482 patients was 0.41%.
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