CASE REPORT
Laparoscopic Anterior Approach of Major Hepatectomy Combined With Colorectal Resection for Synchronous Colorectal Liver Metastases Lu Liu, MD,* Yujie Zeng, MD,* Wei Lai, MD,* Feiyu Diao, MD,* Heng Wu, MD,* Jie Wang, MD,w and Zhonghua Chu, MD*
Purpose: The aim of the study was to evaluate the feasibility and operative outcomes of the anterior approach technique for a simultaneous colorectal and liver laparoscopic procedure given its demonstrated benefits and discuss the advantages of this strategy. Patient and Methods: In the presented case, a total laparoscopic anterior approach was used for a left hemihepatectomy in combination with laparoscopic colorectal resections for synchronous liver metastases, which emphasizes the technical aspects of this procedure. The duration of surgery, blood loss, and postoperative outcomes were evaluated. Results: The laparoscopic anterior approach for a left hepatectomy with simultaneous colon resection for liver metastases was feasible and safe without postoperative complications. The duration of surgery was 190 minutes with an estimated blood loss of 200 mL. The postoperative course was uneventful. Conclusions: The laparoscopic anterior approach for a major hepatectomy for unilobular synchronous metastases can be safely performed simultaneously with colorectal surgery in select patients. Key Words: colorectal liver metastases, anterior approach, laparoscopic hepatectomy
(Surg Laparosc Endosc Percutan Tech 2014;24:e237–e240)
L
aparoscopic colorectal resection has been shown to be safe and oncologically equivalent to conventional surgery with low morbidity and reduced hospital stay.1 The early resection of primary lesions without distant spread is associated with excellent prognosis, but many patients present with more extensive disease. The liver is the most common site for blood-borne metastases, particularly from malignancies arising in organs drained by the portal circulation. Among newly diagnosed patients with colorectal cancer, approximately 15% to 25% of the patients are found to have synchronous metastases.2 Surgical resection is the only option for curative treatment for synchronous colorectal liver metastases. An increasing number of studies
Received for publication May 27, 2013; accepted September 30, 2013. From the Departments of *Gastrointestinal Surgery; and wHepatoBiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China. L.L. and Y.Z. contributed equally. Funded by The National Natural Science Foundation of China (No. 81001306). Reprints: Zhonghua Chu, MD, Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Yanjiangxilu, No. 107, Guangzhou 510120, China (e-mail: [email protected]). Copyright r 2014 by Lippincott Williams & Wilkins
Surg Laparosc Endosc Percutan Tech
have reported that combined colorectal and liver resection is feasible and safe.3–7 Although laparoscopic liver resection has several disadvantages (eg, the risk of bleeding from resection plane, gas embolism, and port-site metastasis), it has been reported to be safe and feasible, while also improving the postoperative course.8,9 The anterior approach for liver resection is associated with significantly lower intraoperative blood loss and blood transfusion requirements, lower hospital mortality rates, lower incidence of pulmonary metastases, and improved median disease-free survival rates.10 Several reports have supported the use of the anterior approach technique as the preferred approach in patients with large hepatocellular carcinoma.11,12 The feasibility, safety, and efficiency of a combined laparoscopic colorectal and liver resection in primary colorectal cancer with synchronous liver metastases has been recently reported, leading to the slow expansion of this new minimally invasive approach.13,14 This study was designed to focus on the feasibility of the laparoscopic anterior approach during a simultaneous rectal and liver resection given the benefits of laparoscopy in both colorectal and liver resection. It also discussed the advantages of the laparoscopic anterior approach for a hemihepatectomy.
CASE REPORT A 64-year-old woman presented with symptoms of rectal bleeding for 1 month. Her colonoscopy showed a rectal mass located 10 cm from the anal verge, and the biopsy of the 48 mm tumor revealed adenocarcinoma. A computed tomography scan revealed a 23 mm lesion located in segment III and an 18-mm-deep lesion located in segment IV of the left liver. Serum levels of carcinoembryonic antigen and cancer antigen 199 were 10 and nearly 28 times their normal levels, respectively. Tumor marker levels (afetoprotein, cancer antigen 125, and cancer antigen 72-4) were normal. According to the TNM classification, the neoplasm was staged as T2N2M1.
Laparoscopic Surgical Technique Under general anesthesia, the patient was positioned in the supine position. The operating surgeon was stationed between the legs of the patient with an assistant on the left for the left hemihepatectomy. Pneumoperitoneum was established and maintained at 12 to 15 mm Hg during tumor assessment and tumor resection. Three 10 mm ports were created roughly at equidistances and traversing a shallow arc just below the transpyloric plane and above the umbilicus. Another 2 ports were placed, including a 5 mm port in the right mid-abdomen and a 10 mm port in the right lower quadrant. After laparoscopic evaluation of the liver, a laparoscopic liver ultrasound was used to determine the location and extent of intraparenchymal lesions, exclude any other lesions, mark the
Volume 24, Number 6, December 2014 www.surgical-laparoscopy.com |
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Surg Laparosc Endosc Percutan Tech
resection line, and identify potentially hazardous intrahepatic vascular and biliary structures. The anterior approach was used for the left hemihepatectomy. The left hepatic artery and left portal vein were identified and controlled extraparenchymally to allow for a safer and more hemostatic parenchymal dissection. The artery was dissected first using an ultrasonic dissector (Ethicon Endosurgery, Cincinnati, OH). The division of the artery opened the plane for the dissection of the left portal vein, which was then controlled and divided in a similar manner. The left hepatic artery and left portal vein were controlled with Hem-o-Lock clips (Teleflex Medical, Research Triangle Park, NC) and then divided. After the hilar dissection, the plane of parenchymal transection was marked on the Glisson capsule with the assistance of intraoperative ultrasonography. The transection was performed using a combination of the electrocoagulation spade (Stryker Medical, Kalamazoo, MI) and ultrasonic dissector from the anterior surface of the liver to the left liver hilum and down to the anterior surface of the inferior vena cava, which was completely exposed. The transection was extended deeper into the liver parenchyma and, as larger biliovascular structures were encountered, a combination of Titanium (Ethicon Endosurgery) and Hem-o-Lock clips were used. This permitted the safe dissection of the vascular structures, which were then divided between the clips. Next, the left hepatic vein was isolated and divided with Hem-o-Lock clips extrahepatically. When the left liver was completely disconnected from the inferior vena cava, the triangular, coronaric and falciform ligaments were divided to allow for the delivery of the specimen. During the dissection, the ultrasound probe (B and K Medical, Marborough, MA) was intermittently applied to each raw surface to demonstrate the intact tumor with a margin of normal liver in the specimen and to confirm the hepatic vein. The branches of the middle hepatic vein were controlled with Titanium and Hem-oLock clips. Once the resection of the tumor was complete, the resected margins were examined carefully for bleeding and bile leaks using an electrocoagulation spade. Hemostatic agents, such as fibrin sealants (Baxter Inc., Irvine, CA), were applied routinely to the cut liver surface to promote biliostasis and hemostasis. Central venous pressures of 1 cm, which has been associated with better long-term outcomes.30
CONCLUSIONS The laparoscopic anterior approach for a major hepatectomy can be performed safely for unilobular synchronous metastases simultaneously with colorectal surgery in select patients. Larger prospective studies are needed to confirm the advantages of this combined strategy. REFERENCES 1. Koopmann MC, Heise CP. Laparoscopic and minimally invasive resection of malignant colorectal disease. Surg Clin North Am. 2008;88:1047–1072. r
2014 Lippincott Williams & Wilkins
Laparoscopic Resection For Liver Metastases
2. Bengtsson G, Carlsson G, HafstrO¨m L, et al. Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg. 1981;141:586–589. 3. Weber JC, Bachellier P, Oussoultzoglou E, et al. Simultaneous resection of colorectal primary tumour and synchronous liver metastases. Br J Surg. 2003;90:956–962. 4. Martin R, Paty P, Fong Y, et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg. 2003;197:233–241. 5. Schlag P, Hohenberger P, Herfarth C. Resection of liver metastases in colorectal cancer-competitive analysis of treatment results in synchronous versus metachronous metastases. Eur J Surg Oncol. 1990;16:360–365. 6. Chua HK, Sondenaa K, Tsiotos GG, et al. Concurrent vs staged colectomy and hepatectomy for primary colorectal cancer with synchronous hepatic metastases. Dis Colon Rectum. 2004;47:1310–1316. 7. Tanaka K, Shimada H, Matsuo K, et al. Outcome after simultaneous colorectal and hepatic resection for colorectal cancer with synchronous metastases. Surgery. 2004;136:650–659. 8. Cherqui D, Husson E, Hammoud R, et al. Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg. 2000;232:753–762. 9. Dagher I, Proske J, Carloni A, et al. Laparoscopic liver resection: results for 70 patients. Surg Endosc. 2007;21:619–624. 10. Liu CL, Fan ST, Cheung ST, et al. Anterior approach versus conventional approach right hepatic resection for large hepatocellular carcinoma. Ann Surg. 2006;224:194–203. 11. Azoulay D, Marin-Hargreaves G, Castaing D, et al. The anterior approach: the right way for right massive hepatectomy. J Am Coll Surg. 2001;192:412–417. 12. Belghiti J, Guevara OA, Noun R, et al. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg. 2001;193:109–111. 13. Abu Hilal M, Underwood T, Zuccaro M, et al. Short- and medium-term results of totally laparoscopic resection for colorectal liver metastases. Br J Surg. 2010;97:927–933. 14. Tranchart H, Diop PS, Lainas P, et al. Laparoscopic major hepatectomy can be safely performed with colorectal surgery for synchronous colorectal liver metastasis. HPB (Oxford). 2011;13:46–50. 15. Seymour MT, Stenning SP, Cassidy J. Attitudes and practice in the management of metastatic colorectal cancer in Britain. Colorectal Cancer Working Party of the UK Medical Research Council. Clin Oncol (R Coll Radiol). 1997;9:248–251. 16. Bolton JS, Fuhrman GM. Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma. Ann Surg. 2000;231:743–751. 17. Nordlinger B, Guiguet M, Vaillant JC, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Cancer. 1996;77:1254–1262. 18. Figueras J, Llado L, Ruiz D, et al. Complete versus selective portal triad clamping for minor liver resections: a prospective randomized trial. Ann Surg. 2005;241:582–590. 19. Capussotti L, Ferrerro A, Vigano L, et al. Major liver resections synchronous with colorectal surgery. Ann Surg Oncol. 2007;14:195–201. 20. Nguyen KT, Laurent A, Dagher I, et al. Minimally invasive liver resection for metastatic colorectal cancer: a multi-institutional, international report of safety, feasibility, and early outcomes. Ann Surg. 2009;250:842–848. 21. Kazaryan AM, Pavlik Marangos I, Rosseland AR, et al. Laparoscopic liver resection for malignant and benign lesions: ten-year Norwegian single-center experience. Arch Surg. 2010;145:34–40. 22. Abu Hilal M, McPhail MJ, Zeidan B, et al. Laparoscopic versus open left lateral hepatic sectionectomy: a comparative study. Eur J Surg Oncol. 2008;34:1285–1288. 23. Lesurtel M, Cherqui D, Laurent A, et al. Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg. 2003;196:236–242.
www.surgical-laparoscopy.com |
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Surg Laparosc Endosc Percutan Tech
24. Champagne BJ, Delaney CP. Laparoscopy for metastatic colorectal cancer. Surg Oncol. 2007;16:15–24. 25. Kianmanesh R, Regimbeau JM, Belghiti J. Selective approach to major hepatic resection for hepatocellular carcinoma in chronic liver disease. Surg Oncol Clin N Am. 2003;12: 51– 63. 26. Suzuki M, Unno M, Katayose Y, et al. Hepatic resection through an anterior approach employing a modified liver hanging maneuver in patients with a massive liver tumor severely oppressing the inferior vena cava. Hepatogastroenterology. 2004;51:1459 –1463. 27. Hayashi N, Egami H, Kai M, et al. No-touch isolation technique reduces intraoperative shedding of tumor cells into
e240 | www.surgical-laparoscopy.com
Volume 24, Number 6, December 2014
the portal vein during resection of colorectal cancer. Surgery. 1999;125:369–374. 28. Liu CL, Fan ST, Lo CM, et al. Anterior approach for major right hepatic resection for large hepatocellular carcinoma. Ann Surg. 2000;232:25–31. 29. Gigot JF, Glineur D, Santiago Azagra J, et al. Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg. 2002;236:90–97. 30. Kato T, Yasui K, Hirai T, et al. Therapeutic results for hepatic metastasis of colorectal cancer with special reference to effectiveness of hepatectomy: analysis of prognostic factors for 763 cases recorded at 18 institutions. Dis Colon Rectum. 2003;46:S22–S31.
r
2014 Lippincott Williams & Wilkins
Laparoscopic Anterior Approach of Major Hepatectomy Combined With Colorectal Resection for Synchronous Colorectal Liver Metastases Lu Liu, MD,* Yujie Zeng, MD,* Wei Lai, MD,* Feiyu Diao, MD,* Heng Wu, MD,* Jie Wang, MD,w and Zhonghua Chu, MD*
Purpose: The aim of the study was to evaluate the feasibility and operative outcomes of the anterior approach technique for a simultaneous colorectal and liver laparoscopic procedure given its demonstrated benefits and discuss the advantages of this strategy. Patient and Methods: In the presented case, a total laparoscopic anterior approach was used for a left hemihepatectomy in combination with laparoscopic colorectal resections for synchronous liver metastases, which emphasizes the technical aspects of this procedure. The duration of surgery, blood loss, and postoperative outcomes were evaluated. Results: The laparoscopic anterior approach for a left hepatectomy with simultaneous colon resection for liver metastases was feasible and safe without postoperative complications. The duration of surgery was 190 minutes with an estimated blood loss of 200 mL. The postoperative course was uneventful. Conclusions: The laparoscopic anterior approach for a major hepatectomy for unilobular synchronous metastases can be safely performed simultaneously with colorectal surgery in select patients. Key Words: colorectal liver metastases, anterior approach, laparoscopic hepatectomy
(Surg Laparosc Endosc Percutan Tech 2014;24:e237–e240)
L
aparoscopic colorectal resection has been shown to be safe and oncologically equivalent to conventional surgery with low morbidity and reduced hospital stay.1 The early resection of primary lesions without distant spread is associated with excellent prognosis, but many patients present with more extensive disease. The liver is the most common site for blood-borne metastases, particularly from malignancies arising in organs drained by the portal circulation. Among newly diagnosed patients with colorectal cancer, approximately 15% to 25% of the patients are found to have synchronous metastases.2 Surgical resection is the only option for curative treatment for synchronous colorectal liver metastases. An increasing number of studies
Received for publication May 27, 2013; accepted September 30, 2013. From the Departments of *Gastrointestinal Surgery; and wHepatoBiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China. L.L. and Y.Z. contributed equally. Funded by The National Natural Science Foundation of China (No. 81001306). Reprints: Zhonghua Chu, MD, Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Yanjiangxilu, No. 107, Guangzhou 510120, China (e-mail: [email protected]). Copyright r 2014 by Lippincott Williams & Wilkins
Surg Laparosc Endosc Percutan Tech
have reported that combined colorectal and liver resection is feasible and safe.3–7 Although laparoscopic liver resection has several disadvantages (eg, the risk of bleeding from resection plane, gas embolism, and port-site metastasis), it has been reported to be safe and feasible, while also improving the postoperative course.8,9 The anterior approach for liver resection is associated with significantly lower intraoperative blood loss and blood transfusion requirements, lower hospital mortality rates, lower incidence of pulmonary metastases, and improved median disease-free survival rates.10 Several reports have supported the use of the anterior approach technique as the preferred approach in patients with large hepatocellular carcinoma.11,12 The feasibility, safety, and efficiency of a combined laparoscopic colorectal and liver resection in primary colorectal cancer with synchronous liver metastases has been recently reported, leading to the slow expansion of this new minimally invasive approach.13,14 This study was designed to focus on the feasibility of the laparoscopic anterior approach during a simultaneous rectal and liver resection given the benefits of laparoscopy in both colorectal and liver resection. It also discussed the advantages of the laparoscopic anterior approach for a hemihepatectomy.
CASE REPORT A 64-year-old woman presented with symptoms of rectal bleeding for 1 month. Her colonoscopy showed a rectal mass located 10 cm from the anal verge, and the biopsy of the 48 mm tumor revealed adenocarcinoma. A computed tomography scan revealed a 23 mm lesion located in segment III and an 18-mm-deep lesion located in segment IV of the left liver. Serum levels of carcinoembryonic antigen and cancer antigen 199 were 10 and nearly 28 times their normal levels, respectively. Tumor marker levels (afetoprotein, cancer antigen 125, and cancer antigen 72-4) were normal. According to the TNM classification, the neoplasm was staged as T2N2M1.
Laparoscopic Surgical Technique Under general anesthesia, the patient was positioned in the supine position. The operating surgeon was stationed between the legs of the patient with an assistant on the left for the left hemihepatectomy. Pneumoperitoneum was established and maintained at 12 to 15 mm Hg during tumor assessment and tumor resection. Three 10 mm ports were created roughly at equidistances and traversing a shallow arc just below the transpyloric plane and above the umbilicus. Another 2 ports were placed, including a 5 mm port in the right mid-abdomen and a 10 mm port in the right lower quadrant. After laparoscopic evaluation of the liver, a laparoscopic liver ultrasound was used to determine the location and extent of intraparenchymal lesions, exclude any other lesions, mark the
Volume 24, Number 6, December 2014 www.surgical-laparoscopy.com |
e237
Liu et al
Surg Laparosc Endosc Percutan Tech
resection line, and identify potentially hazardous intrahepatic vascular and biliary structures. The anterior approach was used for the left hemihepatectomy. The left hepatic artery and left portal vein were identified and controlled extraparenchymally to allow for a safer and more hemostatic parenchymal dissection. The artery was dissected first using an ultrasonic dissector (Ethicon Endosurgery, Cincinnati, OH). The division of the artery opened the plane for the dissection of the left portal vein, which was then controlled and divided in a similar manner. The left hepatic artery and left portal vein were controlled with Hem-o-Lock clips (Teleflex Medical, Research Triangle Park, NC) and then divided. After the hilar dissection, the plane of parenchymal transection was marked on the Glisson capsule with the assistance of intraoperative ultrasonography. The transection was performed using a combination of the electrocoagulation spade (Stryker Medical, Kalamazoo, MI) and ultrasonic dissector from the anterior surface of the liver to the left liver hilum and down to the anterior surface of the inferior vena cava, which was completely exposed. The transection was extended deeper into the liver parenchyma and, as larger biliovascular structures were encountered, a combination of Titanium (Ethicon Endosurgery) and Hem-o-Lock clips were used. This permitted the safe dissection of the vascular structures, which were then divided between the clips. Next, the left hepatic vein was isolated and divided with Hem-o-Lock clips extrahepatically. When the left liver was completely disconnected from the inferior vena cava, the triangular, coronaric and falciform ligaments were divided to allow for the delivery of the specimen. During the dissection, the ultrasound probe (B and K Medical, Marborough, MA) was intermittently applied to each raw surface to demonstrate the intact tumor with a margin of normal liver in the specimen and to confirm the hepatic vein. The branches of the middle hepatic vein were controlled with Titanium and Hem-oLock clips. Once the resection of the tumor was complete, the resected margins were examined carefully for bleeding and bile leaks using an electrocoagulation spade. Hemostatic agents, such as fibrin sealants (Baxter Inc., Irvine, CA), were applied routinely to the cut liver surface to promote biliostasis and hemostasis. Central venous pressures of 1 cm, which has been associated with better long-term outcomes.30
CONCLUSIONS The laparoscopic anterior approach for a major hepatectomy can be performed safely for unilobular synchronous metastases simultaneously with colorectal surgery in select patients. Larger prospective studies are needed to confirm the advantages of this combined strategy. REFERENCES 1. Koopmann MC, Heise CP. Laparoscopic and minimally invasive resection of malignant colorectal disease. Surg Clin North Am. 2008;88:1047–1072. r
2014 Lippincott Williams & Wilkins
Laparoscopic Resection For Liver Metastases
2. Bengtsson G, Carlsson G, HafstrO¨m L, et al. Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg. 1981;141:586–589. 3. Weber JC, Bachellier P, Oussoultzoglou E, et al. Simultaneous resection of colorectal primary tumour and synchronous liver metastases. Br J Surg. 2003;90:956–962. 4. Martin R, Paty P, Fong Y, et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg. 2003;197:233–241. 5. Schlag P, Hohenberger P, Herfarth C. Resection of liver metastases in colorectal cancer-competitive analysis of treatment results in synchronous versus metachronous metastases. Eur J Surg Oncol. 1990;16:360–365. 6. Chua HK, Sondenaa K, Tsiotos GG, et al. Concurrent vs staged colectomy and hepatectomy for primary colorectal cancer with synchronous hepatic metastases. Dis Colon Rectum. 2004;47:1310–1316. 7. Tanaka K, Shimada H, Matsuo K, et al. Outcome after simultaneous colorectal and hepatic resection for colorectal cancer with synchronous metastases. Surgery. 2004;136:650–659. 8. Cherqui D, Husson E, Hammoud R, et al. Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg. 2000;232:753–762. 9. Dagher I, Proske J, Carloni A, et al. Laparoscopic liver resection: results for 70 patients. Surg Endosc. 2007;21:619–624. 10. Liu CL, Fan ST, Cheung ST, et al. Anterior approach versus conventional approach right hepatic resection for large hepatocellular carcinoma. Ann Surg. 2006;224:194–203. 11. Azoulay D, Marin-Hargreaves G, Castaing D, et al. The anterior approach: the right way for right massive hepatectomy. J Am Coll Surg. 2001;192:412–417. 12. Belghiti J, Guevara OA, Noun R, et al. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg. 2001;193:109–111. 13. Abu Hilal M, Underwood T, Zuccaro M, et al. Short- and medium-term results of totally laparoscopic resection for colorectal liver metastases. Br J Surg. 2010;97:927–933. 14. Tranchart H, Diop PS, Lainas P, et al. Laparoscopic major hepatectomy can be safely performed with colorectal surgery for synchronous colorectal liver metastasis. HPB (Oxford). 2011;13:46–50. 15. Seymour MT, Stenning SP, Cassidy J. Attitudes and practice in the management of metastatic colorectal cancer in Britain. Colorectal Cancer Working Party of the UK Medical Research Council. Clin Oncol (R Coll Radiol). 1997;9:248–251. 16. Bolton JS, Fuhrman GM. Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma. Ann Surg. 2000;231:743–751. 17. Nordlinger B, Guiguet M, Vaillant JC, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Cancer. 1996;77:1254–1262. 18. Figueras J, Llado L, Ruiz D, et al. Complete versus selective portal triad clamping for minor liver resections: a prospective randomized trial. Ann Surg. 2005;241:582–590. 19. Capussotti L, Ferrerro A, Vigano L, et al. Major liver resections synchronous with colorectal surgery. Ann Surg Oncol. 2007;14:195–201. 20. Nguyen KT, Laurent A, Dagher I, et al. Minimally invasive liver resection for metastatic colorectal cancer: a multi-institutional, international report of safety, feasibility, and early outcomes. Ann Surg. 2009;250:842–848. 21. Kazaryan AM, Pavlik Marangos I, Rosseland AR, et al. Laparoscopic liver resection for malignant and benign lesions: ten-year Norwegian single-center experience. Arch Surg. 2010;145:34–40. 22. Abu Hilal M, McPhail MJ, Zeidan B, et al. Laparoscopic versus open left lateral hepatic sectionectomy: a comparative study. Eur J Surg Oncol. 2008;34:1285–1288. 23. Lesurtel M, Cherqui D, Laurent A, et al. Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg. 2003;196:236–242.
www.surgical-laparoscopy.com |
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Liu et al
Surg Laparosc Endosc Percutan Tech
24. Champagne BJ, Delaney CP. Laparoscopy for metastatic colorectal cancer. Surg Oncol. 2007;16:15–24. 25. Kianmanesh R, Regimbeau JM, Belghiti J. Selective approach to major hepatic resection for hepatocellular carcinoma in chronic liver disease. Surg Oncol Clin N Am. 2003;12: 51– 63. 26. Suzuki M, Unno M, Katayose Y, et al. Hepatic resection through an anterior approach employing a modified liver hanging maneuver in patients with a massive liver tumor severely oppressing the inferior vena cava. Hepatogastroenterology. 2004;51:1459 –1463. 27. Hayashi N, Egami H, Kai M, et al. No-touch isolation technique reduces intraoperative shedding of tumor cells into
e240 | www.surgical-laparoscopy.com
Volume 24, Number 6, December 2014
the portal vein during resection of colorectal cancer. Surgery. 1999;125:369–374. 28. Liu CL, Fan ST, Lo CM, et al. Anterior approach for major right hepatic resection for large hepatocellular carcinoma. Ann Surg. 2000;232:25–31. 29. Gigot JF, Glineur D, Santiago Azagra J, et al. Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg. 2002;236:90–97. 30. Kato T, Yasui K, Hirai T, et al. Therapeutic results for hepatic metastasis of colorectal cancer with special reference to effectiveness of hepatectomy: analysis of prognostic factors for 763 cases recorded at 18 institutions. Dis Colon Rectum. 2003;46:S22–S31.
r
2014 Lippincott Williams & Wilkins
