Gon Hidetoshi, Komatsu Shohei, Soyama Hirotoshi, Tanaka Motofumi, Kido Masahiro, Fukushima Kenji, Urade Takeshi, So Shinichi, Yoshida Toshihiko, Arai Keisuke, Tsugawa Daisuke, Yanagimoto Hiroaki, Toyama Hirochika, Fukumoto Takumi
Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University, Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
Department of Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan.
Langenbecks Arch Surg. 2025 Jan 13;410(1):37. doi: 10.1007/s00423-025-03605-y.
The impact of body-cavity depth on open (OLR) and laparoscopic liver resection (LLR) of segment 7 remains unclear. Therefore, we investigated the influence of body-cavity depth at the upper-right portion of the abdomen on LLR and OLR of segment 7.
In total, 101 patients who underwent segment-7 liver resection over 2010-2023 were included. Body-cavity depth was measured from the abdominal-wall surface to the deepest site on the right side of the liver. Patients were categorized into shallow (< 18.4 cm) and deep (≥ 18.4 cm) populations based on median body-cavity depth. We compared surgical outcomes between OLR and LLR in shallow and deep populations after propensity-score adjustments.
In OLR and LLR groups, 27 and 22 patients in the shallow population, respectively, and 26 and 26 patients were included in the deep population, respectively, were included. The OLR group in the deep population had significantly greater blood loss than the corresponding LLR group (difference: 144 mL, 95% confidence interval (CI): [50, 238], P = 0.004). Other surgical outcomes, including operative time, were similar between groups. In the shallow population, the OLR group had significantly shorter operative time (difference: - 54 mL, 95% CI: [-101, - 6], P = 0.028) and similar blood loss than the LLR group.
For segment-7 liver resection, LLR is likely favorable for patients with a deep body cavity, with similar operative time and lower blood loss compared to OLR. Body-cavity depth could be a useful indicator for determining the suitable surgical approach for segment-7 liver resection.
体腔深度对肝7段开放肝切除术（OLR）和腹腔镜肝切除术（LLR）的影响尚不清楚。因此，我们研究了上腹部右侧体腔深度对肝7段LLR和OLR的影响。
总共纳入了2010年至2023年间接受肝7段切除术的101例患者。体腔深度从腹壁表面测量至肝脏右侧最深部位。根据体腔深度中位数，将患者分为浅体腔组（<18.4 cm）和深体腔组（≥18.4 cm）。在进行倾向得分调整后，我们比较了浅体腔组和深体腔组中OLR和LLR的手术结果。
在OLR组和LLR组中，浅体腔组分别有27例和22例患者，深体腔组分别有26例和26例患者。深体腔组的OLR组失血明显多于相应的LLR组（差异：144 mL，95%置信区间（CI）：[50, 238]，P = 0.004）。包括手术时间在内的其他手术结果在两组之间相似。在浅体腔组中，OLR组的手术时间明显更短（差异：-54 mL，95% CI：[-101, -6]，P = 0.028），且与LLR组的失血量相似。
对于肝7段切除术，LLR可能对体腔深的患者有利，与OLR相比，手术时间相似且失血量更低。体腔深度可能是确定肝7段切除术合适手术方式的有用指标。
