Laparoscopic Versus Open Surgery For Hepatic Caudate Lobectomy:A Retrospective Study

Objective To evaluate the feasibility and safety of caudate lobectomy,the perioperative related indicators were compared within the Laparoscopic hepatic Caudate Lobectomy(LHCL)and Open hepatic Caudate Lobectomy(OHCL)in the management of caudate lobe resection in the present study.Methods Twenty-four patients,diagnosed with liver tumor and selected from the Qilu Hospital of the Shandong University from January 2014 to January 2019,were enrolled for LHCL group.Twenty-four patients of OHCL group were selected from forty liver sections,performed by open hepatectomy at the same period,matched for gender,age,degree of cirrhosis,tumor size and location.The total operative time,the length of incision,intraoperative blood loss,blood transfusion,Pringle maneuver occlusion blocking rate and time,conversion to laparotomy rate,postoperative anal exhausting time,time for dieting after operation,time for removal of the abdominal cavity drainage tube postoperative liver function recovery,postoperative hospital stay and complications and incidence were analyzed.This study has been approval by the Ethics Committee of the Qilu Hospital of the Shandong University and all selections were based on voluntary.Results:(1)There was no great difference in gender,age,tumor size,preoperative liver function,tumor size,degree of cirrhosis,proportion of liver cirrhosis and Child-Pugh grading between LHCL and OHCL group(P>0.05),indicating that the two groups were comparable.All surgeries were successfully completed.(2)All operations were successfully performed and there was no death case in both LHCL group and OHCL group.The length of incision in LHCL group was lower than that in OHCL group(22.46± 4.40 cm vs 4.22± 11.40 cm,P<0.001))and the intraoperative blood loss in LHCL group was less than that in OHCL group(371.74±579.35 ml vs 116.82±71.61 ml,P=0.047).Four patients of OHCL group had blood transfusion,while no cases of LHCL group required blood transfusion.There were no significant differences statistically between LHCL and OHCL group of patients in total operative time,Pringle maneuver occlusion blocking rate and time(P>0.05).None of the cases underwent a conversion to open surgery.(3)The time for dieting after operation(1.75± 0.91d vs 1.06 ±0.25 d,P=0.004),time for removal of the abdominal cavity drainage tube(7.61 ±2.23 d vs 4.94±1.77 d,P<0.001),postoperative anal exhausting time(4.21±1.28 d vs 3.08±0.83 d,P=0.001)in OHCL group was longer than those in LHCL group.(4)The postoperative complication rate in OHCL group was higher than that in LHCL group,however,there were no statistically significant differences between LHCL and OHCL group of the postoperative complication rate(20.83%vs 12.50%,P=0.701).And all the complications occurred did not require a surgical revision.(5)The serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL)were increased Id after hepatiec audate lobeetomy both in the two group(P<0.05).The levels of ALT,AST,and TBIL in LHCL group 3 d and 5 d after operation were lower than those in 1d after operation,but still higher than those in pre-operation(P<0.05).Conclusions:(1)Compared to open operation,the Laparoscopic operation had advantages such as clear vision surgical vision,less blood loss and transfusion,which decrease the postoperative complication made by them.(2)The characteristic of Laparoscopic operation,such as smaller abdominal incision,faster postoperative recovery,lower postoperative complication rate and shorter postoperative hospital stay,supposed that Laparoscopic operation was effective,minimal invasive,safe and feasible with caudate lobe resection.(3)The changes of ALT,AST,and TBIL implied that both Laparoscopic and open operation could lead to hepatic injury and affect the hepatic function,however,the Laparoscopic operation was superior to open operation in aspects of post-operation functions Laparoscopic operation was superior to open operation in aspects of post-operation functions,and was an advantageous,implementable technique providing promising short-term postoperative outcomes.