RESUMEN
Liver resection in secondary liver tumors may associated with the consequences of posthepatectomy liver failure (PHLF). Systematic extended right posterior sectionectomy (SERPS) is offered as an alternative to resect secondary liver tumors in segment 6-7 with vascular invasion of right hepatic vein, with less risk of PHLF compared to right hepatectomy. This case series is important to demonstrate the effectivity and safety of SERPS procedure performed in developing country. Cases presentation: The authors reported the case of four patients that underwent SERPS procedure due to metachronous and synchronous liver metastases caused by gastric gastrointestinal stromal tumor and colorectal cancer. Thulium doped fiber laser and harmonic scalpel were used as an energy device. Intra and postoperative parameters were evaluated. SERPS data was collected in 2020-2021 at Prof. dr. R.D. Kandou General Hospital. There were no postoperative complications and no tumor recurrences were found in all four patients in two years surveillance. Clinical discussion: Liver resection poses a relatively moderate risk of mortality and morbidity. Nowadays, parenchyma-sparing liver surgery is the procedure of choice compared to major liver resection whenever feasible. SERPS was first developed to minimize the need for major resection. SERPS may serve as a first-choice procedure due to its superior safety and comparable effectivity compared to major hepatectomy. Conclusion: SERPS is a safe and promising alternative for secondary liver tumors at segments 6-7 and right hepatic vein vascular invasion, compared to right hepatectomy. Thus, minimizing the risk of PHLF by saving a larger volume of future liver remnant.
RESUMEN
INTRODUCTION: Several modalities are used to improve the outcome of liver resection surgery. Laser-based surgery may become promising option; therefore we aim to report our experience regarding the efficacy and safety of Thulium-Doped Fiber Laser (TDFL) 1940 nm in liver parenchyma resection. METHODS: A cross sectional study in which patients with pre-existing liver pathology during July 2019 and July 2020 were randomly assigned to receive liver resection using TDFL integrated with raman laser emitting at 1940 nm and 1470 nm wavelength. Data on estimated blood loss during liver transection, liver transection speed, morbidity rate, and postoperative variables including complications, length of hospital stay (days), and mortality were analyzed. RESULTS: A total of 17 consecutive liver resections were performed, among them are 7 major and 11 minor hepatectomies. The Multipulse TM+1470 were used on 8 procedures consisted of 1 major and 7 minor hepatectomies, the mean amount of blood loss during operation and liver transection was 628.13 ± 141.31 mL and 294.63 ± 94.81 ml, respectively. The mean liver transection speed was 1.52 ± 0.27 cm2/min. No biliary leak, post-hepatectomy-liver failure, and mortality were reported. CONCLUSION: TDFL provided by Multipulse TM+1470 is an effective and safe tool for liver surgery, providing good hemostasis and allowing for safe and effective exposure of vascular. Further study with larger samples might be needed proved the efficacy and safety of TDFL in liver surgery.