Laparoscopic major hepatectomy (LMH) remains restricted to a few specialized centers and poses a challenge to surgeons performing laparoscopic resections. Laparoscopic extended resections are even more complex and rarely conducted. From a single-institution database, we compared the short-term outcomes of patients who underwent major and extended laparoscopic resections, stratifying the entire retrospective cohort into four groups: right hepatectomy, left hepatectomy, right extended hepatectomy, and left extended hepatectomy. Patient demographics, tumor characteristics, operative variables, and especially postoperative outcomes were evaluated. 250 patients underwent major and extended laparoscopic liver resections, including 160 right, 31 right extended, 36 left, and 23 left extended laparoscopic hepatectomies. The most common indication for resection was colorectal liver metastases (64%). Laparoscopic extended hepatectomy (LEH) showed significantly longer operative time, more blood loss, need for Pringle maneuver, conversion to open surgery, higher rates of liver failure, postoperative ascites, and intra-abdominal hemorrhage, R1 margins and length of stay when compared with the LMH group. Mortality rates were similar between groups. Multivariate analysis revealed intraoperative blood transfusion (OR = 5.1[CI-95%: 1.15–6.79]; p = 0.02) as an independent predictor for major complications. LEH showed to be feasible, however with higher blood loss and significantly associated to major complications.

中文翻译：

---

腹腔镜扩大肝切除术与主要肝切除术的短期结果：单中心经验

腹腔镜主要肝切除术（LMH）仍然仅限于少数专业中心，这对进行腹腔镜切除术的外科医生构成了挑战。腹腔镜扩大切除术更加复杂且很少进行。我们从单一机构数据库中比较了接受大腹腔镜切除术和扩大腹腔镜切除术的患者的短期结果，将整个回顾性队列分为四组：右肝切除术、左肝切除术、右扩大肝切除术和左扩大肝切除术。评估了患者人口统计、肿瘤特征、手术变量，尤其是术后结果。250 例患者接受了主要和扩大的腹腔镜肝切除术，其中右侧 160 例、右侧扩大 31 例、左侧 36 例和左侧扩大腹腔镜肝切除术 23 例。最常见的切除指征是结直肠肝转移（64%）。与腹腔镜扩大肝切除术（LEH）相比，腹腔镜扩大肝切除术（LEH）的手术时间明显更长，失血量更多，需要普林格手术，转开腹手术，肝功能衰竭、术后腹水和腹内出血、R1切缘和住院时间更高。 LMH组。各组之间的死亡率相似。多变量分析显示术中输血（OR = 5.1[CI-95%：1.15–6.79]；p = 0.02）是主要并发症的独立预测因素。LEH 被证明是可行的，但失血量较多，并且与主要并发症显着相关。