Feasibility of laparoscopic hepatectomy of malignant liver tumors under the day surgery management model: based on concept of enhanced recovery after surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Jiakao ^1,2 , HAN Chuangye ^1,2 , PENG Kai ^1,2 , WU Longyan ³ , QIAN Jing ⁴ ,  PENG Tao ^1,2

1. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, P. R. China;
2. Guangxi Key Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, Nanning 530021, P. R. China;
3. Day Surgery Center, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, P. R. China;
4. Medical Insurance Management Office, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, P. R. China;

Corresponding author：

PENG Tao, Email: pengtaogmu@163.com

Keywords：

same-day surgery; enhanced recovery after surgery; laparoscopic hepatectomy; malignant liver tumor

DOI：

10.7507/1007-9424.202506040

Video：

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Objective To explore the feasibility of laparoscopic hepatectomy of malignant liver tumors under the day surgery management model based on the concept of enhanced recovery after surgery (ERAS). Methods Three patients who underwent same-day laparoscopic resection of malignant liver tumors in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Guangxi Medical University from June to November 2022 were retrospectively collected. The clinical application effects of this model were comprehensively evaluated. Results All 3 patients (cases 1–3) successfully completed complete laparoscopic anatomical partial liver resection, with operation times of 155, 183, and 201 min, respectively, and intraoperative blood loss of all <100 mL (20, 100, and 50 mL, respectively). Postoperative pathology confirmed that cases 1 and 2 were hepatocellular carcinoma, and case 3 was colorectal adenocarcinoma with liver metastasis, and the resection margins all met the R0 standard. All patients resumed oral feeding 6 h after surgery and were able to get out of bed within 8 h after surgery. All 3 patients were discharged within 24 h after surgery. The hospitalization cost of the three patients was (22 602.0±3 400.0) yuan. All patients were followed up for more than 24 months and maintained a tumor-free survival state, without tumor recurrence and metastasis. Conclusion The results of this limited cases suggest that same-day laparoscopic liver resection is initially feasible and safe for strictly selected patients with liver malignancies combined with a standardized ERAS management pathway.

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2.	韩超, 祝学梅, 王莹, 等. 日间医疗的规范化发展思考. 实用医学杂志, 2024, 40(8): 1038-1041.
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6.	Reich H, McGlynn F, Wilkie W. Laparoscopic excision of benign liver lesions. Obstet Gynecol, 1991, 78(5 Pt 2): 956-958.
7.	Ban D, Tanabe M, Kumamaru H, et al. Safe dissemination of laparoscopic liver resection in 27, 146 cases between 2011 and 2017 from the National Clinical Database of Japan. Ann Surg, 2021, 274(6): 1043-1050.
8.	Ibuki S, Hibi T, Tanabe M, et al. Short-term outcomes of “Difficult” laparoscopic liver resection at specialized centers: Report from INSTALL (International Survey on Technical Aspects of Laparoscopic Liver Resection)-2 on 4 478 Patients. Ann Surg, 2022, 275(5): 940-946.
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11.	中国心胸血管麻醉学会日间手术麻醉分会, “基于术后加速康复的日归手术全程管理专家共识”工作组. 基于术后加速康复的日归手术全程管理专家共识. 中华麻醉学杂志, 2023, 43(4): 385-399.
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14.	Yeung KTD, Vellaisamy R, Hussain A, et al. Introduction of day-case robotic liver surgery: a case series from a tertiary hepatobiliary and pancreatic centre. Surg Endosc, 2024, 38(8): 4329-4335.
15.	潘立超, 王兆海, 刘荣. 日间肝切除术2例报道. 中华腔镜外科杂志(电子版), 2024, 17(4): 253-256.
16.	李志超, 王煜, 王小成, 等. 基于快速康复外科理念的疼痛管理模式在日间腹腔镜胆囊切除术的应用. 华西医学, 2015, 30(5): 804-807.
17.	林德新, 李旋, 张勇, 等. 加速康复外科程序在肝胆管结石肝切除术中的应用. 中国普通外科杂志, 2018, 27(2): 169-174.
18.	方宁波, 陈伟力. 腹腔镜胆囊切除术日间手术围术期指标观察及患者延迟出院原因分析. 江西医药, 2022, 57(10): 1524-1527.
19.	胡若男, 胡超华. 快速康复理念下多模式镇痛在腹腔镜胆囊切除术中的应用研究. 实用肝脏病杂志, 2018, 21(5): 777-780.
20.	陈相军, 宋应寒, 陈敏, 等. 四川大学华西医院日间手术质量和安全管理规范. 华西医学, 2019, 34(2): 155-158.
21.	汤佳祯. 基于快速康复外科理念的多学科协作模式在腹腔镜下肝切除患者围手术期护理中的应用. 文科技期刊数据库(引文版)医药卫生, 2022, 11(11): 16-19.
22.	叶志霞. 加速康复外科理念在肝切除围手术期护理中的应用思考. 上海护理, 2022, 22(10): 1-5.
23.	俞德梁, 刘小南. 日间手术发展展望. 医学与哲学, 2022, 43(22): 61-64.

1. Nicoll JH. The surgery of infancy. Br Med J, 1909, 2(753): 4-5.
2. 韩超, 祝学梅, 王莹, 等. 日间医疗的规范化发展思考. 实用医学杂志, 2024, 40(8): 1038-1041.
3. 乐逵, 朱岭. 快速康复外科在腹腔镜肝切除术围手术期的应用效果研究. 现代医药卫生, 2021, 37(7): 1220-1222.
4. 孙辉, 王凯, 朱宏, 等. 2016-2022年我国日间手术术式变化及对日间手术规范化发展的思考. 中国医院, 2022, 26(8): 10-13.
5. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
6. Reich H, McGlynn F, Wilkie W. Laparoscopic excision of benign liver lesions. Obstet Gynecol, 1991, 78(5 Pt 2): 956-958.
7. Ban D, Tanabe M, Kumamaru H, et al. Safe dissemination of laparoscopic liver resection in 27, 146 cases between 2011 and 2017 from the National Clinical Database of Japan. Ann Surg, 2021, 274(6): 1043-1050.
8. Ibuki S, Hibi T, Tanabe M, et al. Short-term outcomes of “Difficult” laparoscopic liver resection at specialized centers: Report from INSTALL (International Survey on Technical Aspects of Laparoscopic Liver Resection)-2 on 4 478 Patients. Ann Surg, 2022, 275(5): 940-946.
9. Zhu P, Liao W, Zhang WG, et al. A prospective study using propensity score matching to compare long-term survival outcomes after robotic-assisted, laparoscopic, or open liver resection for patients with bclc stage 0–A hepatocellular carcinoma. Ann Surg, 2023, 277(1): e103-e111. doi: 10.1097/SLA.0000000000005380.
10. Tranchart H, Fuks D, Lainas P, et al. Laparoscopic liver surgery: towards a day-case management. Surg Endosc, 2017, 31(12): 5295-5302.
11. 中国心胸血管麻醉学会日间手术麻醉分会, “基于术后加速康复的日归手术全程管理专家共识”工作组. 基于术后加速康复的日归手术全程管理专家共识. 中华麻醉学杂志, 2023, 43(4): 385-399.
12. 加速康复外科专家委员会, 中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识暨路径管理指南(2018): 肝胆手术部分. 中华麻醉学杂志, 2018, 38(1): 13-18.
13. Rebibo L, Leourier P, Badaoui R, et al. Minor laparoscopic liver resection as day-case surgery (without overnight hospitalisation): a pilot study. Surg Endosc, 2019, 33(1): 261-271.
14. Yeung KTD, Vellaisamy R, Hussain A, et al. Introduction of day-case robotic liver surgery: a case series from a tertiary hepatobiliary and pancreatic centre. Surg Endosc, 2024, 38(8): 4329-4335.
15. 潘立超, 王兆海, 刘荣. 日间肝切除术2例报道. 中华腔镜外科杂志(电子版), 2024, 17(4): 253-256.
16. 李志超, 王煜, 王小成, 等. 基于快速康复外科理念的疼痛管理模式在日间腹腔镜胆囊切除术的应用. 华西医学, 2015, 30(5): 804-807.
17. 林德新, 李旋, 张勇, 等. 加速康复外科程序在肝胆管结石肝切除术中的应用. 中国普通外科杂志, 2018, 27(2): 169-174.
18. 方宁波, 陈伟力. 腹腔镜胆囊切除术日间手术围术期指标观察及患者延迟出院原因分析. 江西医药, 2022, 57(10): 1524-1527.
19. 胡若男, 胡超华. 快速康复理念下多模式镇痛在腹腔镜胆囊切除术中的应用研究. 实用肝脏病杂志, 2018, 21(5): 777-780.
20. 陈相军, 宋应寒, 陈敏, 等. 四川大学华西医院日间手术质量和安全管理规范. 华西医学, 2019, 34(2): 155-158.
21. 汤佳祯. 基于快速康复外科理念的多学科协作模式在腹腔镜下肝切除患者围手术期护理中的应用. 文科技期刊数据库(引文版)医药卫生, 2022, 11(11): 16-19.
22. 叶志霞. 加速康复外科理念在肝切除围手术期护理中的应用思考. 上海护理, 2022, 22(10): 1-5.
23. 俞德梁, 刘小南. 日间手术发展展望. 医学与哲学, 2022, 43(22): 61-64.

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