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Updated: Jun 28, 2025
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Laparoscopic Left Hemihepatectomy Combined with Caudate Lobe Resection
Published on: April 11, 2025
137
Laparoscopic Versus Open Hemihepatectomy: The ORANGE II PLUS Multicenter Randomized Controlled Trial
Robert S Fichtinger1,2, Luca A Aldrighetti3, Mohammed Abu Hilal4,5
1Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands.
Summary
Laparoscopic major liver resection (hemihepatectomy) offers faster functional recovery and better quality of life compared to open surgery. This approach also speeds up adjuvant therapy for cancer patients without compromising outcomes.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Major liver resections, including hemihepatectomy, are complex procedures for primary or metastatic liver cancer.
- Traditional open surgery carries significant recovery times and potential impacts on quality of life.
- Advancements in minimally invasive techniques, such as laparoscopy, offer potential benefits in surgical recovery and patient outcomes.
Purpose of the Study:
- To compare functional recovery, morbidity, and quality of life (QoL) after laparoscopic versus open major liver resection (hemihepatectomy).
- To evaluate oncologic outcomes, including resection margin status and time to adjuvant therapy, in patients with cancer undergoing hemihepatectomy.
Main Methods:
- A multicenter, randomized controlled, patient-blinded, superiority trial involving adult patients undergoing hemihepatectomy.
- Data collected from 16 European hospitals between November 2013 and December 2018.
- Primary outcome: time to functional recovery; Secondary outcomes: morbidity, QoL, resection margins, time to adjuvant therapy.
Main Results:
- Laparoscopic hemihepatectomy showed a significantly shorter median time to functional recovery (4 days vs. 5 days; P < .001).
- No significant difference in major complication rates between laparoscopic and open approaches (14.5% vs. 16.9%; P = .58).
- Laparoscopic surgery led to significantly higher QoL scores (global health status and body image) and a shorter time to adjuvant systemic therapy for cancer patients (P = .009).
Conclusions:
- Laparoscopic hemihepatectomy provides a faster functional recovery compared to open surgery.
- The laparoscopic approach is associated with improved quality of life and expedited adjuvant therapy for cancer patients.
- Laparoscopic major liver resection is a safe and effective alternative to open surgery, with enhanced recovery and oncologic benefits.
