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René Adam - One of the best experts on this subject based on the ideXlab platform.
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Outcomes of Parenchyma-Preserving Hepatectomy and Right Hepatectomy for Solitary Small Colorectal Liver Metastasis: A LiverMetSurvey Study
Surgery, 2017Co-Authors: Isamu Hosokawa, Marc Antoine Allard, Real Lapointe, Gernot M. Kaiser, Alessandro Ferrero, Eduardo Barroso, Christophe Laurent, Darius F Mirza, Masaru Miyazaki, René AdamAbstract:Background Occasionally, right Hepatectomy, rather than parenchyma-preserving Hepatectomy, has been performed for solitary small colorectal liver metastasis. The relative oncologic benefits of parenchyma-preserving Hepatectomy and right Hepatectomy are unclear. This study compared the outcomes of patients with solitary small colorectal liver metastasis in the right liver who underwent parenchyma-preserving Hepatectomy and those who underwent right Hepatectomy. Methods The study population consisted of a multicentric cohort of 21,072 patients operated for colorectal liver metastasis between 2000 and 2015 whose data were collected in the LiverMetSurvey registry. Patients with a pathologically confirmed solitary tumor of less than 30 mm in size in the right liver were included. The short- and long-term outcomes of patients who underwent parenchyma-preserving Hepatectomy were compared to those of patients who underwent right Hepatectomy. Results Of the 1,720 patients who were eligible for the study, 1,478 (86%) underwent parenchyma-preserving Hepatectomy and 242 (14%) underwent right Hepatectomy. The parenchyma-preserving Hepatectomy group was associated with lower rates of major complications (3% vs 10%; P P = .008). Liver recurrence occurred similarly in both groups (20% vs 22%; P = .39). The 5-year recurrence-free survival and overall survival rates were similar in both groups. However, in patients with liver-only recurrence, repeat Hepatectomy was more frequently performed in the parenchyma-preserving Hepatectomy group than in the right Hepatectomy group (67% vs 31%; P P Conclusion Parenchyma-preserving Hepatectomy should be considered the standard procedure for solitary small colorectal liver metastasis in the right liver when technically feasible.
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outcome after associating liver partition and portal vein ligation for staged Hepatectomy and conventional two stage Hepatectomy for colorectal liver metastases
British Journal of Surgery, 2016Co-Authors: Marc Antoine Allard, René Adam, Eric Vibert, Katsunori Imai, Castro C BenitezAbstract:Background Although associating liver partition and portal vein ligation for staged Hepatectomy (ALPPS) has been increasingly adopted by many centres, the oncological outcome for colorectal liver metastases compared with that after two-stage Hepatectomy is still unknown. Methods Between January 2010 and June 2014, all consecutive patients who underwent either ALPPS or two-stage Hepatectomy for colorectal liver metastases in a single institution were included in the study. Morbidity, mortality, disease recurrence and survival were compared. Results The two groups were comparable in terms of clinicopathological characteristics. ALPPS was completed in all 17 patients, whereas the second-stage Hepatectomy could not be completed in 15 of 41 patients. Ninety-day mortality rates for ALPPS and two-stage resection were 0 per cent (0 of 17) versus 5 per cent (2 of 41) (P = 0·891). Major complication rates (Clavien grade at least III) were 41 per cent (7 of 17) and 39 per cent (16 of 41) respectively (P = 0·999). Overall survival was significantly lower after ALPPS than after two-stage Hepatectomy: 2-year survival 42 versus 77 per cent respectively (P = 0·006). Recurrent disease was more often seen in the liver in the ALPPS group. Salvage surgery was less often performed after ALPPS (2 of 8 patients) than after two-stage Hepatectomy (10 of 17). Conclusion Although major complication and 90-day mortality rates of ALPPS were similar to those of two-stage Hepatectomy, overall survival was significantly lower following ALPPS.
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repeat Hepatectomy for recurrent colorectal metastases
British Journal of Surgery, 2013Co-Authors: Dennis A Wicherts, René Adam, R J De Haas, C Salloum, Paola Andreani, G Pascal, Dobromir Sotirov, Denis CastaingAbstract:Background The oncological benefit of repeat Hepatectomy for patients with recurrent colorectal metastases is not yet proven. This study assessed the value of repeat Hepatectomy for these patients within current multidisciplinary treatment. Methods Consecutive patients treated by repeat Hepatectomy for colorectal metastases between January 1990 and January 2010 were included. Patients undergoing two-stage Hepatectomy were excluded. Postoperative outcome was analysed and compared with that of patients who had only a single Hepatectomy. Results A total of 1036 patients underwent 1454 hepatectomies for colorectal metastases. Of these, 288 patients had 362 repeat hepatectomies for recurrent metastases. Some 225 patients (78·1 per cent) had two hepatectomies, 52 (18·1 per cent) had three hepatectomies, and 11 patients (3·8 per cent) had a fourth Hepatectomy. Postoperative morbidity following repeat Hepatectomy was similar to that after initial liver resection (27·1 per cent after first, 34·4 per cent after second and 33·3 per cent after third Hepatectomy) (P = 0·069). The postoperative mortality rate was 3·1 per cent after repeat Hepatectomy versus 1·6 per cent after first Hepatectomy. Three- and 5-year overall survival rates following first Hepatectomy in patients who underwent repeat Hepatectomy were 76 and 54 per cent respectively, compared with 58 and 45 per cent in patients who had only one Hepatectomy (P = 0·003). In multivariable analysis, repeat Hepatectomy performed between 2000 and 2010 was the sole independent factor associated with longer overall survival. Conclusion Repeat Hepatectomy for recurrent colorectal metastases offers long-term survival in selected patients.
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comparison of simultaneous or delayed liver surgery for limited synchronous colorectal metastases
British Journal of Surgery, 2010Co-Authors: R J De Haas, René Adam, Eric Vibert, D A Wicherts, D Azoulay, H Bismuth, Chady Salloum, F Perdigao, Amine BenkabbouAbstract:BACKGROUND: The optimal surgical strategy for patients with synchronous colorectal liver metastases (CLMs) is still unclear. The aim of this study was to compare simultaneous colorectal and hepatic resection with a delayed strategy in patients who had a limited Hepatectomy (fewer than three segments). METHODS: All patients with synchronous CLMs who underwent limited Hepatectomy between 1990 and 2006 were included retrospectively. Short-term outcome, overall and progression-free survival were compared in patients having simultaneous colorectal and hepatic resection and those treated by delayed Hepatectomy. RESULTS: Of 228 patients undergoing Hepatectomy for synchronous CLMs, 55 (24.1 per cent) had a simultaneous colorectal resection and 173 (75.9 per cent) had delayed Hepatectomy. The mortality rate following Hepatectomy was similar in the two groups (0 versus 0.6 per cent respectively; P = 0.557), but cumulative morbidity was significantly lower in the simultaneous group (11 per cent versus 25.4 per cent in the delayed group; P = 0.015). Three-year overall and progression-free survival rates were 74 and 8 per cent respectively in the simultaneous group, compared with 70.3 and 26.1 per cent in the delayed group (overall survival: P = 0.871; progression-free survival: P = 0.005). Significantly more recurrences were observed in the simultaneous group at 3 years (85 versus 63.6 per cent; P = 0.002); a simultaneous strategy was an independent predictor of recurrence. CONCLUSION: Combining colorectal resection with a limited Hepatectomy is safe in patients with synchronous CLMs and associated with less cumulative morbidity than a delayed procedure. However, the combined strategy has a negative impact on progression-free survival.
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long term results of two stage Hepatectomy for irresectable colorectal cancer liver metastases
Annals of Surgery, 2008Co-Authors: Dennis A Wicherts, R J De Haas, Denis Castaing, R K Miller, Georgia Bitsakou, Eric Vibert, Lucantoine Veilhan, Daniel Azoulay, Henri Bismuth, René AdamAbstract:Objective:To assess feasibility, risks, and long-term outcome of 2-stage Hepatectomy as a means to improve resectability of colorectal liver metastases (CLM).Summary Background Data:Two-stage Hepatectomy uses compensatory liver regeneration after a first noncurative Hepatectomy to enable a second cu
Marc Antoine Allard - One of the best experts on this subject based on the ideXlab platform.
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Outcomes of Parenchyma-Preserving Hepatectomy and Right Hepatectomy for Solitary Small Colorectal Liver Metastasis: A LiverMetSurvey Study
Surgery, 2017Co-Authors: Isamu Hosokawa, Marc Antoine Allard, Real Lapointe, Gernot M. Kaiser, Alessandro Ferrero, Eduardo Barroso, Christophe Laurent, Darius F Mirza, Masaru Miyazaki, René AdamAbstract:Background Occasionally, right Hepatectomy, rather than parenchyma-preserving Hepatectomy, has been performed for solitary small colorectal liver metastasis. The relative oncologic benefits of parenchyma-preserving Hepatectomy and right Hepatectomy are unclear. This study compared the outcomes of patients with solitary small colorectal liver metastasis in the right liver who underwent parenchyma-preserving Hepatectomy and those who underwent right Hepatectomy. Methods The study population consisted of a multicentric cohort of 21,072 patients operated for colorectal liver metastasis between 2000 and 2015 whose data were collected in the LiverMetSurvey registry. Patients with a pathologically confirmed solitary tumor of less than 30 mm in size in the right liver were included. The short- and long-term outcomes of patients who underwent parenchyma-preserving Hepatectomy were compared to those of patients who underwent right Hepatectomy. Results Of the 1,720 patients who were eligible for the study, 1,478 (86%) underwent parenchyma-preserving Hepatectomy and 242 (14%) underwent right Hepatectomy. The parenchyma-preserving Hepatectomy group was associated with lower rates of major complications (3% vs 10%; P P = .008). Liver recurrence occurred similarly in both groups (20% vs 22%; P = .39). The 5-year recurrence-free survival and overall survival rates were similar in both groups. However, in patients with liver-only recurrence, repeat Hepatectomy was more frequently performed in the parenchyma-preserving Hepatectomy group than in the right Hepatectomy group (67% vs 31%; P P Conclusion Parenchyma-preserving Hepatectomy should be considered the standard procedure for solitary small colorectal liver metastasis in the right liver when technically feasible.
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outcome after associating liver partition and portal vein ligation for staged Hepatectomy and conventional two stage Hepatectomy for colorectal liver metastases
British Journal of Surgery, 2016Co-Authors: Marc Antoine Allard, René Adam, Eric Vibert, Katsunori Imai, Castro C BenitezAbstract:Background Although associating liver partition and portal vein ligation for staged Hepatectomy (ALPPS) has been increasingly adopted by many centres, the oncological outcome for colorectal liver metastases compared with that after two-stage Hepatectomy is still unknown. Methods Between January 2010 and June 2014, all consecutive patients who underwent either ALPPS or two-stage Hepatectomy for colorectal liver metastases in a single institution were included in the study. Morbidity, mortality, disease recurrence and survival were compared. Results The two groups were comparable in terms of clinicopathological characteristics. ALPPS was completed in all 17 patients, whereas the second-stage Hepatectomy could not be completed in 15 of 41 patients. Ninety-day mortality rates for ALPPS and two-stage resection were 0 per cent (0 of 17) versus 5 per cent (2 of 41) (P = 0·891). Major complication rates (Clavien grade at least III) were 41 per cent (7 of 17) and 39 per cent (16 of 41) respectively (P = 0·999). Overall survival was significantly lower after ALPPS than after two-stage Hepatectomy: 2-year survival 42 versus 77 per cent respectively (P = 0·006). Recurrent disease was more often seen in the liver in the ALPPS group. Salvage surgery was less often performed after ALPPS (2 of 8 patients) than after two-stage Hepatectomy (10 of 17). Conclusion Although major complication and 90-day mortality rates of ALPPS were similar to those of two-stage Hepatectomy, overall survival was significantly lower following ALPPS.
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Oncological benefit of parenchyma-preserving Hepatectomy for colorectal liver metastasis.
Journal of Clinical Oncology, 2016Co-Authors: Isamu Hosokawa, Marc Antoine Allard, Catherine Hubert, Real Lapointe, Gernot M. Kaiser, Hidetoshi Nitta, Gennaro Nuzzo, Eduardo Barroso, Darius F Mirza, Lorenzo CapussottiAbstract:3526Background: Occasionally, major Hepatectomy (MH), rather than parenchyma-preserving Hepatectomy (PH), is performed for solitary colorectal liver metastasis (CLM). It is unclear whether PH has a...
Denis Castaing - One of the best experts on this subject based on the ideXlab platform.
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repeat Hepatectomy for recurrent colorectal metastases
British Journal of Surgery, 2013Co-Authors: Dennis A Wicherts, René Adam, R J De Haas, C Salloum, Paola Andreani, G Pascal, Dobromir Sotirov, Denis CastaingAbstract:Background The oncological benefit of repeat Hepatectomy for patients with recurrent colorectal metastases is not yet proven. This study assessed the value of repeat Hepatectomy for these patients within current multidisciplinary treatment. Methods Consecutive patients treated by repeat Hepatectomy for colorectal metastases between January 1990 and January 2010 were included. Patients undergoing two-stage Hepatectomy were excluded. Postoperative outcome was analysed and compared with that of patients who had only a single Hepatectomy. Results A total of 1036 patients underwent 1454 hepatectomies for colorectal metastases. Of these, 288 patients had 362 repeat hepatectomies for recurrent metastases. Some 225 patients (78·1 per cent) had two hepatectomies, 52 (18·1 per cent) had three hepatectomies, and 11 patients (3·8 per cent) had a fourth Hepatectomy. Postoperative morbidity following repeat Hepatectomy was similar to that after initial liver resection (27·1 per cent after first, 34·4 per cent after second and 33·3 per cent after third Hepatectomy) (P = 0·069). The postoperative mortality rate was 3·1 per cent after repeat Hepatectomy versus 1·6 per cent after first Hepatectomy. Three- and 5-year overall survival rates following first Hepatectomy in patients who underwent repeat Hepatectomy were 76 and 54 per cent respectively, compared with 58 and 45 per cent in patients who had only one Hepatectomy (P = 0·003). In multivariable analysis, repeat Hepatectomy performed between 2000 and 2010 was the sole independent factor associated with longer overall survival. Conclusion Repeat Hepatectomy for recurrent colorectal metastases offers long-term survival in selected patients.
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atp release after partial Hepatectomy regulates liver regeneration in the rat
Journal of Hepatology, 2010Co-Authors: E Gonzales, Daniel Azoulay, B Julien, Valerie Serrierelanneau, Alexandra Nicou, Isabelle Doignon, Laura Lagoudakis, Isabelle Garcin, Jeancharles Duclosvallee, Denis CastaingAbstract:Background & Aims Paracrine interactions are critical to liver physiology, particularly during regeneration, although physiological involvement of extracellular ATP, a crucial intercellular messenger, remains unclear. The physiological release of ATP into extracellular milieu and its impact on regeneration after partial Hepatectomy were investigated in this study. Methods Hepatic ATP release after Hepatectomy was examined in the rat and in human living donors for liver transplantation. Quinacrine was used for in vivo staining of ATP-enriched compartments in rat liver sections and isolated hepatocytes. Rats were treated with an antagonist for purinergic receptors (Phosphate-6-azo(benzene-2,4-disulfonic acid), PPADS), and liver regeneration after Hepatectomy was analyzed. Results A robust and transient ATP release due to acute portal hyperpressure was observed immediately after Hepatectomy in rats and humans. Clodronate liposomal pre-treatment partly inhibited ATP release in rats. Quinacrine-stained vesicles, co-labeled with a lysosomal marker in liver sections and isolated hepatocytes, were predominantly detected in periportal areas. These vesicles significantly disappeared after Hepatectomy, in parallel with a decrease in liver ATP content. PPADS treatment inhibited hepatocyte cell cycle progression after Hepatectomy, as revealed by a reduction in bromodeoxyuridine incorporation, phosphorylated histone 3 immunostaining, cyclin D1 and A expression and immediate early gene induction. Conclusion Extracellular ATP is released immediately after Hepatectomy from hepatocytes and Kupffer cells under mechanical stress and promotes liver regeneration in the rat. We suggest that in hepatocytes, ATP is released from a lysosomal compartment. Finally, observations made in living donors suggest that purinergic signalling could be critical for human liver regeneration.
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long term results of two stage Hepatectomy for irresectable colorectal cancer liver metastases
Annals of Surgery, 2008Co-Authors: Dennis A Wicherts, R J De Haas, Denis Castaing, R K Miller, Georgia Bitsakou, Eric Vibert, Lucantoine Veilhan, Daniel Azoulay, Henri Bismuth, René AdamAbstract:Objective:To assess feasibility, risks, and long-term outcome of 2-stage Hepatectomy as a means to improve resectability of colorectal liver metastases (CLM).Summary Background Data:Two-stage Hepatectomy uses compensatory liver regeneration after a first noncurative Hepatectomy to enable a second cu
Eric Vibert - One of the best experts on this subject based on the ideXlab platform.
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outcome after associating liver partition and portal vein ligation for staged Hepatectomy and conventional two stage Hepatectomy for colorectal liver metastases
British Journal of Surgery, 2016Co-Authors: Marc Antoine Allard, René Adam, Eric Vibert, Katsunori Imai, Castro C BenitezAbstract:Background Although associating liver partition and portal vein ligation for staged Hepatectomy (ALPPS) has been increasingly adopted by many centres, the oncological outcome for colorectal liver metastases compared with that after two-stage Hepatectomy is still unknown. Methods Between January 2010 and June 2014, all consecutive patients who underwent either ALPPS or two-stage Hepatectomy for colorectal liver metastases in a single institution were included in the study. Morbidity, mortality, disease recurrence and survival were compared. Results The two groups were comparable in terms of clinicopathological characteristics. ALPPS was completed in all 17 patients, whereas the second-stage Hepatectomy could not be completed in 15 of 41 patients. Ninety-day mortality rates for ALPPS and two-stage resection were 0 per cent (0 of 17) versus 5 per cent (2 of 41) (P = 0·891). Major complication rates (Clavien grade at least III) were 41 per cent (7 of 17) and 39 per cent (16 of 41) respectively (P = 0·999). Overall survival was significantly lower after ALPPS than after two-stage Hepatectomy: 2-year survival 42 versus 77 per cent respectively (P = 0·006). Recurrent disease was more often seen in the liver in the ALPPS group. Salvage surgery was less often performed after ALPPS (2 of 8 patients) than after two-stage Hepatectomy (10 of 17). Conclusion Although major complication and 90-day mortality rates of ALPPS were similar to those of two-stage Hepatectomy, overall survival was significantly lower following ALPPS.
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comparison of simultaneous or delayed liver surgery for limited synchronous colorectal metastases
British Journal of Surgery, 2010Co-Authors: R J De Haas, René Adam, Eric Vibert, D A Wicherts, D Azoulay, H Bismuth, Chady Salloum, F Perdigao, Amine BenkabbouAbstract:BACKGROUND: The optimal surgical strategy for patients with synchronous colorectal liver metastases (CLMs) is still unclear. The aim of this study was to compare simultaneous colorectal and hepatic resection with a delayed strategy in patients who had a limited Hepatectomy (fewer than three segments). METHODS: All patients with synchronous CLMs who underwent limited Hepatectomy between 1990 and 2006 were included retrospectively. Short-term outcome, overall and progression-free survival were compared in patients having simultaneous colorectal and hepatic resection and those treated by delayed Hepatectomy. RESULTS: Of 228 patients undergoing Hepatectomy for synchronous CLMs, 55 (24.1 per cent) had a simultaneous colorectal resection and 173 (75.9 per cent) had delayed Hepatectomy. The mortality rate following Hepatectomy was similar in the two groups (0 versus 0.6 per cent respectively; P = 0.557), but cumulative morbidity was significantly lower in the simultaneous group (11 per cent versus 25.4 per cent in the delayed group; P = 0.015). Three-year overall and progression-free survival rates were 74 and 8 per cent respectively in the simultaneous group, compared with 70.3 and 26.1 per cent in the delayed group (overall survival: P = 0.871; progression-free survival: P = 0.005). Significantly more recurrences were observed in the simultaneous group at 3 years (85 versus 63.6 per cent; P = 0.002); a simultaneous strategy was an independent predictor of recurrence. CONCLUSION: Combining colorectal resection with a limited Hepatectomy is safe in patients with synchronous CLMs and associated with less cumulative morbidity than a delayed procedure. However, the combined strategy has a negative impact on progression-free survival.
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long term results of two stage Hepatectomy for irresectable colorectal cancer liver metastases
Annals of Surgery, 2008Co-Authors: Dennis A Wicherts, R J De Haas, Denis Castaing, R K Miller, Georgia Bitsakou, Eric Vibert, Lucantoine Veilhan, Daniel Azoulay, Henri Bismuth, René AdamAbstract:Objective:To assess feasibility, risks, and long-term outcome of 2-stage Hepatectomy as a means to improve resectability of colorectal liver metastases (CLM).Summary Background Data:Two-stage Hepatectomy uses compensatory liver regeneration after a first noncurative Hepatectomy to enable a second cu
Jia Hong Dong - One of the best experts on this subject based on the ideXlab platform.
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preserving hepatic artery flow during portal triad blood inflow occlusion improves remnant liver regeneration in rats after partial Hepatectomy
Journal of Surgical Research, 2013Co-Authors: Pengfei Wang, Yong Wei Chen, Chong Hui Li, Aiqun Zhang, Jia Hong DongAbstract:BACKGROUND: In the present study, we compared preservation of the hepatic artery flow during liver blood inflow occlusion with total portal triad blood flow clamping (the Pringle maneuver) to examine their effects on liver regeneration in rats after partial Hepatectomy. MATERIALS AND METHODS: Male Wistar rats were randomized to a control group (without hepatic inflow occlusion), an occlusion of the portal triad (OPT) group (OPT for 30 min under portal blood bypass), and an occlusion of the portal vein (OPV) group (OPV only for 30 min under portal blood bypass). All the rats underwent partial Hepatectomy at the end of hepatic blood control. Liver regeneration was assessed on days 3 and 7 after Hepatectomy. Liver damage, extracellular signal-regulated kinase-1/2 activation, and cytokine expression of the remnant liver in the first 24 h after Hepatectomy were also assessed. RESULTS: Significantly greater liver regeneration, at a level similar to that of the control group, as indicated by the percentage of the initial liver weight, proliferating cell nuclear antigen and Ki-67 labeling indexes, and technetium-99m galactosyl human serum albumin liver uptake, was observed in the OPV group on day 3 after Hepatectomy (P < 0.05 versus the OPT group). Liver damage, as represented by alanine aminotransferase and aspartate aminotransferase measurement and histopathologic examination, was substantially alleviated in the OPV group compared with the OPT group. In contrast to the control and OPV groups, the OPT group had markedly increased extracellular signal-regulated kinase-1/2 activation, heat shock protein 70, and interleukin-6 expression in response to ischemia and partial Hepatectomy. CONCLUSIONS: Our results have indicated that compared with the Pringle maneuver, clamping the portal vein while preserving the hepatic artery flow during partial Hepatectomy is better for remnant liver regeneration at an early postHepatectomy stage.
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robotic assisted laparoscopic anatomic Hepatectomy in china initial experience
Annals of Surgery, 2011Co-Authors: Hongguang Wang, Zhiming Zhao, Weidong Duan, Jia Hong DongAbstract:Objective To assess the feasibility and safety of robotic-assisted laparoscopic anatomic Hepatectomy. Background The development of minimally invasive surgery has led to an increase in the use of laparoscopic Hepatectomy. However, laparoscopic Hepatectomy remains technically challenging and is not widely developed. Robotic surgery represents a recent evolution in minimally invasive surgery that is being used increasingly for complex minimally invasive surgical procedures. Herein, we report our initial experience with robotic-assisted laparoscopic anatomic Hepatectomy in 13 consecutive patients. Patients and methods Between April and July 2009, 13 consecutive patients underwent robotic-assisted laparoscopic anatomic hepatectomies for benign and malignant hepatic diseases. Major hepatectomies were performed in 9 patients, left lateral sectionectomies in 4 patients. Eight major hepatectomies were for malignant diseases and 5 hepatectomies (1 left Hepatectomy and 4 left lateral sectionectomies) were for benign diseases. All the robotic-assisted Hepatectomy procedures were performed anatomically with hilum dissection. Prior to starting the parenchymal transaction, vascular control of the portal vessels was carried out whenever possible. These robotic-assisted laparoscopic anatomic hepatectomies were compared with 20 traditional laparoscopic hepatectomies and 32 open resections that were contemporaneous and cohort-matched. Results All 13 robotic-assisted laparoscopic anatomic hepatectomies were performed successfully in the manner of pure laparoscopic resection. No conversion to laparotomy or hand-assisted laparoscopic resection occurred. Despite its longer operative time (338 minutes) and higher hospital cost ($12,046), robotic liver surgery compared favorably with traditional laparoscopic Hepatectomy and open resection in blood loss (280 vs. 350, 470 mL), transfusion requirement (0 vs. 3 of 20, 4 of 32), use of the Pringle maneuver (0 vs. 3 of 20, 6 of 32) and overall operative complications (7.8% vs. 10%,12.5%). Neither ascites nor transient hepatic decompensation occurred in the robotic group. The surgical margins in all 8 patients with malignant lesions were negative and as yet, no intrahepatic recurrences or metastases have been observed in the robotic group. The mean postoperative stay was shorter with the traditional laparoscopic procedure (5.2 days) than with robotic (6.7 days)or open surgery (9.6 days). Conversions from traditional laparoscopic to open and hand-assisted laparoscopic resection occurred in 2 patients (10.0%) who underwent right hemiHepatectomy and left Hepatectomy, respectively. Conclusions These preliminary results show that robotic-assisted laparoscopic anatomic Hepatectomy is safe and feasible with a much lower complication and conversion rate than traditional laparoscopic Hepatectomy or open resection. The robotic surgical system may broaden the indications for laparoscopic hepatactomy, and it enabled the surgeon to perform precise laparoscopic liver resection which required hylum dissection, hepatocaval dissection, endoscopic suturing, and microanastamosis. However, more long-term, evidence-based outcomes will be necessary to prove its efficacy, and further research on its cost-effectiveness is still required.