Laparoscopic liver resection: 5-year experience at a single center

Abstract

Background Hepatocellular carcinoma (HCC) is a common cancer, especially in the Association of Southeast Asian Nations (ASEAN) region, where the prevalence of hepatitis virus infection is high. Liver resection is a potentially curative and popular therapy for HCC. Laparoscopic surgery using minimally invasive techniques potentially brings benefits to patients who need liver resection for HCC. This study aimed to evaluate the effectiveness, safety, and benefits of laparoscopic liver resection for HCC with long-term follow-up evaluation.MethodsThis cohort study with 5-year results of total laparoscopic hepatectomy for HCC was conducted in one center. Patients with HCC were selected for laparoscopic liver resection by the same team. The operation also was performed by one team of surgeons. The follow-up protocol was similar to that for open surgery. The patients were scheduled to return for examination every 2 months after the operation. The data for the patients were collected and analyzed using SPSS software.ResultsFrom January 2008 to December 2012, 173 enrolled patients with HCC underwent laparoscopic liver resection. The male-to-female ratio was 3:1. The mean age of the patients was 56 years (range 16–83 years). The follow-up period for 130 patients was 21.6 ± 16.0 months (range 0–60 months). The mean tumor size was 3.73 cm (range 2–10 cm). The stages of HCC according to the Barcelona Clinic Liver Cancer (BCLC) categorization were as follows: 0 (6 %), A1 (59.5 %), A2 (6.9 %), A4 (2.9 %), and B (27.2 %). Four patients required conversion to other techniques (2.3 %) because of the potential for major bleeding and tumor perforation. The types of resection were resection of one segment (segments 2, 3, 4, 5, 6, 7, and 8; 43.8 %), resection of two segments (posterior sector, anterior sector, segments 5 and 6, and left lateral sector; 47.9 %), resection of three segments (left and central liver; 4.7 %), and four segments (right liver; 3.6 %). The mean operation time was 112 ± 56 min (range 30–345 min), and the median blood loss was 100 ml (range 20–1,200 ml). The mean hospital stay was 6.5 ± 2.0 days (range, 3–19 days). No perioperative mortality occurred. The overall survival rates were 94.2 % at 1 year, 87 % at 2 years, 72.9 % at 3 years, 72.9 % at 4 years, and 72.9 % at 5 years. The mean overall survival time was 49.7 ± 2.1 months (range 45.5–53.9 months). The disease-free survival rates were 79.1 % at 1 year, 60 % at 2 years, 57 % at 3 years, 52 % at 4 years, and 26.3 % at 5 years. The mean disease-free survival time was 38.9 ± 2.6 months (range 33.9–44.0 months).ConclusionLaparoscopic liver resection for HCC is feasible, safe, and effective, with good oncologic results. Major and anatomic hepatectomy are possible with improved skill and experience. Laparoscopic liver resection is a promising treatment option with minimally invasive benefits for HCC patients.

Factors associated with and outcomes of open conversion after laparoscopic minor hepatectomy: initial experience at a single institution

“…Nonetheless, although we have demonstrated that open conversion results in poorer perioperative outcomes, it is imperative to remember that conversion per se should not be considered a failure or complication as patient safety and oncologic integrity is of utmost importance [10]. Conversion rates for LH have been reported to range from 0 to 55 % in the literature depending on the experience of the center and type of resections in the study [10,[20][21][22]. Some authors [15] have also proposed a policy of early conversion to reduce blood loss and operative time with the aim of improving patient safety.…”

Laparoscopic hepatectomy versus radiofrequency ablation for minimally invasive treatment of single, small hepatocellular carcinomas

“…LH may thus have advantages regarding tumor removal, while RFA may have advantage in relation to minimal invasiveness. Laparoscopic liver resection evolved from traditional liver resection, but is superior in several ways: It can be performed on a microscopic scale, offers a clean and clear surgical field, and allows for fine-featured anatomical resection [27]. It has thus been used extensively for more Fig.…”

Laparoscopic versus open liver resection for hepatocellular carcinoma at a North-American Centre: a 2-to-1 matched pair analysis

“…In the setting of chronic liver disease, many centres are reluctant to employ a laparoscopic resection owing to what were, initially, well‐founded technical concerns. However, there is now a growing body of literature to support the safety and adequacy of LLR in the setting of benign and metastatic disease . This study sought to examine the utility of LLR for HCC compared with OLR in a single, large volume, North American institution.…”