Laparoscopic liver resection for hepatocellular carcinoma

Dagher, Ibrahim; Laïnas, Panagiotis; Carloni, Alessio; Caillard, C.; Champault, Axèle; Smadja, Claude; Franco, Dominique

doi:10.1007/s00464-007-9487-2

Cited by 97 publications

(73 citation statements)

References 36 publications

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“…In line with previous published data [5,6], the present authors have already shown good operative and oncological mid-term results of LLS in patients with HCC on cirrhosis [7]. However, few studies have reported survival outcome or pattern of recurrence after LLR for HCC on cirrhosis.…”

Section: Introductionsupporting

confidence: 80%

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Laparoscopic Liver Resection for Hepatocellular Carcinoma in Cirrhosis: Long-Term Outcomes

et al. 2011

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Background:Few data regarding survival or pattern of recurrence after laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) on cirrhosis have been reported so far. Methods: A retrospective analysis of a prospectively maintained database of 109 laparoscopic interventional procedures performed for HCC in cirrhotic liver between 2000 and 2008 was conducted. Results: Sixty-five patients underwent an LLR. Morbidity rates were 20% (13/65), whereas there was only 1 death (1.5%). Reoperation was required in 2 patients. The overall mean postoperative hospital stay was 8.2 (2.6; 3–15) days. The actuarial overall 1-, 3-, and 5-year survival rates were 95, 70, and 55%, respectively, with a median overall survival of 75 months. Excluding the one hospital death, the actuarial 1-, 3-, and 5-year disease-free survival rates were 81, 62, and 32%, respectively, with a median overall disease-free survival of 42 months (95% confidence interval, CI: 18–65). On multivariate analysis, tumor grade (OR: 3.5, 95% CI: 1.1–10.7, p = 0.026) and microvascular invasion (OR: 4.9, 95% CI: 1.2–18.8, p = 0.020) resulted as independent predictors of overall survival. On multivariate analysis, gender (OR: 3.4, 95% CI: 1.1–10.2, p = 0.023), satellite tumor (OR: 4.3, 95% CI: 1.5–12.3, p = 0.006), microvascular invasion (OR: 3.3, 95% CI: 1.0–10.1, p = 0.036) and surgical margin (OR: 3.7, 95% CI: 1.0–10.1, p = 0.036) were identified as independent prognostic predictors of better disease-free survival. After a median follow-up of 29 (range 3–81) months, 31 (48%) out of 64 patients had recurrence. The cumulative recurrence rates at 1, 3, and 5 years were 19, 39, and 68%, respectively. Conclusion: This prospective observational study has confirmed the feasibility and safety of LLR in selected patients with HCC in cirrhotic liver, and proved that it can warrant long-term outcome similar to those reported with the traditional open approach.

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Section: Introductionsupporting

confidence: 80%

“…With the improvements of new technology and equipment, laparoscopic liver resection (LLR) has been progressively developed, and is now considered a safe procedure even in the management of liver tumors, if performed by experienced surgeons [5]. …”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Liver Resection for Hepatocellular Carcinoma in Cirrhosis: Long-Term Outcomes

et al. 2011

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“…The safety and feasibility of the laparoscopic approach and its short-term benefits for HCC patients with chronic liver dysfunction have been demonstrated by several series [21][22][23][24][25][26][27][28][29][30][31] . To date, several studies have investigated the major differences between laparoscopic hepatectomy and open hepatectomy (Tables 1 and 2) [32][33][34][35][36][37][38][39] .…”

Section: Laparoscopic Hepatectomy For Hcc Patients: An Overviewmentioning

confidence: 99%

Pure laparoscopic hepatectomy for hepatocellular carcinoma with chronic liver disease

Morise¹,

Kawabe

Kawase

et al. 2013

WJH

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Pure laparoscopic hepatectomy is a less invasive procedure than conventional open hepatectomy for the resection of hepatic lesions. Increases in experiences with the technique, in combination with advances in technology, have promoted the popularity of pure laparoscopic hepatectomy. However, indications for usage and potential contraindications of the procedure remain unresolved. The characteristics and specific advantages of the procedure, especially for hepatocellular carcinoma (HCC) patients with chronic liver diseases, are reviewed and discussed in this paper. For cirrhotic patients with liver tumors, pure laparoscopic hepatectomy minimizes destruction of the collateral blood and lymphatic flow from laparotomy and mobilization, and mesenchymal injury from compression. Therefore, pure laparoscopic hepatectomy has the specific advantage of minimal postoperative ascites production that leads to lowering the risk of disturbance in water or electrolyte balance and hypoproteinemia. It minimizes complications that routinely trigger postoperative serious liver failure. Under adequate patient positioning and port arrangement, the partial resection of the liver in the area of subphrenic space, peri-inferior vena cava area or next to the attachment of retro-peritoneum is facilitated in pure laparoscopic surgery by providing good vision and manipulation in the small operative field. Furthermore, the features of reduced post-operative adhesion, good vision, and manipulation within the small area between the adhesions make this procedure safer in the context of repeat hepatectomy procedures. These improved features are especially advantageous for patients with liver cirrhosis and multicentric and/or metachronous HCCs. Key words: Laparoscopic hepatectomy; Hepatocellular carcinoma; Liver cirrhosis; Chronic liver disease; Liver Tumor; Liver resection; Repeat hepatectomy; Bridging therapy to transplantation; Ascites; Postoperative liver failure Core tip: For cirrhotic patients with liver tumor, pure laparoscopic hepatectomy minimizes destruction of the collateral blood/lymphatic flow from laparotomy and mobilization, and has advantage of minimal postoperative ascites. It restrains the complications, which trigger the postoperative liver failure. The partial resection in the area of subphrenic space, peri-inferior vena cava area or next to the attachment of retro-peritoneum is facilitated with good vision and manipulation in the small operative field. Furthermore, repeat pure laparoscopic hepatectomy for patients with multicentric/ metachronous hepatocellular carcinomas was feasible and safe with the advantages of less post-operative adhesion and good vision and manipulation between the adhesions.

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“…Benefícios específicos do acesso VL são a preservação da parede abdominal e sua circulação colateral venosa, diminuindo assim o regime de hipertensão portal no pós-operatório, menor necessidade de reposição volêmica e melhor reabsorção da ascite pela preservação peritoneal 7 . Alguns grupos têm demonstrado benefício das ressecções laparoscópicas para pequenos CHC em cirróticos, com diminuição da morbidade, em especial na ocorrência de ascite pós-operatória 3,8,11,26 . Dois estudos caso-controle compararam os resultados de ressecções hepáticas VL e abertas em pacientes cirróticos.…”

Section: Tumores Primáriosunclassified

Ressecões hepáticas por videolaparoscopia

Herman¹,

Coelho²,

Lupinacci³

et al. 2009

ABCD, arq. bras. cir. dig.

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INTRODUÇÃOOs avanços técnicos da cirurgia videolaparoscópica (VL) transformaram a terapêutica cirúrgica de grande número de doenças. Com a constante evolução e advento de novas tecnologias a VL tem sido empregada com bons resultados na ressecção de diversos órgãos intra-abdominais e retroperitoneais, tais como estômago, cólon, rins, pâncreas, adrenal e baço 12 . No tratamento de algumas doenças, como colecistolitíase e doença do refluxo gastroesofágico, transformaram-se na terapêutica de escolha com vantagens inquestionáveis sobre a abordagem convencional 41 .Na cirurgia hepática, o emprego da via VL está bem estabelecido em alguns procedimentos como biópsias hepáticas, destelhamento de cistos hepáticos simples e drenagem de abscessos 17 . No entanto, as ressecções hepáticas representam umas das últimas fronteiras vencidas pela cirurgia VL 7,12,13 .Os fatores para essa dificuldade passam pelo risco teórico de embolia gasosa, potencial de sangramento intraoperatório incontrolável, incertezas sobre a obtenção de margens cirúrgicas adequadas e risco de disseminação tumoral nos casos de doenças malignas, além da necessidade de grande incorporação de tecnologia, como a necessária para secção do parênquima hepático (bisturi harmônico, grampeadores vasculares laparoscópicos, etc), transdutores laparoscópicos para ultrassonografia intra-operatória e necessidade de afastadores e instrumentais específicos para a mobilização hepática. Adicionalmente a curva de aprendizado do método é longa, exigindo cirurgiões com experiência em cirurgia hepática e formação em cirurgia VL avançada 7,13,23 . A primeira hepatectomia VL foi publicada por Gagner at al. 16 em 1992 para o tratamento de hiperplasia nodular focal hepática e, em 1995, Ferzl et al. 14 reportaram a ressecção de um adenoma hepático de 9 cm no segmento IV. A primeira hepatectomia regrada foi publicada por Azagra et al 1 . em 1996, que realizaram uma segmentectomia lateral esquerda em paciente com adenoma hepático. Ulteriormente a essas experiências iniciais, trabalhos subsequentes restringiam-se a relatos e séries de casos de poucos centros especializados. Só mais recentemente, em especial nos últimos cinco anos, é que os trabalhos sobre o tema cresceram de forma expressiva 1,7,24,38 . (4):226-32 RESUMO -Introdução -As ressecções hepáticas representam umas das últimas fronteiras vencidas pela cirurgia videolaparoscópica. Apesar da complexidade do procedimento, da demanda de grande incorporação de tecnologia e necessidade de experiência em cirurgia hepática e laparoscópica, a indicação do método tem crescido de forma expressiva nos últimos anos. Objetivo -Realizar análise crítica do método, baseada nos trabalhos existentes na literatura, ressaltando o estado atual de suas indicações, exequibilidade, segurança, resultados e aspectos técnicos primordiais. Mé-todo -Foram identificados e analisados os trabalhos pertinentes nas bases de dados LILACS e PUBMED até dezembro de 2009, utilizando-se os descritores "liver resection", "laparoscopic" e "liver surgery". Não foram enc...

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Laparoscopic liver resection for hepatocellular carcinoma

Abstract: Laparoscopic liver resection for HCC is feasible and well tolerated. Midterm survival and recurrence rates are similar to those after laparotomy.

Cited by 97 publications

References 36 publications

Laparoscopic Liver Resection for Hepatocellular Carcinoma in Cirrhosis: Long-Term Outcomes

Laparoscopic Liver Resection for Hepatocellular Carcinoma in Cirrhosis: Long-Term Outcomes

Pure laparoscopic hepatectomy for hepatocellular carcinoma with chronic liver disease

Ressecões hepáticas por videolaparoscopia

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