Laparoscopic liver resection for F4 liver cirrhosis in Hepatocellular carcinoma

Shinjiro Tomiyasu, MD, Ryuma Tokunaga, MD, Hiroshi Tanaka, MD, Shinji Ishikawa, MD, Hiroki Sugita, MD, Tetsumasa Arita, MD, Yasushi Yagi, MD, Masahiko Hirota, MD, Tsuyoshi Yamanaka, MD, Toru Beppu, MD, Hideo Baba, MD

Kumamoto Regional Medical Center

Introduction: Laparoscopic liver resection (LLR) was published insurance by partial resection and left lateral segmentectomy in Japan. Progress of surgical tools and improvement of surgical procedure cased LLR spread out especially in Japan, Asia, Europe and United States. Laparoscopic partial resection is performed in HCC with liver cirrhosis and metastatic liver tumor. We examined the utility of the LLR in patients with cirrhosis.
Methods and Procedures: Patients (n=24) who underwent laparoscopic liver resection from 2008 in a retrospective analysis. These 24 patients are 19 men and 5 female. The age is 51-85 years old. The disease was 21-hepatocellular carcinoma (HCC), 2 metastatic liver cancers and one intrahepatic calculosis. As for the preoperative liver function, is liver damage degree A 21, B 4 and one re-hepatectomy. Indication for LLR is 5cm or less in tumor diameter, the surface area of the liver is preferable except of left lateral segment, and not apparently invasion to a surrounding tissue. The Hybrid method (laparoscopic assisted liver resection) performed in 14 patients, mobilization under a laparoscope and performed a hepatectomy from a small laparotomy wound. By the Pure-Lap method (totally laparoscopic liver resection) performed in 10 patients, we gradually raised intraabdominal pressure in 12cmHg, used CUSA and LCS for transection of the liver parenchyma using coagulation by BiClamp on the way. A vessel and the Glisson’s capsule used clips, ligation or linear staples. We examine it about a postoperative laboratory data and postoperative results for F2-3 HCC and F4 HCC.
Results: The fibrotic grade is F0-2 7, F3 5, and F4 12. With respect to HCC, the fibrotic grade is F2 4, F3 5, and F4 12. The bleeding, operative time, an SIRS rate until day 3 after surgery, CRP level on the postoperative third day, against the F2-3 HCC by the F4 HCC were not the difference in both groups. WBC level on the postoperative one day is lower (p=0.0205), postoperative complication is lower (p=0.0221), and postoperative hospitalization is tend to be shorter (p=0.081) in F4 HCC
Conclusion: Our outcome shows the feasibility of LLR for F4 HCC. When we perform partially resection for the HCC of the cirrhosis, LLR may be good in comparison with the laparotomy. We accumulate a case and want to review it in future.

Session: Poster Presentation

Program Number: P331

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