Laparoscopic right posterior sectionectomy in patients with hepatocellular carcinoma in the era of laparoscopic surgery

Jai Young Cho, Ho-Seong Han, Yoo-Seok Yoon, Dae Wook Hwang, Kyuwhan Jung, Young Ki Kim, Hong Kyung Shin, Woohyung Lee. Seoul National University Bundang Hospital, Seoul National University College of Medicine.

Background: Although there are only few reports on laparoscopic right posterior sectionectomy (RPS), it will become attractive operative method when the lesion is confined to right posterior section of the liver.

Method: Between September 2003 and June 2012, laparoscopic liver resection was performed in 408 patients in Seoul National University Bundang Hospital. We retrospectively evaluated clinical data for 24 patients who underwent laparoscopic RPS for hepatocellular carcinoma. For inflow control of portal triad, glissonian approach was common method for patients with HCC.

Results: The mean operation time was 567 min and the mean postoperative hospital stay was 10.6 ± 4.8 days. Mean tumor-free margin for HCC was 3.0 ± 5.8 cm. There were no deaths or major complications. Two complications occurred and were managed by percutaneous drainage. Three conversion to laparotomy occurred due to insufficient tumor margin in the early era of our experiences. Extended RPS (n = 6), which is composed of RPS and resection of RHV, was performed to obtain enough margin, when tumor was very close to RHV. 5-year overall and disease-free survival rate of patients with HCC was 66.5% and 37.8%, respectively.

Conclusion: Laparoscopic RPS is feasible in the hands of experienced surgeons, but more refinement of surgical technique is required to reduce operation time.

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