Totally Laparoscopic Liver Resection for Hepatocellular Carcinoma Located in All Segments of the Liver

Introduction: Laparoscopic liver resection (LLR) is still not a well established treatment modality for hepatocelluar carcinoma (HCC). Moreover, most of reported cases have been limited to the anterolateral segments (segments 2, 3, 4b, 5, 6). We evaluate the clinical and oncologic outcome after LLR for HCC including the lesions located in the posterosuperior segments (segments 1, 4a, 7, 8). Methods and Procedures: Sixty-nine patients underwent LLR for HCC between September 2003 and September 2008. LLR was applied to the lesions in all segments with totally laparoscopic procedure unless the tumor was close to the hilum or the main hepatic veins. We retrospectively analyzed the clinical outcome of the 64 patients, excluding 5 patients requiring conversion to open surgery. Results: The operative type of resection were tumorectomy (n=18), segmentectomy (n=18), left-lateral sectionectomy (n=8), left hemihepatectomy (n=3), right hemihepatectomy (n=5), right posterior sectionectomy (n=10), central bisectionectomy (n=1) and caudate lobectomy (n=1). Mean tumor size was 3.3 cm and mean resection margin was 1.5 cm. Mean operative time was 274.8 minutes and intraoperative transfusion was needed in 19 patients (29.7%). There was no postoperative mortality. Postopereative complications occurred in 15 cases (23.4 %), which were improved by conservative management. Mean postoperative hospital stay was 9.7 days. After a mean follow-up of 20.1 months, recurrence was detected in 16 patients (25.0 %): intrahepatic (n=14), extrahepatic (n=1) and both (n=1). The sites of intrahepatic recurrence were ipsilateral (n=3), contralateral (n=6) and bilateral (n=6). The cumulative 3-year overall survival and disease-free survival rates were 87.8% and 67.3%, respectively. Conclusions: Our experience shows that LLR can be safely applied to HCC in all segments of the liver with acceptable survival and recurrence rates.

Session: Podium Presentation

Program Number: S041

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