Validity of laparoscopic liver resection for hepatocellular carcinoma with severe liver dysfunction

Masayasu Aikawa, MD, Mitsuo Miyazawa, MD, Shingo Ishida, MD, Yukihiro Watanabe, MD, Katsuya Okada, MD, Kojun Okamoto, MD, Shinichi Sakuramoto, MD, Shigeki Yamaguchi, MD, Isamu Koyama, MD. Saitama Medical University, International Medical Center

Introduction: Surgical resection is the most effective treatment method for hepatocellular carcinoma (HCC). However, surgical resection of HCC is often avoided because of the risk of liver dysfunction. We believe that laparoscopic liver resection (LLR) is less invasive and thus more effective for preserving liver function. Therefore, we introduce the use of LLR for HCCs with severe liver dysfunction (Child-Pugh class B or C), which are considered to be unresectable in other facilities.

In this study, we identified the advantages and limitations of using LLR for HCC with severe dysfunction in our facility, and determined the validity of LLR in comparison with open surgery for HCC with severe dysfunction.

Methods: Total LLR was performed in 180 patients between January 2008 and September 2015 at the Department of Gastrointestinal Surgery of Saitama Medical University International Medical Center, Saitama, Japan. LLR, as partial resection, was performed in 49 patients with severe liver dysfunction. The other group included cases treated with open partial liver resection (OLR) for HCC with severe dysfunction, before LLR was introduced. Our indication for LLR was decided according to patient performance status, tumor size of <4 cm, and tumor location on the surface. We performed liver resection under minimal mobilization and incision without the Pringle maneuver.

Results:The patients’ backgrounds did not significantly differ between the LLR and OLR groups. None of the patients who underwent LLR required conversion to laparotomy. The operative duration was 206 min (range, 50–470 min) in the LLR group and 175 min (45–355 min) in the OLR group, with no significant differences between the groups. Blood loss, AST peak value, and duration of hospital stay were 30 cc (0–850 cc) and 550 cc (30–1700 cc), 254 IU/L (80–1964 IU/L) and 359 IU/L (49–1601 IU/L), and 6 days (2–21 days) and 11.5 days (6–58 days) in the LLR and OLR groups, respectively; all these values significantly differed between the groups. Postoperative complications of Clavien-Dindo classification grade III or higher occurred in 2 cases in the LLR and 4 cases in the OLR group. No significant differences in surgical margin positivity rate and postoperative survival duration were observed between the LLR and OLR groups.

Conclusion:LLR was found to be safe and valid for the treatment of appropriately selected cases of HCC with severe liver dysfunction. Thus, we suggest LLR can serve as a novel treatment strategy for HCC with severe liver dysfunction.

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