Initial experiences in 70 cases of
Totally Laparoscopic Liver resection for HCC
Background
Laparoscopic surgery now is commonly applied for several kinds of different operations, but laparoscopic liver resection is still under survey. The objective of this study was to evaluate the feasibility and safety of this technique for HCC
Patients and methods
Perspective and descriptive study. From Sep 2005 to Feb 2008, we performed laparoscopic liver resections for 70 patients with HCC.The accompanied cirrhosis was in fifty two patients – 74% (51 with Child A and 1 with Child B); mean tumor size 3.75 cm (2-10) and tumor locations were as follows:
- 31 (44.3%) in left lateral segment,
- 4 (5.7 %) in segment IVb,
- 13 (18.6%) in segment V,
- 12 (17.1%) in segment VI,
- 2 (2.9%) in segment VII,
- 1 (1.4%) in segment VIII
- 3 (4.3%) in the posterior segments
- 4 (5.7%) in segment V and VI
Results
We performed 31 cases of one segmentectomy include:
- 4 cases of segment II, 2 of segment III, 4 of segment IV, 8 of segment V, 11 of segment VI, 1 of segment VII and 1 of segment VIII.
There were 33 cases of bisegmentectomy include:
- 24 (34.3%) cases of left lateral segmentectomies,
- 3 (4.3%) posterior segmentectomy,
- 6 (8.6%) V-VI bisegmentectomy.
After Laparoscopic Diagnostic operation, three (4,3%) patients were not suitable for liver resection because of severe cirrhosis. One of them underwent RFA and 2 had TACE after operation.
We had 3 (4.3%) patients converted to other procedures because of severe intraoperative bleeding. We converted to open operation after right hepatic vein was injured in one patient, or performed Minilaparotomy to control bleeding and continued to transect the parechymal laparoscopically in one, and converted to hand-assissted to define the tumor and divided the parechymal in the other.
Mean operation time was 118 minutes (30-240).
Mean Blood loss was 221 ml (0-1000ml) that required no blood transfusion.
Hospital stay was 6.23 days (4-17 days).
The Surgical margin less than 1cm was in 13 (18.5%) patients; from 1 to 2cm was in 37 (61.5%) and more than 2cm in 14 (20%) patients. But we had only one positive surgical margin.
There was no postoperative complication and no mortality.
After 10-month follow-up (1–31 months) there are 3 recurrence cases and two of them can be reoperated (one open and 1 laparscopic operations).
Conclusion:
Laparoscopic liver resection is feasible and safe for selective patients with peripheral tumors located in the left lobe or in the segment IVb, V, VI, VII of the right liver.
Session: Podium Presentation
Program Number: S017