Laparoscopic left lateral sectionectomy can be standard operation even in patients with cirrhosis

Chami Im, Jai Young Cho, Ho-Seong Han, Yoo-Seok Yoon, YoungRok Choi, Woohyung Lee. Departments of Surgery, Seoul National University Bundang Hospital

Background: Laparoscopic treatment is considered as standard procedure for left lateral sectionectomy (LLS), showing better outcome compared to open LLS. However, laparoscopic LLL in patients with cirrhosis is still controversial.

Methods: We evaluated data of 107 patients who underwent laparoscopic LLS between July 2003 and July 2013. The patients were classified into two groups according to the presence of pathologically proven cirrhosis or not; group A (presence of cirrhosis; n = 22) and group B (absence of cirrhosis; n = 85). Intraoperative and postoperative functional outcomes were compared between two groups. And we analyzed surgical and oncological outcomes of laparoscopic LLS for hepatocellular carcinoma (HCC).

Results: There were no differences between two groups in terms of median operation time and blood loss (P = 0.960 and 0.144, respectively). The rate of transfusion was also similar between two groups (13.6% vs. 7.06%; P = 0.387). Conversion to laparotomy occurred in no patient in group A and one patients in group B (1.18%; P = 1.000). Postoperative peak results of total bilirubin was higher in group A than group B (median 1.3 mg/dL vs. 1.10 mg/dL; P = 0.023), while there was no difference in postoperative complication rate (18.18% vs. 22.35%; P = 0.778) and hospital stay (7 days vs. 7 days; P = 0.719). No statistically significant difference in disease free survival (P = 0.988) and overall survival (P = 0.409) between the cirrhotic and non-cirrhotic groups in HCC. When compared with open LLS in study period (n = 12), there was no difference in the complications (21.5 % vs 41.67%; P = 0.080), operation time (165 min vs 190 min; P = 0.505), blood loss (200 mL vs 300 mL; P = 0.173), transfusion rate (9% vs 1%; P = 1.00) and hospital day (7 days vs 7 days; P = 0.381) between laparoscopic and open LLS groups.

Conclusion: Laparoscopic LLS could be standard operation even in patients with cirrhosis.

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