Ibrahim A Salama, MDPhD, Hosam Soliman, Hazem Zakeria, Mohammed Aboushady. Department of Hepatobiliary Suregry,Menoufiyia University,Egypt
Background: The optimal treatment for Hepatocellular Carcinoma is surgical resection .however, only a small percentage of patients are operative candidates due to associated liver cirrhosis. With progress of technology, laparoscopic liver resection in cirrhosis becomes challenge.
Aim: To assess the feasibility and safety of laparoscopic liver resection in cirrhotic patients.
Patients &Methods: This is a prospective study on 46 patients with HCC with cirrhosis referred from HCC clinic at National Liver Institute, Menoufyia University. Hepatic involvement had to be limited in the left lobe or peripheral right lobe segments (segment 2-6). Tumor had to be 5 cm or less. Laparoscopic hepatic resection was done with a harmonic scalpel and or Habib 4 X needle without porta hepatis clamping. Staplers were used on the portal triad and hepatic veins.
Results: From July 2011 to July 2015, 46 patients of HCC with cirrhosis (18.5%) out of 248 patients were subjected to laparoscopic liver resection in cirrhotic liver (Child A & early B). Laparoscopic resections including 14 segment III, 6 segment II, 5 bisgmentectomy II&III, 3 segment IVB, 5 segment V and 13 segment VI. There were 4 conversions to open due to uncontrolled bleeding. Mean operative time 130 minutes. There was one mortality due to liver cell failure, and morbidity in 4 patients (2 ascitis, 1 Bleeding, 1 pneumonia). Negative safety margins in all patients with no recurrence in follow up period (6-33 months).
Conclusion: With excellent use of existing technology Laparoscopic liver resection become feasible and safe options in cirrhotic patients with liver tumors.