Laparoscopic Liver Resection for Hepatocellular Carcinoma

Osamu Itano, MD PhD, Minoru Tanabe, MD PhD, Shigeyuki Kawachi, MD PhD, Masahiro Shinoda, MD PhD, Go Oshima, MD, Yoshihiro Ono, MD, Noriyuki Tani, MD, Ryo Nishiyama, MD, Hiroto Fujisaki, MD, Kysho Mihara, MD, Tomonori Fujimura, MD, Yoshie Kadota, MD. Departmentt of Surgery, Keio University, School of Medicine, Tokyo, Japan, Department of Surgery, Eiju General Hospital, Tokyo, Japan

INTRODUCTION: The purpose of this work was to evaluate the midterm results of the laparoscopic liver resections for hepatocellular carcinoma.
METHODS: From January 2006 to September 2010, there were 40 laparoscopic (-assisted) liver resection for hepatocellular carcinoma carried out at our hospital. The patients comprised of 34 males and 6 females with a mean age of 67.7+-9.3 years. Eighteen patients were HCV-positive and 9 were HBV-positive. Others without viral infection consisted of 10 alcoholic hepatitis and 3 NASH. The background of the resected livers were 18 Child-pugh A and 22 Child-Pugh B. Laparoscopic-assisted procedures consisted of laparoscopic mobilization of the target organs, followed by open resection and reconstruction through an 8-12 cm extraction site.
RESULTS:As to limited resections, tumor mean size was 2.7+-1.3cm (1.2 to 7.5cm). Totally laparoscopic methods were performed in 13 cases and laparoscopic-assisted method in 11 cases. The mean operative time was 318+-103minutes. The mean blood loss was264+-307ml and no blood transfusion was required. Conversion to laparotomy was required in one patient. Postoperative morbidity rate was 12.5% (3 cases) and the mortality rate was 4% (1 case; strangulation ileus). Mean postoperative hospital stay was 14.8+-14.7 days.
As to anatomical resections, there were 3 subsegmentectomies, 6 lateral segmentectomy, 3 anterior sectionectomies, 2 posterior sectionectomy, 1 left hepatectomy , 1 right hepatectomy. The tumor mean size was 3.2+-1.4cm (1.7 to 5.5cm). Totally laparoscopic methods were performed in 6 cases and laparoscopy-assisted method in 10 cases. The mean operative time was 400+-160minutes. The mean blood loss was 626+-685ml and no blood transfusion and no conversion to laparotomy was required. Postoperative morbidity rate was 31.3% (5 cases) and the mortality rate was 0%. Mean postoperative hospital stay was 16.5+-11.0 days.
Pathological examination showed R0 resections in all cases. Recurrence was detected in 10 cases during a mean-follow-up of 19.3 months. However, no peritoneal carcinomatosis or port-site or resection site recurrence was observed.
CONCLUSION: Laparoscopic liver resection for hepatocellular carcinoma is feasible and safe. But more data may be needed for evaluation of long-term outcome.