Outcome of pure laparoscopic hepatectomy for hepatocellular carcinoma in patient with cirrhosis and thrombocytopenia

Tan To Cheung, MS. The University of Hong Kong Queen Mary Hospital

Introduction

Bleeding in the presence of thrombocytopenia has been a major issue in liver resection even in open procedures. Although laparoscopic liver resection has been reported to be a safe and effective treatment even in patients with liver cirrhosis, there is very little evidence on patients with thrombocytopenia.

Method: Between October 2002 and September 2015, 131 patients had undergone curative pure laparoscopic liver resection for solitary hepatocellular carcinoma (HCC). Thrombocytopenia was define as platelet counts <100x 109/L. Amongst 131, patients received laparoscopic liver resection, 16 patients had platelet count <100x 109/L (Group 1). Another 116 patients with platelet count equal or more than 100x 109/L (Group 2). The immediate operation outcome and survival including operation morbidity, were compared. The disease free survival and median survival were also compared.

Results:

Comparing Group1 to Group 2, the median operation time was 184 minutes vs 175 minutes p=0.582, the median blood loss was 200 ml vs 100 ml (P=0.189). 1 patient (6.3%) from Group 1 had blood transfusion and 3 patients (2.9%) from Group 2 had blood transfusion. (p=1) The hospital stay was 4 days vs 4 days (P=0.984), postoperative complication was 3 (18.8%) vs 8(7.8%) (p=0.351), There was no hospital mortality in both groups of patients. The overall median survival was >114.1 months vs 136.1 months (P=0.289).

Conclusion:

Pure laparoscopic liver resection is a safe treatment option for HCC. Good outcome is observed in patients even with low platelet count.