Preliminary Experience of Laparoscopic Hepatectomy in Hepatocellular Carcinoma

Introduction: Laparoscopic liver resection has gained much popularity in the recent years, but relatively few centers have performed hepatectomies in hepatocellular carcinoma (HCC) patients due to the technical difficulties faced with underlying liver cirrhosis. We herein present the initial experience of laparoscopic liver resection in HCC performed in a single institution.
Methods: From October 2003 until March 2009, 39 laparoscopic liver resections were performed on HCC patients among whom 26 had underlying liver cirrhosis.
Results: The cause of HCC was hepatitis B in 35, C in 1, alcoholic in 2, and unknown in 1. All patients were Child A except one B and the median indocyanin green retention at 15 minutes was 9.95% (0.2-69.3%). The location of the tumor was in the left lateral section in 15, segment 5 or 6 in 20, segment 4 in 3 and caudate lobe in 1. Resection involving less than monosegment was done in 31 and more than 2 segments in 8. Tumor size ranged from 0.8cm to 6.6cm (median 2.35) and the resection margin from 0.1 to 6cm (median 1.5cm). All patients were either stage I (29) or II (10). The median operation time was 210 minutes (60-637). Only one patient required transfusion. The median change of hematocrit before and 7 days after operation was 4.8% (-1~19.6) and no difference was noted between cirrhotic and non-cirrhotic patients (p=0.348). There was 1 wound complication, and 2 myocardial infarct and, 1 delayed gastric empting and all recovered uneventfully. The median hospital stay was 8 days (3~67days). The median follow up duration was 15.1 months. 2-year disease free survival rate was 48.3% and only one death occurred due to recurrence of HCC and progression of cirrhosis 58 months after operation. Two year disease free survival was 83.9% in non-cirrhotic compared to 35.2% in cirrhotic patients (p=0.182), and 58.8% in T1 compared to 23.7% in T2 (p=0.745).
Conclusion: Laparoscopic liver resection in HCC is feasible with minimal morbidity in cases with early stage HCC irrespective of underlying cirrhosis and the midterm results are comparable with the previous reports. However a longer follow up is needed to evaluate its impact in the long term recurrence of HCC and patient survival.