Introduction: We have pursued laparoscopic hepatectomy as a means of surgical therapy for hepatocellular carcinoma (HCC) since 1993. Recent experience has persuaded us that there are great potential benefits in laparoscopic hepatectomy. In this paper, the outcomes of laparoscopic hepatectomy focus on HCC were analysed and compared with conventional open hepatectomy.
Method and Procedure: Laparoscopic hepatectomies were carried out on 108 cases, including 69 cases of HCC. It represents 31% of all liver resections performed during same periods in our hospital.
The important considerations in determining indications for laparoscopic hepatectomy include tumor size, type and location. Nodular tumors smaller than 4 cm or pedunculated tumors smaller than 7 cm are suitable candidates. Concerning location, tumors in the lower segment and the left lateral segment are good candidates. Favourable operative procedure are partial hepatectomy and left lateral sectionectomy. Recently, we have successfully experienced of laparoscopic hepatectomy of recurrece HCC, Giant HCC or tumor located upper segment and hemihepatectomy. The operative procedures were 37 partial hepatectomy cases, 20 left lateral segmentectomy cases, 2 S6 segmentectomy , 2 posterior sectionectomy cases, 2 left hemihepatectomy cases and 1 right hemihepatectomy case.
Results: There were notable differences in blood loss and operating time compared with open hepatectomy (O-Hr), although We have accumulated laparoscopic hepatectomy cases, operative time in recent cases has decreased with less bleeding. To evaluate the less invasive surgery, we utilized an E-PASS (Estimation of Physiologic Ability and Surgical Stress) scoring system. Although there was no difference in preoperative risk score, significantly inferior values were noted in the surgical stress and comprehensive risk scores in O-Hr the compared to the L-Hrs.
In the postoperative course, oral intake, ambulation and hospital stay values were significantly shorter in the L-Hr compared to the O-Hr. The rate of postoperative complications did not significantly differ between the 2 groups.
The five-year survival rate and the survival rate without recurrences for HCCs are almost same as that by open conventional hepatectomy although further analysis would certainly be necessary to reach definitive conclusions.
Conclusion: Laparoscopic hepatectomy is beneficial for the patients’ quality of life as a minimally invasive. Laparoscopic hepatectomy in the patient with HCC appears to be a viable surgical alternative in selected cases. This procedure is expected to develop further in the future as a new surgical method for HCC.
Program Number: P437