Background: Hepatectomy is the treatment of choice for hepatocellular carcinoma, but liver function disorders in many cases limit the resectability. Recently, ablation therapy such as radio waves and microwaves are progressing, and the number of nonoperative cases are increasing. However, for protruding-type tumors, the risk of tumor rupture or dissemination has been pointed out. For such cases, laparoscopic hepatectomy provides radical treatment and minimal invasiveness. For a hepatocellular carcinoma protruding out of the liver, in principle the cervix region of the tumor is ablated by microwaves, and excision is feasible using a laparosonic coagulating shears.
Aim and Methods: In our hospital, we started laparoscopic hepatectomy in August, 2000, and 23 cases were performed by May, 2008. 8 of those cases were hepatocellular carcinomas with protrusions outside the liver. We analyzed these cases for the location of the tumor, tumor diameter, preoperative liver function, operation time, amount of bleeding, postoperative complication and postoperative hospitalization days.
Results: The mean age of patients was 59.6 years old, with a sex ratio of 3 to 5. As for the location of tumors, there were 5 in the lateral segment, and 3 others were S4, S5, and S6 respectively. Tumor size ranged from 20 mm to 70 mm with an average of 38.3 mm. As for liver function, 6 were 5 in Child-Pugh score and 2 were 7. Mean operative time was 184.1 minutes, mean operative blood loss was 168.1 g, mean excision liver weight was 47.6 g. There was no case of conversion to laparotomy. Postoperative complications were only experienced by 2 patients; one wound infection and one wound bleeding. There was no mortality and the median hospital stay was 17.25 days.
Conclusion: Hepatocellular carcinoma with extrahepatic protrusion is a good indication of laparoscopic hepatectomy, because the liver cutting is small and it is rare for a vas to run around the tumor. Operations in our cases were done safely without complications. Laparoscopic hepatectomy for protrusion-type hepatocellular carcinoma is safe and minimally invasive.
Program Number: P390