Surgical Endoscopy

, Volume 27, Issue 8, pp 2721–2726

Laparoscopic left hemihepatectomy a consideration for acceptance as standard of care

Authors

    • S. Maria Loreto Nuovo Hospital, General and Hepato-Pancreato-Biliary Surgery
  • Brice Gayet
    • Department of Digestive Diseases, Institut Mutualiste MontsourisUniversity Paris V
  • Ho-Seong Han
    • Department of SurgerySeoul National University Bundang Hospital
  • Go Wakabayashi
    • Iwate Medical University, Surgery Keio University
  • Ki-hun Kim
    • Division of Hepatobiliary Surgery and Liver TransplantationUniversity of Ulsan College of Medicine and Asan Medical Centre
  • Robert Cannon
    • Division of Surgical Oncology, Department of SurgeryUniversity of Louisville
  • Hironori Kaneko
    • Department of SurgeryToho University School of Medicine
  • Thomas Gamblin
    • Division of Surgical OncologyMedical College of Wisconsin
  • Alan Koffron
    • William Beaumont Hospital
  • Ibrahim Dagher
    • Department of Digestive and Minimally Invasive Surgery, AP-HPAntoine Béclère Hospital
  • Joseph F. Buell
    • Department of SurgeryTulane University School of Medicine
  • International Consensus Group for Laparoscopic Liver Surgery
Article

DOI: 10.1007/s00464-013-2840-8

Cite this article as:
Belli, G., Gayet, B., Han, H. et al. Surg Endosc (2013) 27: 2721. doi:10.1007/s00464-013-2840-8

Abstract

Introduction

Since the inception of laparoscopic liver surgery, the left-lateral sectionectomy has become the standard of care for resection of lesions located in segments II and III. However, few centers employee laparoscopic left hemihepatectomy on a routine basis. This study evaluated the safety and efficacy of the laparoscopic left hemihepatectomy as a standard of care.

Methods

An international database of 1,620 laparoscopic liver resections was established and outcomes analyzed comparing the laparoscopic left lateral sectionectomy (L lat) to laparoscopic left hemihepatectomy (LH). All data are presented as mean ± standard deviation.

Results

A total of 222 laparoscopic L lat and 82 LH were identified. The L lat group compared with LH group had a higher incidence of cirrhosis (27 vs. 21 %; p = 0.003) and cancer (48 vs. 35 %; p = 0.043). Tumors were larger in the LH group (7.09 ± 4.2 vs. 4.89 ± 3.1 cm; p = 0.001). Operating time for LH was longer than L lat (3.9 ± 2.3 vs. 2.9 ± 1.4 h; p < 0.001). Operative blood loss was higher in LH (306 vs. 198 cc; p = 0.003). Patient morbidity (20 vs. 18 %; p = 0.765) was equivalent with a longer length of stay (7.1 ± 5.1 vs. 2.5 ± 2.3 days; p < 0.001) for LH. Patient mortality and tumor recurrence were equivalent.

Conclusions

Laparoscopic left hemihepatectomy is a more technically challenging and often time-consuming procedure than a left-lateral sectionectomy. This international multi-institutional confirmed that intraoperative blood loss, complications, and conversions are more than acceptable for laparoscopic left hemihepatectomy in expert hands. Postoperative morbidity and mortality rates together with adequate surgical margins and long-term recurrence are not compromised by the laparoscopic approach.

Keywords

HemihepatectomyLeft liverLaparoscopic resection

Copyright information

© Springer Science+Business Media New York 2013