Surgical Endoscopy

, Volume 22, Issue 2, pp 372–378

Laparoscopic liver resection for hepatocellular carcinoma

  • Ibrahim Dagher
  • Panagiotis Lainas
  • Alessio Carloni
  • Cécile Caillard
  • Axèle Champault
  • Claude Smadja
  • Dominique Franco
Article

Abstract

Background

Single, small hepatocarcinomas (HCC) are still an indication for partial liver resection in patients ineligible for transplantation. Anatomical resections are recommended for oncological reasons. The mini-invasive approach of laparoscopy should minimize hepatic and parietal injury, thereby decreasing the risk of liver failure and ascites. However, the oncological results of this approach and its presumed benefits remain undemonstrated. We evaluated the short- and midterm results of laparoscopic liver resections for HCC.

Methods

Between 1999 and 2006, we performed 32 laparoscopic liver resections for HCC. Mean tumor size was 3.8 ± 2 cm and the mean age of the patients was 65 ± 11 years. Twenty-two patients had cirrhosis (21 Child A and one Child C). Operative and postoperative results were analyzed, together with recurrence and survival rates.

Results

We carried out 13 unisegmentectomies, nine bisegmentectomies, one trisegmentectomy, two right hepatectomies, one left hepatectomy, and six atypical resections. The duration of the operation was 231 ± 101 minutes. Conversion to laparotomy was required in three patients (9%), none in emergency situations. Mean blood loss was 461 ml, with five patients (15.6%) requiring blood transfusion. The mean surgical margin was 10.4 mm. One cirrhotic patient (Child C) underwent surgery for a partially ruptured tumor and died of liver failure. Two patients had ascites and no transient liver failure occurred in the other 19 cirrhotic patients. Mean hospital stay was 7.1 days. During a mean follow-up of 26 months, 10 patients (31%) presented recurrence within the liver. None of the patients had peritoneal carcinomatosis or trocar site recurrence. Three-year overall and disease-free survival rates were 71.9% and 54.5%, respectively.

Conclusions

Laparoscopic liver resection for HCC is feasible and well tolerated. Midterm survival and recurrence rates are similar to those after laparotomy.

Keywords

Laparoscopy Liver resection Hepatocarcinoma 

References

  1. 1.
    Morino M, De Giuli M, Festa V, Garrone C (1994) Laparoscopic management of symptomatic nonparasitic cysts of the liver. Indications and results. Ann Surg 219:157–164CrossRefPubMedGoogle Scholar
  2. 2.
    Falcone RE, Wanamaker SR, Barnes F, Baxter CG, Santanello SA (1993) Laparoscopic vs. open wedge biopsy of the liver. J Laparoendosc Surg 3:325–329PubMedGoogle Scholar
  3. 3.
    Rogula T, Gagner M (2004) Current status of the laparoscopic approach to liver resection. J Long Term Eff Med Implants 14:23–31CrossRefPubMedGoogle Scholar
  4. 4.
    Kaneko H, Takagi S, Shiba T (1996) Laparoscopic partial hepatectomy and left lateral segmentectomy: technique and results of a clinical series. Surgery 120:468–475CrossRefPubMedGoogle Scholar
  5. 5.
    Katkhouda N, Hurwitz M, Gugenheim J, Mavor E, Mason RJ, Waldrep DJ, Rivera RT, Chandra M, Campos GM, Offerman S, Trussler A, Fabiani P, Mouiel J (1999) Laparoscopic management of benign solid and cystic lesions of the liver. Ann Surg 229:460–466CrossRefPubMedGoogle Scholar
  6. 6.
    Mouiel J, Katkhouda N, Gugenheim J, Fabiani P (2000) Possibilities of laparoscopic liver resection. J Hepatobiliary Pancreat Surg 7:1–8CrossRefPubMedGoogle Scholar
  7. 7.
    Gagner M, Rogula T, Selzer D (2004) Laparoscopic liver resection: benefits and controversies. Surg Clin North Am 84:451–462CrossRefPubMedGoogle Scholar
  8. 8.
    Gutt CN, Riemer V, Kim ZG, Erceg J, Lorenz M (2001) Impact of laparoscopic surgery on experimental hepatic metastases. Br J Surg 88:371–375CrossRefPubMedGoogle Scholar
  9. 9.
    Targarona EM, Martinez J, Nadal A, Balague C, Cardesa A, Pascual S, Trias M (1998) Cancer dissemination during laparoscopic surgery: tubes, gas, and cells. World J Surg 22:55–60; discussion 60–61CrossRefPubMedGoogle Scholar
  10. 10.
    Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, Christensen E, Pagliaro L, Colombo M, Rodes J (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430CrossRefPubMedGoogle Scholar
  11. 11.
    Llovet JM, Fuster J, Bruix J (1999) Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 30:1434–1440CrossRefPubMedGoogle Scholar
  12. 12.
    Yao FY, Bass NM, Nikolai B, Davern TJ, Kerlan R, Wu V, Ascher NL, Roberts JP (2002) Liver transplantation for hepatocellular carcinoma: analysis of survival according to the intention-to-treat principle and dropout from the waiting list. Liver Transpl 8:873–883CrossRefPubMedGoogle Scholar
  13. 13.
    Komorizono Y, Oketani M, Sako K, Yamasaki N, Shibatou T, Maeda M, Kohara K, Shigenobu S, Ishibashi K, Arima T (2003) Risk factors for local recurrence of small hepatocellular carcinoma tumors after a single session, single application of percutaneous radiofrequency ablation. Cancer 97:1253–1262CrossRefPubMedGoogle Scholar
  14. 14.
    Scott DJ, Fleming JB, Watumull LM, Lindberg G, Tesfay ST, Jones DB (2002) The effect of hepatic inflow occlusion on laparoscopic radiofrequency ablation using simulated tumors. Surg Endosc 16:1286–1291CrossRefPubMedGoogle Scholar
  15. 15.
    Buell JF, Thomas MJ, Doty TC, Gersin KS, Merchen TD, Gupta M, Rudich SM, Woodle ES (2004) An initial experience and evolution of laparoscopic hepatic resectional surgery. Surgery 136:804–811CrossRefPubMedGoogle Scholar
  16. 16.
    Teramoto K, Kawamura T, Takamatsu S, Noguchi N, Nakamura N, Arii S (2003) Laparoscopic and thoracoscopic partial hepatectomy for hepatocellular carcinoma. World J Surg 27:1131–1136CrossRefPubMedGoogle Scholar
  17. 17.
    Morino M, Morra I, Rosso E, Miglietta C, Garrone C (2003) Laparoscopic vs. open hepatic resection: a comparative study. Surg Endosc 17:1914–1918CrossRefPubMedGoogle Scholar
  18. 18.
    Gigot JF, Glineur D, Santiago Azagra J, Goergen M, Ceuterick M, Morino M, Etienne J, Marescaux J, Mutter D, van Krunckelsven L, Descottes B, Valleix D, Lachachi F, Bertrand C, Mansvelt B, Hubens G, Saey JP, Schockmel R (2002) Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg 236:90–97CrossRefPubMedGoogle Scholar
  19. 19.
    Yamanaka N, Tanaka T, Tanaka W, Yamanaka J, Yasui C, Ando T, Takada M, Maeda S, Okamoto E (1998) Laparoscopic partial hepatectomy. Hepatogastroenterology 45:29–33PubMedGoogle Scholar
  20. 20.
    Ker CG, Chen HY, Juan CC, Chang WS, Tsai CY, Lo HW, Yau MT (2000) Laparoscopic subsegmentectomy for hepatocellular carcinoma with cirrhosis. Hepatogastroenterology 47:1260–1263PubMedGoogle Scholar
  21. 21.
    Kaneko H, Takagi S, Otsuka Y, Tsuchiya M, Tamura A, Katagiri T, Maeda T, Shiba T (2005) Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg 189:190–194CrossRefPubMedGoogle Scholar
  22. 22.
    Cherqui D, Laurent A, Tayar C, Chang S, Van Nhieu JT, Loriau J, Karoui M, Duvoux C, Dhumeaux D, Fagniez PL (2006) Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg 243:499–506CrossRefPubMedGoogle Scholar
  23. 23.
    Dagher I, Proske JM, Carloni A, Richa H, Tranchart H, Franco D (2007) Laparoscopic liver resection: results for 70 patients. Surg Endosc 21:619–624CrossRefPubMedGoogle Scholar
  24. 24.
    Dagher I, Franco D (2007) Right Hepatectomy by laparoscopic approach. J Chir (Paris) 144:47–51Google Scholar
  25. 25.
    Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362:1907–1917CrossRefPubMedGoogle Scholar
  26. 26.
    Shimada M, Hashizume M, Maehara S, Tsujita E, Rikimaru T, Yamashita Y, Tanaka S, Adachi E, Sugimachi K (2001) Laparoscopic hepatectomy for hepatocellular carcinoma. Surg Endosc 15:541–544CrossRefPubMedGoogle Scholar
  27. 27.
    Laurent A, Cherqui D, Lesurtel M, Brunetti F, Tayar C, Fagniez PL (2003) Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 138:763–769; discussion 769CrossRefPubMedGoogle Scholar
  28. 28.
    Abdel-Atty MY, Farges O, Jagot P, Belghiti J (1999) Laparoscopy extends the indications for liver resection in patients with cirrhosis. Br J Surg 86:1397–1400CrossRefPubMedGoogle Scholar
  29. 29.
    Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484CrossRefPubMedGoogle Scholar
  30. 30.
    COST (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059Google Scholar
  31. 31.
    Tralhao JG, Dagher I, Lino T, Roudie J, Franco D (2006) Treatment of tumour recurrence after resection of hepatocellular carcinoma. Analysis of 97 consecutive patients. Eur J Surg Oncol, DOI:10.1016/j.ejso.2006.11.015, Dec 21, 2006Google Scholar
  32. 32.
    Yamamoto J, Okada S, Shimada K, Okusaka T, Yamasaki S, Ueno H, Kosuge T (2001) Treatment strategy for small hepatocellular carcinoma: comparison of long-term results after percutaneous ethanol injection therapy and surgical resection. Hepatology 34:707–713CrossRefPubMedGoogle Scholar
  33. 33.
    Poon RT, Fan ST, Lo CM, Liu CL, Wong J (2002) Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg 235:373–382CrossRefPubMedGoogle Scholar
  34. 34.
    Bigourdan JM, Jaeck D, Meyer N, Meyer C, Oussoultzoglou E, Bachellier P, Weber JC, Audet M, Doffoel M, Wolf P (2003) Small hepatocellular carcinoma in Child A cirrhotic patients: hepatic resection versus transplantation. Liver Transpl 9:513–520CrossRefPubMedGoogle Scholar
  35. 35.
    Vibert E, Perniceni T, Levard H, Denet C, Shahri NK, Gayet B (2006) Laparoscopic liver resection. Br J Surg 93:67–72CrossRefPubMedGoogle Scholar
  36. 36.
    O’Rourke N, Fielding G (2004) Laparoscopic right hepatectomy: surgical technique. J Gastrointest Surg 8:213–216CrossRefPubMedGoogle Scholar
  37. 37.
    Yoon YS, Han HS, Choi YS, Jang JY, Suh KS, Kim SW, Lee KU, Park YH (2006) Total laparoscopic right posterior sectionectomy for hepatocellular carcinoma. J Laparoendosc Adv Surg Tech A 16:274–277CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Ibrahim Dagher
    • 1
    • 2
  • Panagiotis Lainas
    • 1
  • Alessio Carloni
    • 1
    • 2
  • Cécile Caillard
    • 1
  • Axèle Champault
    • 1
  • Claude Smadja
    • 1
    • 2
  • Dominique Franco
    • 1
    • 2
  1. 1.Department of General SurgeryAntoine Beclere HospitalClamartFrance
  2. 2.Paris-Sud UniversityKremlin-BicêtreFrance

Personalised recommendations