Surgical Endoscopy

, Volume 22, Issue 11, pp 2350–2356

Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors

  • Xiu Jun Cai
  • Jin Yang
  • Hong Yu
  • Xiao Liang
  • Yi Fan Wang
  • Zi Yi Zhu
  • Shu Yong Peng
Article

Abstract

Background

The number of reported laparoscopic hepatectomies for liver malignancy is increasing, but comparative data on the survival outcomes between the patients who have undergone laparoscopic hepatectomy versus open surgery are still lacking.

Methods

We compared 31 laparoscopic liver resections with 31 open liver resections in a pair-matched retrospective analysis with the aim of evaluating the intraoperative hazards, recovery, and survival outcomes of these procedures for liver cancer. The laparoscopic group and the open group were matched for age, sex, the size and location of the tumor, and the presence or absence of cirrhosis.

Results

Thirty cases in the laparoscopic group were performed successfully while one case was converted to open surgery due to intraoperative hemorrhage. The length of hospital stay was 7.5 (5–15) days, which was significantly shorter than those in open group (p < 0.01). The mean operative time and blood loss in the laparoscopic group were 140.1 (60–380) min and 502.9 (50–2000) ml, respectively, which were lower than those in open group but without significant difference. There were no operative complications and no deaths in the laparoscopic group. The mean and median survival times of laparoscopic group were 59.3 and 70 months, compared with 49.4 and 60 months in the open group, respectively. The 1-, 3-, 5-year survival rates in the laparoscopic group were, respectively, 96.55%, 60.47%, and 50.40%, and 96.77%, 68.36%, and 50.64% in the open group. By log-rank test, these two survival curves were not significantly different (p = 0.8535).

Conclusion

This study shows that laparoscopic hepatectomy for liver malignancy in selected patients is a safe, effective, and oncologically efficient procedure with better short-term results and similar survival outcomes to open hepatectomy for liver malignancy after midterm follow-up.

Keywords

Minimally invasive surgery Liver malignancy Hepatectomy Hepatocellular carcinoma Survival rate survival analysis 

References

  1. 1.
    Wayand W, Woisetschlager R (1993) Laparoscopic resection of liver metastasis. Chirurg 64:195–197PubMedGoogle Scholar
  2. 2.
    Dagher I, Proske JM, Carloni A, Richa H, Tranchart H, Franco D (2007) Laparoscopic liver resection: results for 70 patients. Surg Endosc 21:619–624PubMedCrossRefGoogle Scholar
  3. 3.
    Mamada Y, Yoshida H, Taniai N, Mizuquchi Y, Kakinuma D, Ishikawa Y, Yokomuro S,Arima Y, Akimaru K, Tajiri T (2007) Usefulness of laparoscopic hepatectomy. J Nippon Med Sch 74:158–162PubMedCrossRefGoogle Scholar
  4. 4.
    Tang CN, Tsui KK, Ha JP, Yang GP, Li MK (2006) A single-centre experience of 40 laparoscopic liver resections. Hong Kong Med J 12:419–425PubMedGoogle Scholar
  5. 5.
    Simillis C, Constantinides VA, Tekkis PP, Darzi A, Loveqrove R, Jiao L, Antonious A (2007) Laparoscopic versus open hepatic resections for benign and malignant neoplasms–a meta-analysis. Surgery 141:203–211PubMedCrossRefGoogle Scholar
  6. 6.
    Descottes B, Lachachi, F, Sodji M, Valleix D, Durand-Fontaniers, Pech de Laclause B, Grousseau D (2000) Early experience with laparoscopic approach for solid liver tumors: Initial 16 cases. Ann Surg 232:641–645Google Scholar
  7. 7.
    Belli G, Fantini C, D Agostino A, Belli A, Langella S (2005) Laparoscopic hepatic resection for completely exophytic hepatocellular carcinoma on cirrhosis. J Hepatobiliary Pancreat Surg 12:488–493PubMedCrossRefGoogle Scholar
  8. 8.
    Champault A, Dangher I, Vons C, Franco D (2005) Laparoscopic hepatic resection for hepatocellular carcinoma. Retrospective study of 12 patients. Gastroenterol Clin Bio 29:969–973CrossRefGoogle Scholar
  9. 9.
    Belli G, Fantini C, D Agostino A, Belli A, Cioffi L, Russolillo N (2006) Laparoscopic left lateral hepatic lobectomy: a safer and faster technique. J Hepatobiliary Pancreat Surg 13:149–154PubMedCrossRefGoogle Scholar
  10. 10.
    Nagino M, Kamiya J, Arai T, Nishio H, Ebata T, Nimura Y (2006) “Anatomic” right hepatic trisectionectomy (extended right hepatectomy) with caudate lobectomy for hilar cholangiocarcinoma. Ann Surg 243:28–32PubMedCrossRefGoogle Scholar
  11. 11.
    Cai XJ, Yu H, Liang X, Wang YF, Zheng XY, Huang DY, Peng SY (2006) Laparoscopic hepatectomy by curettage and aspiration: Experiences of 62 cases. Surg Endosc 20:1531–1535PubMedCrossRefGoogle Scholar
  12. 12.
    Kaneko H (2005) Laparoscopic hepatectomy: indications and outcomes. J Hepatobiliary Pancreat Surg 12:438–443PubMedCrossRefGoogle Scholar
  13. 13.
    Kaneko H, Takaqi S, Otsuka Y, Tsuchiva M, Tamura A, Kataqiri T, Maeda T, Shiba T (2005) Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg 189:190–194PubMedCrossRefGoogle Scholar
  14. 14.
    Berends FJ, Meijer S, Prevoo W, Bonjer HJ, Cuesta MA (2001) Technical considerations in laparoscopic liver surgery. Surg Endosc 15:794–798PubMedCrossRefGoogle Scholar
  15. 15.
    Cherqui D, Husson E, Hammoud R, Malassaqne B, Stephan F, Bensaid S, Rotman N, Faqniez PL (2000) Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 232:753–762PubMedCrossRefGoogle Scholar
  16. 16.
    Fong Y, Jarnaqin W, Conlon KC, Dematteo R, Douqherty E, Blumqart LH (2000) Hand-assisted laparoscopic liver resection: lessons from an initial experience. Arch Surg135:854–859Google Scholar
  17. 17.
    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
  18. 18.
    Teramoto K, Kawamura T, Takamatsu S, Noquchi N, Nakamura N, Arii S (2003) Laparoscopic and thoracoscopic partial hepatectomy for hepatocellular carcinoma. World J Surg 27:1131–1136PubMedCrossRefGoogle Scholar
  19. 19.
    Santambrogio R, Opocher E, Ceretti AP, Barabino M, Leone S, Montorsi M (2007) Impact of intraoperative ultrasonography in laparoscopic liver surgery. Surg Endosc 21:181–188PubMedCrossRefGoogle Scholar
  20. 20.
    Jacquet P, Averbach AM, Stephens AD, Sugarbaker PH (1995) Cancer recurrence following laparoscopic colectomy. Report of two patients treated with heated intraperitoneal chemotherapy. Dis Colon Rectum 38:1110–1114PubMedCrossRefGoogle Scholar
  21. 21.
    Tsuchiya Y, Sawada S, Yoshioka L, Ohashi Y, Matsuo M, Harimaya Y, Tsukada K, Saiki I (2003) Increased surgical stress promotes tumor metastasis. Surgery 133:547–555PubMedCrossRefGoogle Scholar
  22. 22.
    Vibert E, Perniceni T, Levard H, Denet C, Shahri NK, Gayet B (2006) Laparoscopic liver resection. Br J Surg 93:67–72PubMedCrossRefGoogle Scholar
  23. 23.
    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 138:763–769PubMedCrossRefGoogle Scholar
  24. 24.
    Daniel C, Alexis L, Claude T, Stephen C, Jeanne T, Jerome L, Mehdi K, Christophe D, Daniel D, Pierre L (2006) Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease :midterm results and perspectives. Ann Surg 243:499–506CrossRefGoogle Scholar
  25. 25.
    Lang BH, Poon RT, Fan ST, Wong J (2003) Perioperative and long-term outcome of major hepatic resection for solitary hepatocellular carcinoma in patients with cirrhosis. Arch Surg 138:1207–1213PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Xiu Jun Cai
    • 1
  • Jin Yang
    • 1
  • Hong Yu
    • 1
  • Xiao Liang
    • 1
  • Yi Fan Wang
    • 1
  • Zi Yi Zhu
    • 1
  • Shu Yong Peng
    • 1
  1. 1.Department of General SurgerySir Run Run Shaw Hospital, College of Medicine, Zhejiang UniversityHangzhouP.R. China

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