Surgical Endoscopy

, Volume 27, Issue 7, pp 2592–2597 | Cite as

Impact of laparoscopic liver resection for hepatocellular carcinoma with F4-liver cirrhosis

  • Akishige Kanazawa
  • Tadashi Tsukamoto
  • Sadatoshi Shimizu
  • Shintaro Kodai
  • Sadaaki Yamazoe
  • Satoshi Yamamoto
  • Shoji Kubo
Article

Abstract

Background

Although the utility of laparoscopic liver resection for hepatocellular carcinoma (HCC) has been recognized in recent years, the impact of the laparoscopic liver resection for HCC with complete liver cirrhosis (F4) is still unknown.

Methods

Retrospective analysis of 56 patients who underwent partial hepatectomy for HCC (3 cm or smaller in a diameter) and had complete liver cirrhosis (F4) diagnosed histologically was performed. Of the 56 patients, partial hepatectomy was performed under laparotomy in 28 patients (laparotomy group) or under laparoscopy in 28 patients (laparoscopy group). Perioperative outcome was analyzed in the two groups.

Results

There were no significant differences in the results of the preoperative liver function tests and the operation time between the two groups. The intraoperative blood loss was lower in the laparoscopy group than the laparotomy group (p = 0.0003). The incidence of the postoperative complications was significantly higher in the laparotomy group (20/36 patients) than in the laparoscopy group (3/28 patients, p < 0.0001). The incidences of surgical site infection, especially incisional infection, and intractable ascites were significantly higher in the laparotomy group than in the laparoscopy group (p = 0.0095, p < 0.0001, respectively). The proportions of patients who were classified into Clavien’s grade I and IIIa were higher in the laparotomy group than in the laparoscopy group (p = 0.0043, p = 0.051, respectively). The duration of the postoperative hospital stay was significantly shorter in the laparoscopy group than in the laparotomy group (p < 0.0001).

Conclusions

The postoperative morbidity, such as surgical site infection and intractable ascites, decreased by the induction of laparoscopic liver resection in patients with liver cirrhosis. As the results, the necessity of invasive treatment for postoperative complications decreased and the duration of the postoperative stay was shortened.

Keywords

Laparoscopic liver resection Liver cirrhosis Hepatocellular carcinoma Ascites SSI 

Notes

Disclosures

Drs. Akishige Kanazawa, Tadashi Tsukamoto, Sadatoshi Shimizu, Shintaro Kodai, Sadaaki Yamazoe, Satoshi Yamamoto, and Shoji Kubo have no conflict of interest or financial ties to disclosure.

References

  1. 1.
    Llovet JM, Fuster J, Bruix J (1999) Intension-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 30:1434–1440PubMedCrossRefGoogle Scholar
  2. 2.
    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 8:873–883PubMedCrossRefGoogle Scholar
  3. 3.
    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 97:1253–1262PubMedCrossRefGoogle Scholar
  4. 4.
    Llovet JM, Real MI, Monana X, Planas R, Coll S, Ayuso C, Sala M, Muchart J, Sola R, Rodes J, Bruix J, Barcelona Liver Cancer Group (2002) Arterial embolization of chemoembolization versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomized controlled trial. Lancet 359:1734–1739Google Scholar
  5. 5.
    Cha CH, Ruo L, Fong Y, Jarnagin WR, Shia J, Blumgart LH, DeMatteo RP (2003) Resection of hepatocellular carcinoma in patients otherwise eligible for transplantation. Ann Surg 238:315–321PubMedGoogle Scholar
  6. 6.
    Gagner M, Rheault M, Dubuc J (1992) Laparoscopic partial hepatectomy for liver tumor. Abstr Surg Endosc 6:99Google Scholar
  7. 7.
    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 189:190–194PubMedCrossRefGoogle Scholar
  8. 8.
    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 243:499–506PubMedCrossRefGoogle Scholar
  9. 9.
    Ichida F, Tsuji T, Omata M, Ichida T, Inoue K, Kamimura T (1996) New Inuyama classification; new criteria for histological assessment of chronic hepatitis. Int Hepatol Commun 6:112–119CrossRefGoogle Scholar
  10. 10.
    Desmet VJ, Gerber M, Hoofnagle JH, Manns M, Scheuer PJ (1994) Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology 19:1513–1520PubMedCrossRefGoogle Scholar
  11. 11.
    Dindo D, Demartines N, Clavien P (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRefGoogle Scholar
  12. 12.
    Makuuchi M, Kosuge T, Takayama T, Yamazaki S, Kakazu T, Miyagawa S (1993) Surgery for small liver cancers. Semin Surg Oncol 9:298–304PubMedCrossRefGoogle Scholar
  13. 13.
    Fong Y, Jarnagin W, Conlon KC, DeMateo R, Dougherty E, Blumagart LH (2000) Hand-assisted laparoscopic liver resection: lessons from an initial experience. Arch Surg 135:854–859PubMedCrossRefGoogle Scholar
  14. 14.
    Nitta H, Sasaki A, Fujita T, Itabashi H, Hoshikawa K, Takahara T, Nishizawa S, Wakabayashi G (2010) Laparoscopy-assisted major liver resections employing a hanging technique. Ann Surg 251:450–453PubMedCrossRefGoogle Scholar
  15. 15.
    Tanaka S, Hirohashi K, Tanaka H, Shuto T, Lee SH, Kubo S, Takemura S, Yamamoto T, Uenishi T, Kinoshita H (2002) Incidence and management of bile leakage after hepatic resection for malignant hepatic tumors. J Am Coll Surg 195:484–489PubMedCrossRefGoogle Scholar
  16. 16.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–278 (quiz 279–280)Google Scholar
  17. 17.
    Kubo S, Tsukamoto T, Hirohashi K, Tanaka H, Shuto T, Takemura S, Yamamoto T, Uenishi T, Ogawa M, Kinoshita H (2004) Correlation between preoperative serum concentration of type IV collagen 7s domain and hepatic failure following resection of hepatocellular carcinoma. Ann Surg 239:186–193PubMedCrossRefGoogle Scholar
  18. 18.
    Tanaka S, Kubo S, Tsukamoto T, Hirohashi K, Tanaka H, Shuto T, Takemura S, Kinoshita H (2004) Risk factors for intractable pleural effusion after liver resection for hepatocellular carcinoma. Osaka City Med J 50:9–18PubMedGoogle Scholar
  19. 19.
    Togo S, Matsuo K, Tanaka K, Matsumoto C, Shimizu T, Ueda M, Morioka D, Nagano Y, Endo I, Shimada H (2007) Perioperative infection control and its effectiveness in hepatectomy patients. J Gastroenterol Hepatol 22:1942–1948PubMedCrossRefGoogle Scholar
  20. 20.
    Wu CC, Yeh DC, Lin MC, Liu TJ, P’eng FK (1998) Prospective randomized trial of systemic antibiotics in patients undergoing liver resection. Br J Surg 85:489–493PubMedCrossRefGoogle Scholar
  21. 21.
    Murray BW, Cipher DJ, Pham T, Anthony T (2010) The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. J Am Coll Surg 211:812–822PubMedCrossRefGoogle Scholar
  22. 22.
    Shafaee Z, Kazaryan AM, Marvin MR, Cannon R, Buell JF, Edwin B, Gayet B (2011) Is laparoscopic repeat hepatectomy feasible? A tri-institutional analysis. J Am Coll Surg 212:171–179PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Akishige Kanazawa
    • 1
  • Tadashi Tsukamoto
    • 1
  • Sadatoshi Shimizu
    • 1
  • Shintaro Kodai
    • 1
  • Sadaaki Yamazoe
    • 1
  • Satoshi Yamamoto
    • 1
  • Shoji Kubo
    • 2
  1. 1.Department of Hepato-Biliary-Pancreatic SurgeryOsaka City General HospitalMiyakojima-ku, OsakaJapan
  2. 2.Department of Hepato-Biliary-Pancreatic SurgeryOsaka City University Graduate School of MedicineOsakaJapan

Personalised recommendations