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Surgical Endoscopy

, Volume 29, Issue 10, pp 2994–3001 | Cite as

Laparoscopic versus open liver resection for hepatocellular carcinoma in posterosuperior segments

  • Le Xiao
  • Lun-jian Xiang
  • Jian-wei Li
  • Jian Chen
  • Yu-dong Fan
  • Shu-guo ZhengEmail author
Article

Abstract

Background

Traditional open liver resection remains the classic procedure for hepatocellular carcinoma (HCC) located in the posterosuperior segments of the liver (segments I, IVa, VII, and VIII). This study compared the perioperative and oncologic results for laparoscopic versus open liver resection of HCC located in the posterosuperior segments, especially in patients with cirrhosis.

Methods

This study included 41 patients who underwent laparoscopic liver resection (LLR) and 86 who underwent open liver resection (OLR) for HCC in the posterosuperior segments between January 1, 2010, and December 31, 2012. There perioperative course and oncologic outcomes were retrospectively evaluated.

Results

There were no significant differences between the LLR and OLR groups in length of operation (242.41 ± 73.69 vs. 235.38 ± 65.80 min), transfusion rate (7.3 vs. 14.0 %), R0 resection rate (100 vs. 97.7 %), or tumor size (4.22 ± 2.05 vs. 4.30 ± 1.49 cm). In contrast, postoperative hospital stay (9.44 ± 2.72 vs. 14.53 ± 6.03 days) was significantly shorter, and postoperative complication rates (17.1 vs. 37.2 %) and intraoperative blood loss (272.20 ± 170.86 vs. 450.12 ± 344.70 mL) significantly lower in the LLR than in the OLR group. In addition, there was no significant difference between the two groups (LLR vs. OLR) regarding 1-year overall survival rate (95.1 vs. 89.5 %), 3-year overall survival rate (78 vs. 76.7 %,), 1-year disease-free survival rate (87.8 vs. 82.6 %,), and 3-year disease-free survival rate (70.7 vs. 68.6 %).

Conclusions

LLR for selected patients with HCC in the posterosuperior segments may offer the same oncologic outcomes as conventional procedures, while being associated with such advantages as lower blood loss, fewer postoperative complications, and shorter hospital stay.

Keywords

Laparoscopy Hepatectomy Posterosuperior segment Hepatocellular carcinoma 

Notes

Acknowledgments

The authors thank Li Cao for excellent technical support and valuable discussion. This study was supported by the Foundation of Clinical Scientific Research, Third Military Medical University (No. SWH2012LC09).

Disclosures

Le Xiao, Lun-jian Xiang, Jian-wei Li, Jian Chen, Yu-dong Fan, Shu-guo Zheng have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker C-G, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey J-N, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS (2009) The international position on laparoscopic liver surgery. Ann Surg 250(5):825–830CrossRefPubMedGoogle Scholar
  2. 2.
    Ishizawa T, Gumbs AA, Kokudo N, Gayet B (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256(6):959–964CrossRefPubMedGoogle Scholar
  3. 3.
    Kazaryan AM, Rosok BI, Marangos IP, Rosseland AR, Edwin B (2011) Comparative evaluation of laparoscopic liver resection for posterosuperior and anterolateral segments. Surg Endosc 25(12):3881–3889PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Cho JY, Han HS, Yoon YS, Shin SH (2008) Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location. Surgery 144(1):32–38CrossRefPubMedGoogle Scholar
  5. 5.
    Croome KP, Yamashita MH (2010) Laparoscopic vs open hepatic resection for benign and malignant tumors: an updated meta-analysis. Arch Surg 145(11):1109–1118CrossRefPubMedGoogle Scholar
  6. 6.
    Belli G, Limongelli P, Fantini C, D’Agostino A, Cioffi L, Belli A, Russo G (2009) Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg 96(9):1041–1048CrossRefPubMedGoogle Scholar
  7. 7.
    Ker CG, Chen JS, Kuo KK, Chuang SC, Wang SJ, Chang WC, Lee KT, Chen HY, Juan CC (2011) Liver surgery for hepatocellular carcinoma: laparoscopic versus open approach. Int J Hepatol 2011:596792PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Cheung TT, Poon RT, Yuen WK, Chok KS, Jenkins CR, Chan SC, Fan ST, Lo CM (2013) Long-term survival analysis of pure laparoscopic versus open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a single-center experience. Ann Surg 257(3):506–511CrossRefPubMedGoogle Scholar
  9. 9.
    Nguyen KT, Marsh JW, Tsung A, Steel JJ, Gamblin TC, Geller DA (2011) Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch Surg 146(3):348–356CrossRefPubMedGoogle Scholar
  10. 10.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRefPubMedGoogle Scholar
  11. 11.
    Yoon YS, Han HS, Cho JY, Ahn KS (2010) Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc 24(7):1630–1637CrossRefPubMedGoogle Scholar
  12. 12.
    Herman P, Kruger JA, Perini MV, Coelho FF, Lupinacci RM (2013) Laparoscopic hepatic posterior sectionectomy: a hand-assisted approach. Ann Surg Oncol 20(4):1266CrossRefPubMedGoogle Scholar
  13. 13.
    Huang MT, Lee WJ, Wang W, Wei PL, Chen RJ (2003) Hand-assisted laparoscopic hepatectomy for solid tumor in the posterior portion of the right lobe: initial experience. Ann Surg 238(5):674–679PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Casaccia M, Andorno E, Di Domenico S, Santori G, Fazio F, Gelli M, Valente U (2012) Laparoscopic right posterior sectionectomy for hepatocellular carcinoma using a modified liver-hanging maneuver. J Laparoendosc Adv Surg Tech A 22(5):488–491CrossRefPubMedGoogle Scholar
  15. 15.
    Ikeda T, Toshima T, Harimoto N, Yamashita Y, Ikegami T, Yoshizumi T, Soejima Y, Shirabe K, Maehara Y (2014) Laparoscopic liver resection in the semiprone position for tumors in the anterosuperior and posterior segments, using a novel dual-handling technique and bipolar irrigation system. Surg Endosc 28(8):2484–2492PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Casciola L, Patriti A, Ceccarelli G, Bartoli A, Ceribelli C, Spaziani A (2011) Robot-assisted parenchymal-sparing liver surgery including lesions located in the posterosuperior segments. Surg Endosc 25(12):3815–3824CrossRefPubMedGoogle Scholar
  17. 17.
    Giulianotti PC, Coratti A, Sbrana F, Addeo P, Bianco FM, Buchs NC, Annechiarico M, Benedetti E (2011) Robotic liver surgery: results for 70 resections. Surgery 149(1):29–39CrossRefPubMedGoogle Scholar
  18. 18.
    Ai JH, Li JW, Chen J, Bie P, Wang SG, Zheng SG (2013) Feasibility and safety of laparoscopic liver resection for hepatocellular carcinoma with a tumor size of 5–10 cm. PLoS ONE 8(8):e72328PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Shi M, Guo RP, Lin XJ, Zhang YQ, Chen MS, Zhang CQ, Lau WY, Li JQ (2007) Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial. Ann Surg 245(1):36–43PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Hamady ZZ, Cameron IC, Wyatt J, Prasad RK, Toogood GJ, Lodge JP (2006) Resection margin in patients undergoing hepatectomy for colorectal liver metastasis: a critical appraisal of the 1 cm rule. Eur J Surg Oncol 32(5):557–563CrossRefPubMedGoogle Scholar
  21. 21.
    Matsui Y, Terakawa N, Satoi S, Kaibori M, Kitade H, Takai S, Kwon AH, Kamiyama Y (2007) Postoperative outcomes in patients with hepatocellular carcinomas resected with exposure of the tumor surface: clinical role of the no-margin resection. Arch Surg 142(7):596–602; discussion 603Google Scholar
  22. 22.
    Ikai I, Arii S, Kojiro M, Ichida T, Makuuchi M, Matsuyama Y, Nakanuma Y, Okita K, Omata M, Takayasu K, Yamaoka Y (2004) Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey. Cancer 101(4):796–802CrossRefPubMedGoogle Scholar
  23. 23.
    Slakey DP, Simms E, Drew B, Yazdi F, Roberts B (2013) Complications of liver resection: laparoscopic versus open procedures. JSLS 17(1):46–55PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Sarpel U, Hefti MM, Wisnievsky JP, Roayaie S, Schwartz ME, Labow DM (2009) Outcome for patients treated with laparoscopic versus open resection of hepatocellular carcinoma: case-matched analysis. Ann Surg Oncol 16(6):1572–1577CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Le Xiao
    • 1
  • Lun-jian Xiang
    • 1
  • Jian-wei Li
    • 1
  • Jian Chen
    • 1
  • Yu-dong Fan
    • 1
  • Shu-guo Zheng
    • 1
    Email author
  1. 1.Institute of Hepatobiliary Surgery, Southwest HospitalThird Military Medical UniversityChongqingChina

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