Advertisement

Surgical Endoscopy

, Volume 30, Issue 2, pp 638–648 | Cite as

Laparoscopic liver resection for hepatocellular carcinoma in cirrhotic patients: 10-year single-center experience

  • Ahmed Shehta
  • Ho-Seong HanEmail author
  • Yoo-Seok Yoon
  • Jai Young Cho
  • YoungRok Choi
Article

Abstract

Background

Liver resection in cirrhotic patients reported to have higher morbidity and mortality rates compared to non-cirrhotic patients. Recently, there is increased acceptance of laparoscopic approach in liver surgery. However, few reports evaluated laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) in cirrhotic patients. The aim of this study is to evaluate our experience of LLR for HCC and to compare perioperative and long-term outcomes between patients with and without liver cirrhosis (LC).

Methods

A retrospective analysis of 232 patients who underwent LLR for HCC between 2004 and 2013 was carried out. Patients were divided into two groups according to the pathological status of their liver parenchyma, in terms of presence or absence of LC.

Results

LC group had 141 patients, and non-LC group had 91 patients. There were no statistically significant differences between both groups regarding operation time, blood loss, transfusion requirements, intraoperative complications, hospital stay, and postoperative complications. Long-term oncologic outcomes were comparable between both groups regarding the recurrence rates (p = 0.067), overall survival (OS) rates (p = 0.908), and disease-free survival (DFS) rates (p = 0.197). The 1-, 3-, 5-, and 7-year OS were 91.7, 85.5, 79.4, and 70.1 % in LC group, and 93.9, 86, 79.5, and 72.3 % in non-LC group. The 1-, 3-,5-, and 7-year DFS were 75.3, 52.4, 42.6, and 32.7 % in LC group, and 74.1, 57.6, 55.3, 50.2 % in non-LC group.

Conclusions

LLR for HCC is feasible in patients with LC. Cirrhotic patients showed comparable perioperative and long-term outcomes to non-cirrhotic patients.

Keywords

Hepatocellular carcinoma Liver resection Liver cirrhosis Laparoscopy 

Notes

Disclosures

Ahmed Shehta, Ho-Seong Han, Yoo-Seok Yoon, Jai Young Cho, and YoungRok Choi declared that there were no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Li T, Fan J, Qin LX, Zhou J, Sun HC, Qiu SJ, Ye QH, Wang L, Tang ZY (2011) Risk factors, prognosis, and management of early and late intrahepatic recurrence after resection of primary clear cell carcinoma of the liver. Ann Surg Oncol 18:1955–1963CrossRefPubMedGoogle Scholar
  2. 2.
    Llovet JM, Bruix J (2008) Novel advancements in the management of hepatocellular carcinoma in 2008. J Hepatol 48(Suppl 1):S20–S37CrossRefPubMedGoogle Scholar
  3. 3.
    Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, Christensen E, Pagliaro L, Colombo M, Rodés J; EASL Panel of Experts on HCC (2001) Clinical management of hepatocellular carcinoma: conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430CrossRefGoogle Scholar
  4. 4.
    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
  5. 5.
    Arii S, Yamaoka Y, Futagawa S, Inoue K, Kobayashi K, Kojiro M, Makuuchi M, Nakamura Y, Okita K, Yamada R (2000) Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: a retrospective andnationwide survey in Japan. The Liver Cancer Study Group of Japan. Hepatology 32:1224–1229CrossRefPubMedGoogle Scholar
  6. 6.
    Farges O, Malassagne B, Flejou JF, Balzan S, Sauvanet A, Belghiti J (1999) Risk of major liver resection in patients with underlying chronic liver disease: a reappraisal. Ann Surg 229:210–215PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Han HS, Yoon YS, Cho JY, Hwang DW (2013) Laparoscopic liver resection for hepatocellular carcinoma: Korean experiences. Liver Cancer 2:25–30PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Han HS, Cho JY, Yoon YS (2009) Techniques for performing laparoscopic liver resection in various hepatic locations. J Hepatobiliary Pancreat Surg 16(4):427–432CrossRefPubMedGoogle Scholar
  9. 9.
    Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection 2,804 patients. Ann Surg 250:831–841CrossRefPubMedGoogle Scholar
  10. 10.
    Parks KR, Kuo YH, Davis JM, O’ Brien B, Hagopian EJ (2014) Laparoscopic versus open liver resection: a meta-analysis of long term outcome. HPB 16(2):109–118PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    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 96:1041–1048CrossRefPubMedGoogle Scholar
  12. 12.
    Santambrogio R, Aldrighetti L, Barabino M, Pulitanò C, Costa M, Montorsi M, Ferla G, Opocher E (2009) Laparoscopic liver resections for hepatocellular carcinoma. Is it a feasible option for patients with liver cirrhosis? Langenbecks Arch Surg 394:255–264CrossRefPubMedGoogle Scholar
  13. 13.
    Truant S, Bouras AF, Hebbar M, Boleslawski E, Fromont G, Dharancy S, Leteurtre E, Zerbib P, Pruvot FR (2011) Laparoscopic resection vs. open liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: a case-matched study. Surg Endosc 25(11):3668–3677CrossRefPubMedGoogle Scholar
  14. 14.
    Casaccia M, Andorno E, Domenico SD, Nardi I, Bottino G, Gelli M, Valente U (2011) Laparoscopic liver resection for hepatocellular carcinoma in cirrhotic patients. Feasibility of nonanatomic resection in difficult tumor locations. J Minim Access Surg 7(4):222–226PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Kanazawa A, Tsukamoto T, Shimizu S, Kodai S, Yamazoe S, Yamamoto S, Kubo S (2013) Impact of laparoscopic liver resection for hepatocellular carcinoma with F4-liver cirrhosis. Surg Endosc 27:2592–2597CrossRefPubMedGoogle Scholar
  16. 16.
    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
  17. 17.
    Bedossa P, Poynard T (1996) An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology 24:289–293CrossRefPubMedGoogle Scholar
  18. 18.
    Wolters U, Wolf T, Stützer H, Schröder T (1996) ASA classification and perioperative variables as predictors of postoperative outcomes. Br J Anaesth 77:217–222CrossRefPubMedGoogle Scholar
  19. 19.
    Terminology Committee of the International Hepato-Pancreato-Biliary Association (2000) The IHPBA Brisbane 2000 terminology of liver anatomy and resections. HPB Surg 2:333–339Google Scholar
  20. 20.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, Fan ST, Yokoyama Y, Crawford M, Makuuchi M, Christophi C, Banting S, Brooke-Smith M, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Nimura Y, Figueras J, DeMatteo RP, Büchler MW, Weitz J (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149(5):680–688CrossRefPubMedGoogle Scholar
  22. 22.
    Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, Koch M, Makuuchi M, Dematteo RP, Christophi C, Banting S, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Yokoyama Y, Fan ST, Nimura Y, Figueras J, Capussotti L, Büchler MW, Weitz J (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 145:713–724CrossRefGoogle Scholar
  23. 23.
    Fattovich G, Stroffolini T, Zagni I, Donato F (2004) Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology 127:S35–S50CrossRefPubMedGoogle Scholar
  24. 24.
    de Lope CR, Tremosini S, Forner A, Reig M, Bruix J (2012) Management of HCC. J Hepatol 56(Suppl 1):S75–S87CrossRefPubMedGoogle Scholar
  25. 25.
    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 liver disease. Ann Surg 243:499–506PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Tranchart H, Di Giuro G, Lainas P, Roudie J, Agostini H, Franco D, Dagher I (2010) Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 24:1170–1176CrossRefPubMedGoogle Scholar
  27. 27.
    Lee KF, Chong CN, Wong J, Cheung YS, Wong J, Lai P (2011) Long-term results of laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma: a case-matched analysis. World J Surg 35:2268–2274CrossRefPubMedGoogle Scholar
  28. 28.
    Descottes B, Glineur D, Lachachi F, Valleix D, Paineau J, Hamy A, Morino M, Bismuth H, Castaing D, Savier E, Honore P, Detry O, Legrand M, Azagra JS, Goergen M, Ceuterick M, Marescaux J, Mutter D, de Hemptinne B, Troisi R, Weerts J, Dallemagne B, Jehaes C, Gelin M, Donckier V, Aerts R, Topal B, Bertrand C, Mansvelt B, Van Krunckelsven L, Herman D, Kint M, Totte E, Schockmel R, Gigot JF (2003) Laparoscopic liver resection of benign liver tumors. Surg Endosc 17:23–30CrossRefPubMedGoogle Scholar
  29. 29.
    Marks J, Mouiel J, Katkhouda N, Gugenheim J, Fabiani P (1998) Laparoscopic liver surgery: a report on 28 patients. Surg Endosc 12:331–334CrossRefPubMedGoogle Scholar
  30. 30.
    Memeo R, de’Angelis N, Compagnon P, Salloum C, Cherqui D, Laurent A (2014) Laparoscopic vs. open liver resection for hepatocellular carcinoma of cirrhotic liver: a case–control study. World J Surg 38:2919–2926CrossRefPubMedGoogle Scholar
  31. 31.
    Cauchy F, Fuks D, Belghiti J (2012) HCC: current surgical treatment concepts. Langenbecks Arch Surg 397:681–695CrossRefPubMedGoogle Scholar
  32. 32.
    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(11):1397–1400CrossRefPubMedGoogle Scholar
  33. 33.
    Mizuguchi T, Kawamoto M, Meguro M, Nakamura Y, Ota S, Hui TT, Hirata K (2013) Prognosis and predictors of surgical complications in hepatocellular carcinoma patients with or without cirrhosis after hepatectomy. World J Surg 37:1379–1387CrossRefPubMedGoogle Scholar
  34. 34.
    Ahn KS, Han HS, Yoon YS, Cho JY, Kim JH (2011) Laparoscopic anatomical S5 segmentectomy by the Glissonian approach. J Laparoendosc Adv Surg Tech A 21(4):345–348CrossRefPubMedGoogle Scholar
  35. 35.
    Ahn KS, Han HS, Yoon YS, Cho JY (2011) Laparoscopic anatomic S4 segmentectomy for hepatocellular carcinoma. Surg Laparosc Endosc Percutan Tech 21(4):e183–e186CrossRefPubMedGoogle Scholar
  36. 36.
    Ziser A, Plevak DJ, Wiesner RH, Rakela J, Offord KP, Brown DL (1999) Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Anesthesiology 90:42–53CrossRefPubMedGoogle Scholar
  37. 37.
    Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O (2000) Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 191:38–46CrossRefPubMedGoogle Scholar
  38. 38.
    Farges O, Malassagne B, Flejou JF, Balzan S, Sauvanet A, Belghiti J (1999) Risk of major liver resection in patients with underlying chronic liver disease: a reappraisal. Ann Surg 229:210–215PubMedCentralCrossRefPubMedGoogle Scholar
  39. 39.
    Cucchetti A, Ercolani G, Vivarelli M, Cescon M, Ravaioli M, La Barba G (2006) Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis. Liver Transpl 12:966–971CrossRefPubMedGoogle Scholar
  40. 40.
    Dinant S, de Graaf W, Verwer BJ, Bennink RJ, van Lienden KP, Gouma DJ, van Vliet AK, van Gulik TM (2007) Risk assessment of posthepatectomy liver failure using hepatobiliary scintigraphy and CT volumetry. J Nucl Med 48:685–692CrossRefPubMedGoogle Scholar
  41. 41.
    Mullen JT, Ribero D, Reddy SK, Donadon M, Zorzi D, Gautam S, Abdalla EK, Curley SA, Capussotti L, Clary BM, Vauthey JN (2007) Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg 204:854–862CrossRefPubMedGoogle Scholar
  42. 42.
    Aldrighetti L, Guzzetti E, Pulitanò C, Cipriani F, Catena M, Paganelli M, Ferla G (2010) Case-matched analysis of totally laparoscopic versus open liver resection for HCC: short and middle term results. J Surg Oncol 102:82–86CrossRefPubMedGoogle Scholar
  43. 43.
    Gaillard M, Tranchart H, Dagher I (2014) Laparoscopic liver resections for hepatocellular carcinoma: current role and limitations. WJG 20(17):4892–4899PubMedCentralCrossRefPubMedGoogle Scholar
  44. 44.
    Cucchetti A, Cescon M, Trevisani F, Pinna AD (2012) Current concepts in hepatic resection for hepatocellular carcinoma in cirrhotic patients. WJG 18(44):6398–6408PubMedCentralCrossRefPubMedGoogle Scholar
  45. 45.
    Yoon YS, Han HS, Cho JY, Kim JH, Kwon Y (2013) Laparoscopic liver resection for centrally located tumors close to the hilum, major hepatic veins, or inferior vena cava. Surgery 153:502–509CrossRefPubMedGoogle Scholar
  46. 46.
    Han HS, Yoon YS, Cho JY, Ahn KS (2010) Laparoscopic right hemihepatectomy for hepatocellular carcinoma. Ann Surg Oncol 17:2090–2091CrossRefPubMedGoogle Scholar
  47. 47.
    Takada Y, Otsuka M, Todoroki T, Fukao K (2003) Accompanying liver cirrhosis as a risk factor for recurrence after resection of solitary hepatocellular carcinoma. Hepato-gastroenterol 50(54):1991–1995Google Scholar
  48. 48.
    Taura K, Ikai I, Hatano E, Yasuchika K, Nakajima A, Tada M, Seo S, Machimoto T, Uemoto S (2007) Influence of coexisting cirrhosis on outcomes after partial hepatic resection for hepatocellular carcinoma fulfilling the Milan criteria: an analysis of 293 patients. Surgery 142(5):685–694CrossRefPubMedGoogle Scholar
  49. 49.
    Laurent A, Tayar C, Andréoletti M, Lauzet JY, Merle JC, Cherqui D (2009) Laparoscopic liver resection facilitates salvage liver transplantation for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 16(3):310–314CrossRefPubMedGoogle Scholar
  50. 50.
    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 235:373–382PubMedCentralCrossRefPubMedGoogle Scholar
  51. 51.
    Zhou XD, Tang ZY, Yang BH, Lin ZY, Ma ZC, Ye SL, Wu ZQ, Fan J, Qin LX, Zheng BH (2001) Experience of 1000 patients who underwent hepatectomy for small hepatocellular carcinoma. Cancer 91:1479–1486CrossRefPubMedGoogle Scholar
  52. 52.
    Ng KK, Vauthey JN, Pawlik TM, Lauwers GY, Regimbeau JM, Belghiti J, Ikai I, Yamaoka Y, Curley SA, Nagorney DM, Ng IO, Fan ST, Poon RT, International Cooperative Study Group on Hepatocellular Carcinoma (2005) Is hepatic resection for large or multinodular hepatocellular carcinoma justified? Results from a multi-institutional database. Ann Surg Oncol 12:364–373CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Ahmed Shehta
    • 1
  • Ho-Seong Han
    • 2
    Email author
  • Yoo-Seok Yoon
    • 2
  • Jai Young Cho
    • 2
  • YoungRok Choi
    • 2
  1. 1.Gastroenterology Surgical Center, Department of SurgeryMansoura UniversityMansouraEgypt
  2. 2.Department of Surgery, Seoul National University Bundang Hospital, College of MedicineSeoul National UniversitySeongnam-siKorea

Personalised recommendations