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Laparoscopic hepatectomy for liver tumors: proposals for standardization

  • Yuichiro OtsukaEmail author
  • Masaru Tsuchiya
  • Tetsuya Maeda
  • Toshio Katagiri
  • Jun Isii
  • Akira Tamura
  • Kunihiro Yamazaki
  • Yoshihisa Kubota
  • Takashi Suzuki
  • Takayuki Suzuki
  • Satoru Kagami
  • Hironori Kaneko
Topics Evolution and challenge in endoscopic HBP surgery

Abstract

Background/purpose

We draw on our experience with laparoscopic hepatectomy (LH) to present recommendations for standardization of LH for the treatment of liver tumors.

Methods

At our center, 90 LHs were performed from April 1993 to January 2008. These were divided equally into early cases and late cases, and short-term postoperative results were compared. Forty-nine of the LH procedures were total-laparoscopic procedures, 16 were hand-assisted procedures, and 25 were laparoscopy-assisted procedures. The tumors were malignant in 76 cases and benign in 14 cases.

Results

Among late cases, the numbers of malignant tumors and tumors located in the posterosuperior region of the liver (Segments VII, VIII, and IVb) were significantly higher than among early cases; however, operative blood loss and postoperative hospital stay were significantly lower in the late cases (158.9 ± 213.4 vs. 377.6 ± 421.2 cc, P = 0.007; and 8.7 ± 3.6 vs. 15.3 ± 8.7 days, P = 0.0001, respectively). No operative deaths occurred in either group.

Conclusions

Although LH does have a steep learning curve, we believe that it can be standardized and provide a less invasive surgical option—with no reduction in disease curability—for the treatment of liver tumors in selected patients.

Keywords

Laparoscopic hepatectomy Laparoscopic liver resection Minimally invasive liver resection Minimally invasive hepatectomy Hepatocellular carcinoma 

References

  1. 1.
    Reich H, McGlynn F, DeCaprio J, Budin R. Laparoscopic excision of benign liver lesions. Obstet Gynecol. 1991;78:956–8.PubMedGoogle Scholar
  2. 2.
    Kaneko H, Takagi S, Shiba T. Laparoscopic partial hepatectomy and left lateral segmentectomy: technique and results of a clinical series. Surgery. 1996;120:468–75.CrossRefPubMedGoogle Scholar
  3. 3.
    Koffron AJ, Kung R, Baker T, Fryer J, Clark L, Abecassis M. Laparoscopic-assisted right lobe donor hepatectomy. Am J Transplant. 2006;6:2522–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Otsuka Y, Tsuchiya M, Katagiri T, Maeda T, Suzuki T, Kubota Y, et al. Hepatic parenchymal transection in laparoscopic hepatectomy for hepatocellular carcinoma with liver cirrhosis: selection and technique of surgical devices. J Microw Surg. 2006;24:73–7.CrossRefGoogle Scholar
  5. 5.
    Takagi S. Hepatic and portal vein blood flow during carbon dioxide pneumoperitoneum for laparoscopic hepatectomy. Surg Endosc. 1998;12:427–31.CrossRefPubMedGoogle Scholar
  6. 6.
    Min SK, Kim JH, Lee SY. Carbon dioxide and argon gas embolism during laparoscopic hepatic resection. Acta Anaesthesiol Scand. 2007;51:949–53.CrossRefPubMedGoogle Scholar
  7. 7.
    Curley SA, Izzo F, Ellis LM, Nicolas Vauthey J, Vallone P. Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis. Ann Surg. 2000;232:381–91.CrossRefPubMedGoogle Scholar
  8. 8.
    Llovet JM, Vilana R, Brú C, Bianchi L, Salmeron JM, Boix L, et al. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology. 2001;33:1124–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Teratani T, Yoshida H, Shiina S, Obi S, Sato S, Tateishi R, et al. Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations. Hepatology. 2006;43:1101–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Cherqui D, Laurent A, Tayar C, Chang S, Van Nhieu JT, Loriau J, et al. Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg. 2006;243:499–506.CrossRefPubMedGoogle Scholar
  11. 11.
    Haga Y, Ikei S, Wada Y, Takeuchi H, Sameshima H, Kimura O, et al. Evaluation of an Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system to predict postoperative risk: a multicenter prospective study. Surg Today. 2001;31:569–74.CrossRefPubMedGoogle Scholar
  12. 12.
    Kaneko H, Takagi S, Otsuka Y, Tsuchiya M, Tamura A, Katagiri T, et al. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg. 2005;189:190–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Simillis C, Constantinides VA, Tekkis PP, Darzi A, Lovegrove R, Jiao L, et al. Laparoscopic versus open hepatic resections for benign and malignant neoplasms—a meta-analysis. Surgery. 2007;141:203–11.CrossRefPubMedGoogle Scholar
  14. 14.
    Tanaka A, Takeda R, Mukaihara S, Hayakawa K, Shibata T, Itoh K, et al. Treatment of ruptured hepatocellular carcinoma. Int J Clin Oncol. 2001;6:291–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Rees M, Tekkis PP, Welsh FK, O’Rourke T, John TG. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg. 2008;247:125–35.CrossRefPubMedGoogle Scholar
  16. 16.
    Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240:644–57.CrossRefPubMedGoogle Scholar
  17. 17.
    Poon RT, Fan ST, Lo CM, Liu CL, Ngan H, Ng IO, et al. Hepatocellular carcinoma in the elderly: results of surgical and nonsurgical management. Am J Gastroenterol. 1999;94:2460–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Hanazaki K, Kajikawa S, Shimozawa N, Shimada K, Hiraguri M, Koide N, et al. Hepatic resection for hepatocellular carcinoma in the elderly. J Am Coll Surg. 2001;192:38–46.CrossRefPubMedGoogle Scholar
  19. 19.
    Delgado S, Lacy AM, García Valdecasas JC, Balagué C, Pera M, Salvador L, et al. Could age be an indication for laparoscopic colectomy in colorectal cancer? Surg Endosc. 2000;14:22–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Senagore AJ, Madbouly KM, Fazio VW, Duepree HJ, Brady KM, Delaney CP. Advantages of laparoscopic colectomy in older patients. Arch Surg. 2003;138:252–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Kaneko H, Tsuchiya M, Otsuka Y, Tamura A, Katagiri T, Maeda T, et al. Laparoscopy-assisted Hepatectomy for Giant Hepatocellular Carcinoma. Surg Laparosc Endosc Percutan Tech. 2008;18:127–31.CrossRefGoogle Scholar
  22. 22.
    Cho JY, Han HS, Yoon YS, Shin SH. 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. 2008;144:32–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • Yuichiro Otsuka
    • 1
    Email author
  • Masaru Tsuchiya
    • 1
  • Tetsuya Maeda
    • 1
  • Toshio Katagiri
    • 1
  • Jun Isii
    • 1
  • Akira Tamura
    • 1
  • Kunihiro Yamazaki
    • 1
  • Yoshihisa Kubota
    • 1
  • Takashi Suzuki
    • 1
  • Takayuki Suzuki
    • 1
  • Satoru Kagami
    • 1
  • Hironori Kaneko
    • 1
  1. 1.Division of General and Gastroenterological Surgery, Department of Surgery (Omori)Toho University School of MedicineTokyoJapan

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