Abstract
Background
Laparoscopic liver resection (LLR) is still not a well-established treatment modality for hepatocellular carcinoma (HCC). Moreover, most reported cases have been limited to tumors in the anterolateral (AL) segments (segments 2, 3, 4b, 5, and 6). We evaluated clinical and oncologic outcomes after LLR for HCC located in all segments, including lesions located in the posterosuperior (PS) segments (segments 1, 4a, 7, and 8).
Methods
This retrospective study included 69 patients who had undergone LLR for HCC between September 2003 and November 2008. The patients were divided into two groups (group AL and group PS) according to tumor location. The clinical data of the two groups were retrospectively analyzed.
Result
There was no postoperative mortality. Fifteen patients (21.7%) experienced 19 postoperative complications. During a median follow-up period of 21.3 months, recurrence was detected in 21 (30.4%) patients. The 3-year overall survival rate and disease-free survival rate were 90.4 and 60.4%, respectively. There was no difference in clinicopathologic characteristics between the two groups except for a male predominance in group PS (p = 0.021) and that there were more patients with thrombocytopenia in group AL (p = 0.001). Although group PS patients had longer operative time (p = 0.001) and longer postoperative hospital stay (p = 0.039), along with a tendency toward a higher rate of open conversion (p = 0.054) and greater blood loss (p = 0.068), there was no significant difference in rates of postoperative complications (p = 0.375), recurrence (p = 0.740), 3-year overall survival (p = 0.237) or disease-free survival (p = 0.411) between the two groups.
Conclusions
Our experience shows that LLR can be safely performed in selected patients with HCC located in all segments of the liver, including the posterosuperior segments, with acceptable postoperative morbidity and oncologic results.
Similar content being viewed by others
References
Morino M, Morra I, Rosso E, Miglietta C, Garrone C (2003) Laparoscopic vs open hepatic resection: a comparative study. Surg Endosc 17:1914–1918
Simillis C, Constantinides VA, Tekkis PP, Darzi A, Lovegrove R, Jiao L, Antoniou A (2007) Laparoscopic versus open hepatic resections for benign and malignant neoplasms—a meta-analysis. Surgery 141:203–211
Vibert E, Perniceni T, Levard H, Denet C, Shahri NK, Gayet B (2006) Laparoscopic liver resection. Br J Surg 93:67–72
Belli G, Fantini C, D’Agostino A, Cioffi L, Langella S, Russolillo N, Belli A (2007) Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results. Surg Endosc 21:2004–2011
Chen HY, Juan CC, Ker CG (2008) Laparoscopic liver surgery for patients with hepatocellular carcinoma. Ann Surg Oncol 15:800–806
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 243:499–506
Dagher I, Lainas P, Carloni A, Caillard C, Champault A, Smadja C, Franco D (2008) Laparoscopic liver resection for hepatocellular carcinoma. Surg Endosc 22:372–378
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 189:190–194
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 138:763–769 discussion 769
Cho JY, Han HS, Yoon YS, Shin SH (2008) Experiences of laparoscopic liver resection including lesions in the posterosuperior segments of the liver. Surg Endosc 22:2344–2349
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 144:32–38
Dulucq JL, Wintringer P, Stabilini C, Mahajna A (2006) Isolated laparoscopic resection of the hepatic caudate lobe: surgical technique and a report of 2 cases. Surg Laparosc Endosc Percutan Tech 16:32–35
Gumbs AA, Gayet B (2008) Totally laparoscopic central hepatectomy. J Gastrointest Surg 12:1153
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 238:674–679
O’Rourke N, Fielding G (2004) Laparoscopic right hepatectomy: surgical technique. J Gastrointest Surg 8:213–216
Yoon YS, Han HS, Choi YS, Jang JY, Suh KS, Kim SW, Lee KU, Park YH (2006) Total laparoscopic right posterior sectionectomy for hepatocellular carcinoma. J Laparoendosc Adv Surg Tech A 16:274–277
Yoon YS, Han HS, Choi YS, Lee SI, Jang JY, Suh KS, Kim SW, Lee KU, Park YH (2006) Total laparoscopic left lateral sectionectomy performed in a child with benign liver mass. J Pediatr Surg 41:e25–e28
Lee CS, Sheu JC, Wang M, Hsu HC (1996) Long-term outcome after surgery for asymptomatic small hepatocellular carcinoma. Br J Surg 83:330–333
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 235:373–382
Shimada M, Hashizume M, Maehara S, Tsujita E, Rikimaru T, Yamashita Y, Tanaka S, Adachi E, Sugimachi K (2001) Laparoscopic hepatectomy for hepatocellular carcinoma. Surg Endosc 15:541–544
Suh KS (2005) Systematic hepatectomy for small hepatocellular carcinoma in Korea. J Hepatobiliary Pancreat Surg 12:365–370
Yamamoto J, Okada S, Shimada K, Okusaka T, Yamasaki S, Ueno H, Kosuge T (2001) Treatment strategy for small hepatocellular carcinoma: comparison of long-term results after percutaneous ethanol injection therapy and surgical resection. Hepatology 34:707–713
Santambrogio R, Opocher E, Ceretti AP, Barabino M, Costa M, Leone S, Montorsi M (2007) Impact of intraoperative ultrasonography in laparoscopic liver surgery. Surg Endosc 21:181–188
Tabor E (2001) Hepatocellular carcinoma: global epidemiology. Dig Liver Dis 33:115–117
Regimbeau JM, Kianmanesh R, Farges O, Dondero F, Sauvanet A, Belghiti J (2002) Extent of liver resection influences the outcome in patients with cirrhosis and small hepatocellular carcinoma. Surgery 131:311–317
Lau WY, Leung TW, Yu SC, Ho SK (2003) Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg 237:171–179
Abu-Hilal M, Primrose JN, Casaril A, McPhail MJ, Pearce NW, Nicoli N (2008) Surgical resection versus radiofrequency ablation in the treatment of small unifocal hepatocellular carcinoma. J Gastrointest Surg 12:1521–1526
Buell JF, Thomas MT, Rudich S, Marvin M, Nagubandi R, Ravindra KV, Brock G, McMasters KM (2008) Experience with more than 500 minimally invasive hepatic procedures. Ann Surg 248:475–486
Belli G, D’Agostino A, Fantini C, Cioffi L, Belli A, Russolillo N, Langella S (2007) Laparoscopic radiofrequency ablation combined with laparoscopic liver resection for more than one HCC on cirrhosis. Surg Laparosc Endosc Percutan Tech 17:331–334
Dulucq JL, Wintringer P, Rashid LM (2007) Virtually bloodless laparoscopic liver resection of recurrent hepatoma with a new laparoscopic sealer device: report of our initial laparoscopic experience. Surg Laparosc Endosc Percutan Tech 17:413–415
Takagi S, Kaneko H, Ishii T, Tamura A, Yamazaki K, Yoshino M, Tsuchiya M, Joubara N, Otuka Y, Shiba T (2002) Laparoscopic hepatectomy for extrahepatic growing tumor. Surgical strategy based on extrahepatic growing index. Surg Endosc 16:1573–1578
Disclosures
Drs. Yoo-Seok Yoon, Ho-Seong Han, Jai Young Cho, and Keun Soo Ahn have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yoon, YS., Han, HS., Cho, J.Y. et al. Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc 24, 1630–1637 (2010). https://doi.org/10.1007/s00464-009-0823-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-009-0823-6