Laparoscopic liver resection facilitates salvage liver transplantation for hepatocellular carcinoma

  • Alexis Laurent
  • Claude Tayar
  • Marion Andréoletti
  • Jean-Yves Lauzet
  • Jean-Claude Merle
  • Daniel Cherqui
Original article

Abstract

Background/Purpose

In patients with hepatocellular carcinoma (HCC), a previous liver resection (LR) may compromise subsequent liver transplantation (LT) by creating adhesions and increasing surgical difficulty. Initial laparoscopic LR (LLR) may reduce such technical consequences, but its effect on subsequent LT has not been reported. We report the operative results of LT after laparoscopic or open liver resection (OLR).

Methods

Twenty-four LT were performed, 12 following prior LLR and 12 following prior OLR. The LT was performed using preservation of the inferior vein cava. Indication for the LT was recurrent HCC in 19 cases (salvage LT), while five patients were listed for LT and underwent resection as a neoadjuvant procedure (bridge resection).

Results

In the LLR group, absence of adhesions was associated with straightforward access to the liver in all cases. In the OLR group, 11 patients required long and hemorrhagic dissection. Median durations of the hepatectomy phase and whole LT were 2.5 and 6.2 h, and 4.5 and 8.3 h in the LLR and OLR groups, respectively (P < 0.05). Median blood loss was 1200 ml and 2300 ml in the LLR and OLR groups, respectively (P < 0.05). Median transfusions of hepatectomy phase and whole LT were 0 and 3 U, and 2 and 6 U, respectively (P < 0.05). There were no postoperative deaths.

Conclusions

In our study, LLR facilitated the LT procedure as compared with OLR in terms of reduced operative time, blood loss and transfusion requirements. We conclude that LLR should be preferred over OLR when feasible in potential transplant candidates.

Keywords

Hepatocelullar carcinoma Laparoscopic liver resection Liver transplantation Open liver resection Savage liver transplantation 

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Copyright information

© Springer 2009

Authors and Affiliations

  • Alexis Laurent
    • 1
  • Claude Tayar
    • 1
  • Marion Andréoletti
    • 2
  • Jean-Yves Lauzet
    • 2
  • Jean-Claude Merle
    • 2
  • Daniel Cherqui
    • 1
    • 3
  1. 1.Liver Transplantation and Hepatobiliary Unit, Service de Chirurgie Digestive et HépatobiliaireHôpital Henri Mondor—Université Paris 12CréteilFrance
  2. 2.Service d’Anesthésie-Réanimation Chirurgicale-SAMU 94Hôpital Henri Mondor—Université Paris 12CréteilFrance
  3. 3.Department of Digestive SurgeryHôpital Henri MondorCréteilFrance

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