Abstract
Background
The aim of this study is to evaluate clinical and oncologic outcomes after laparoscopic surgery for patients with multiple hepatocellular carcinoma (HCC).
Methods
Among the 260 patients who underwent laparoscopic procedures, including laparoscopic liver resection and laparoscopic radiofrequency ablation (LRFA), between September 2003 and December 2009, 107 patients with HCC were included in this retrospective study. According to tumor multiplicity, patients were divided into multiple lesion (n = 23) and single lesion (n = 84) groups. We compared the operative outcomes after the laparoscopic procedures between the single and multiple tumor groups.
Results
There was no difference in the clinicopathologic characteristics between the two groups, except the multiple group had more frequent previous history of preoperative transarterial chemoembolization. LRFA was more frequently used in the multiple group as compared with the single group. There was no postoperative mortality in either group. Application of laparoscopic surgery in the multiple group did not increase the operative time, rate of intraoperative transfusion, length of postoperative hospital stay, or postoperative complications, as compared with the single group. After median follow-up of 33.7 months, there was no statistically significant difference of the survival rates between the two groups, although there was a better disease-free survival rate in the single group.
Conclusions
This study shows that laparoscopic surgery, including LH and LRFA, can be safely applied to patients with multiple HCCs, and the survival outcomes are acceptable.
Similar content being viewed by others
References
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
Portolani N, Coniglio A, Ghidoni S, Giovanelli M, Benetti A, Tiberio GA, Giulini SM (2006) Early and late recurrence after liver resection for hepatocellular carcinoma: prognostic and therapeutic implications. Ann Surg 243:229–235
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 and nationwide survey in Japan. The liver cancer study group of Japan. Hepatology 32:1224–1229
Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236
Wu CC, Ho WL, Lin MC, Yeh DC, Wu HS, Hwang CJ, Liu TJ, P’eng FK (1998) Hepatic resection for bilobar multicentric hepatocellular carcinoma: is it justified? Surgery 123:270–277
Ishizawa T, Hasegawa K, Aoki T, Takahashi M, Inoue Y, Sano K, Imamura H, Sugawara Y, Kokudo N, Makuuchi M (2008) Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. Gastroenterology 134:1908–1916
Utsunomiya T, Shimada M, Taguchi KI, Hasegawa H, Yamashita Y, Hamatsu T, Aishima SI, Sugimachi K (2000) Clinicopathologic features and postoperative prognosis of multicentric small hepatocellular carcinoma. J Am Coll Surg 190:331–335
Vigano L, Tayar C, Laurent A, Cherqui D (2009) Laparoscopic liver resection: a systematic review. J Hepatobiliary Pancreat Surg 16:410–421
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 CG, 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 JN, 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, World Consensus Conference on Laparoscopic Surgery (2009) The international position on laparoscopic liver surgery: the Louisville statement, 2008. Ann Surg 250:825–830
Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection—2,804 patients. Ann Surg 250:831–841
Koffron AJ, Auffenberg G, Kung R, Abecassis M (2007) Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg 246:385–392
Laurence JM, Lam VW, Langcake ME, Hollands MJ, Crawford MD, Pleass HC (2007) Laparoscopic hepatectomy, a systematic review. ANZ J Surg 77:948–953
O’Rourke N, Fielding G (2004) Laparoscopic right hepatectomy: surgical technique. J Gastrointest Surg 8:213–216
Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC, Lainas P, Laurent A, Nguyen KT, Marvin MR, Thomas M, Ravindra K, Fielding G, Franco D, Buell JF (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250:856–860
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
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 24:1630–1637
Montorsi M, Santambrogio R, Bianchi P, Opocher E, Zuin M, Bertolini E, Bruno S, Podda M (2001) Radiofrequency interstitial thermal ablation of hepatocellular carcinoma in liver cirrhosis. Role of the laparoscopic approach. Surg Endosc 15:141–145
Asahina Y, Nakanishi H, Izumi N (2009) Laparoscopic radiofrequency ablation for hepatocellular carcinoma. Dig Endosc 21:67–72
Santambrogio R, Podda M, Zuin M, Bertolini E, Bruno S, Cornalba GP, Costa M, Montorsi M (2003) Safety and efficacy of laparoscopic radiofrequency ablation of hepatocellular carcinoma in patients with liver cirrhosis. Surg Endosc 17:1826–1832
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
Han HS, Cho JY, Yoon YS (2009) Techniques for performing laparoscopic liver resection in various hepatic locations. J Hepatobiliary Pancreat Surg 16:427–432
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 96:1041–1048
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
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
Zhou YM, Shao WY, Zhao YF, Xu DH, Li B (2011) Meta-analysis of laparoscopic versus open resection for hepatocellular carcinoma. Dig Dis Sci 56:1937–1943
Bruix J, Llovet JM (2002) Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology 35:519–524
Berber E, Rogers S, Siperstein A (2005) Predictors of survival after laparoscopic radiofrequency thermal ablation of hepatocellular cancer: a prospective study. Surg Endosc 19:710–714
Matsuda M, Fujii H, Kono H, Matsumoto Y (2001) Surgical treatment of recurrent hepatocellular carcinoma based on the mode of recurrence: repeat hepatic resection or ablation are good choices for patients with recurrent multicentric cancer. J Hepatobiliary Pancreat Surg 8:353–359
Laurent A, Tayar C, Andreoletti M, Lauzet JY, Merle JC, Cherqui D (2009) Laparoscopic liver resection facilitates salvage liver transplantation for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 16:310–314
Yao FY, Hirose R, LaBerge JM, Davern TJ 3rd, Bass NM, Kerlan RK Jr, Merriman R, Feng S, Freise CE, Ascher NL, Roberts JP (2005) A prospective study on downstaging of hepatocellular carcinoma prior to liver transplantation. Liver Transpl 11:1505–1514
Acknowledgments
This study was supported by a grant from the Korea Healthcare Technology Research and Development Project Ministry of Health and Welfare, Korea (A102065).
Disclosures
Authors Yoo-Seok Yoon, Ho-Seong Han, Jai Young Cho, Chang Jin Yoon, and Ji Hoon Kim 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. Laparoscopic approach for treatment of multiple hepatocellular carcinomas. Surg Endosc 26, 3133–3140 (2012). https://doi.org/10.1007/s00464-012-2304-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-012-2304-6