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Surgical Endoscopy

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01-11-2007

Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results

Authors: G. Belli, C. Fantini, A. D’Agostino, L. Cioffi, S. Langella, N. Russolillo, A. Belli

Published in: Surgical Endoscopy | Issue 11/2007

Abstract

Background

Liver surgery, especially for cirrhotic patients, is one of the last areas of resistance to progress in laparoscopic surgery. This study compares the postoperative results and the 2-year patient outcomes between laparoscopic and open resection for hepatocellular carcinoma in patients with histologically proven cirrhosis.

Methods

From May 2000 to October 2004, 23 consecutive cirrhotic patients who underwent laparoscopic hepatectomy (LH) for HCC were compared in a retrospective analysis with a historic group of 23 patients who underwent open hepatectomy (OH). The two groups were well matched for age, gender, American Society of Anesthesiology (ASA) class, tumor location and size, type of liver resection, and severity of cirrhosis. The selection criteria for both groups specified a small (size < 5 cm), exophytic, or subcapsular tumor located in the left or peripheral right segments of the liver (II–VI segments, Couinaud); a well-compensated cirrhosis (Child-Pugh A); and an ASA score lower than 3. In the LH group, 15 subsegmentectomies, 3 segmentectomies, and 5 left lateral sectionectomies were performed, as compared with 12 subsegmentectomies, 5 segmentectomies, and 6 left lateral sectionectomies in the OH group.

Results

One patient in the LH group (4.3%) underwent conversion to laparotomy for inadequate exposition. The mean operative time was statistically longer for the LH group (LH, 148 min; OH, 125 min; p = 0.016), whereas blood transfusions (LH, 0%; OH, 17.3%; p = 0.036), Pringle maneuver (LH, 0%; OH, 21.73%; p = 0.017), mean hospital stay (LH, 8.3 days; OH, 12 days; p = 0.047), and postoperative complications (LH, 13%; OH, 47.8%; p = 0.010) were significantly greater in OH group. There was no statistically significant difference in mortality and 2-year survival rates between the two groups.

Conclusion

This study shows that LH for HCC in properly selected cirrhotic patients results in fewer early postoperative complications and a shorter hospital stay than the traditional OH. The 2-year survival rate was the same for LH and OH.

Grazi GL, Ercolani G, Pierangeli F, Del Gaudio M, Cescon M, Cavallari A, Mazziotti A (2001) Improved results of liver resection for hepatocellular carcinoma on cirrhosis give the procedure added value. Ann Surg 234:71–78PubMedCrossRef

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 131:311–317PubMedCrossRef

Gagner M, Rheault M, Dubuc J (1992) Laparoscopic partial hepatectomy for liver tumor. Surg Endosc 6:97–98

Azagra JS, Goergen M, Gilbart E, Jacobs D (1996) Laparoscopic anatomical (hepatic) left lateral segmentectomy: technical aspects. Surg Endosc 10:758–761PubMedCrossRef

Huscher CGS, Napolitano C, Chiodini S, Recher A, Buffa PF, Lirici MM (1997) Hepatic resections through the laparoscopic approach. Ann Ital Chir 6:791–797

Yamanaka N, Tanaka T, Tanaka W, Yamanaka J, Yasui C, Ando T, Takada M, Maeda S, Okamoto E (1998) Laparoscopic partial hepatectomy. Hepatogastroenterology 45:29–33PubMed

Marks J, Mouiel J, Katkhouda N, Gugenheim J, Fabiani P (1998) Laparoscopic liver surgery: a report on 28 patients. Surg Endosc 12:331–334PubMedCrossRef

Cherqui D, Husson E, Hammoud R, Malassagne B, Stephan F, Bensaid S, Rotman N, Fagniez PL (2000) Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 232:753–762PubMedCrossRef

Rau HG (1998) Laparoscopic liver resections compared with conventional partial hepatectomy: a prospective analysis. Hepatogastroenterology 45:2333–2338PubMed

10.

Lesurtel M, Cherqui D, Laurent A, Tayar C, Fagniez PL (2003) Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg 196:236–242PubMedCrossRef

11.

Morino M, Morra I, Rosso E, Miglietta C, Garrone C (2003) Laparoscopic vs open hepatic resection: a comparative study. Surg Endosc 17:1914–1918PubMedCrossRef

12.

Belli G, Fantini C, D’Agostino A, Belli A, Russolillo N (2004) Laparoscopic liver resections for hepatocellular carcinoma (HCC) in cirrhotic patients. HPB 6:236–246

13.

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 138:763–769PubMedCrossRef

14.

Farges O, Jagot P, Kirstetter P, Marty J, Belghiti J (2002) Prospective assessment of the safety and benefit of laparoscopic liver resections. J Hepato-Biliary-Pancreatic Surg 9:242–248CrossRef

15.

Dulucq JL, Wintringer P, Stabilini C, Berticelli J, Mahajna A (2005) Laparoscopic liver resections: a single-center experience. Surg Endosc 19:886–891PubMedCrossRef

16.

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 189:190–194PubMedCrossRef

17.

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 15:541–544PubMedCrossRef

18.

Belli G, Fantini C, D’Agostino A, Belli A, Langella S (2005) Laparoscopic hepatic resection for completely exophytic hepatocellular carcinoma on cirrhosis. J Hepatobiliary Pancreat Surg 12:488–493PubMedCrossRef

19.

Strasberg SM, Belghiti J, Clavien PA, Gadzijev E, Garden JO, Lau WY, Makuuchi M, Strong RW (2000) The Brisbane 2000 terminology of liver anatomy and resections. Terminology Committee of the International Hepato-Pancreato-Biliary Association. HPB 2:333–339

20.

Belli G, Fantini C, D’Agostino A, Belli A, Cioffi L, Russolillo N (2006) Laparoscopic left lateral hepatic lobectomy: a safer and faster technique. J Hepatobiliary Pancreat Surg 13:149–154PubMedCrossRef

21.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and result of a survey. Ann Surg 240:205–213PubMedCrossRef

22.

Belli G, Fantini C, D’Agostino A, Belli A, Russolillo N, Cioffi L (2005) Laparoscopic liver resection without Pringle Maneuver for HCC in cirrhotic patients. Chir Ital 57:15–25PubMed

23.

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: results of a multicenter European experience. Surg Endosc 17:23–30PubMedCrossRef

24.

Gigot JF, Glineur D, Azagra JS, Goergen M, Ceuterick M, Morino M, Etienne J, Marescaux J, Mutter D, van Krunckelsven L, Descottes B, Valleix D, Lachachi F, Bertrand C, Mansvelt B, Hubens G, Saey JP, Schockmel R (2002) Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg 236:90–97PubMedCrossRef

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 chronic liver disease: midterm results and perspectives. Ann Surg 243:499–506PubMedCrossRef

26.

Belli G (2004) Symposium on laparoscopic liver surgery: editorial. HPB 6:195–196

27.

Chang S, Laurent A, Tayar C, Karoui M, Cherqui D (2007) Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg 94:58–63PubMedCrossRef

28.

Vibert E, Perniceni T, Levard H, Denet C, Shari NK, Gayet B (2006) Laparoscopic liver resection. Br J Surg 93:67–72PubMedCrossRef

29.

O’Rourke N, Shaw I, Nathanson L, Martin I, Fielding G (2004) Laparoscopic resection of hepatic colorectal metastases. HPB 6:230–235

30.

Lo CM, Lai EC, Liu CL, Fan ST, Wong G (1998) Laparoscopy and laparoscopic ultrasonography avoid exploratory laparotomy in patients with hepatocellular carcinoma. Ann Surg 227:527–532PubMedCrossRef

31.

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 21:181–188PubMedCrossRef

32.

Kaneko H (2005) Laparoscopic hepatectomy: indications and outcomes. J Hepatobiliary Pancreat Surg 12:438–443PubMedCrossRef

33.

Schmidbauer S, Hallfeldt K, Sitzmann G, Kantelhardt T, Trupka A (2002) Experience with ultrasound scissors and blades (Ultracision) in open and laparoscopic liver resection. Ann Surg 235:27–30PubMedCrossRef

34.

Poon RT, Fan ST, Ng IO, Wong J (2000) Significance of resection margin in hepatectomy for hepatocellular carcinoma: a critical reappraisal. Ann Surg 231:544–551PubMedCrossRef

35.

Kyung–Suk Suh (2005) Systematic hepatectomy for small hepatocellular carcinoma in Korea. J Hepatobiliary Pancreat Surg 12:365–370

36.

Poon RTP, 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. Ann Surg 235:373–382PubMedCrossRef

Title: Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results
Authors: G. Belli
C. Fantini
A. D’Agostino
L. Cioffi
S. Langella
N. Russolillo
A. Belli
Publication date: 01-11-2007
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 11/2007
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-007-9503-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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