Back to 2008 Program and Abstracts
Two-Hundred Consecutive Laparoscopic Liver Resections
Andrew a. Gumbs*1,2, Brice Gayet2
1Upper GI and Endocrine Surgery, New York-Presbyterian Hospital, New York, NY; 2Medical and Surgical Department of Digestive Diseases, Institut Mutualiste Montsouris, Paris, France
Introduction: Since the first report of a laparoscopic liver resection in 1992, laparoscopic resection of peripheral hepatic segments has become increasingly more common in the surgical treatment of both benign and malignant tumors. The minimally invasive approach to resections of the entire liver, however, is still only being performed in highly specialized centers do to lingering concerns about feasibility and efficacy.
Methods: Patients who underwent minimally invasive techniques were compared to results in the literature of patients treated at other European referral centers who were approached with open techniques. Our data was collected retrospectively, including our first cases of advanced laparoscopic resections. Five-year Kaplan-Meier curves of patients with hepatocellular carcinoma (HCC) and non-neuroendocrine metastatic disease were calculated to ascertain disease free and overall survival.
Results: Over a 12-year period from January 1995 until June 2007, a total of 357 liver procedures were performed. Of these a total of 200 laparoscopic liver resections were performed. The average OR time, estimated blood loss and length of stay was 192 minutes (+/- 106), 324 mL (+/-365) and 10 days (+/- 9). Conversions occurred in 13 patients (7%). Complications occurred after laparoscopic resection for primary liver cancer in 23% and in 24.2% after resections of non-neuroendocrine hepatic metastases compared to 31% and 25% as reported in the open European literature, respectively. Overall 5-year survival in patients with primary liver cancer is 66% and 55% in patients with non-neuroendocrine secondary hepatic tumors in the laparoscopic group compared to 36% and 32%, respectively, in the open group. Thirty day mortality occurred in 1% in the laparoscopic group compared to 2% in the open group.
Conclusions: Minimally invasive techniques for hepatic resections of the entire liver are feasible and safe, and high volume centers that specialize in these procedures can have results similar to historical open series. Five year overall survival may be superior when minimally invasive techniques are used, however, larger randomized-controlled trials are necessary to ascertain this.
