Laparoscopic Hepatic Resection: Do Favorable Short-Term Outcomes Make It the Procedure of Choice for Lesions of the Left Hemiliver?
C. Kristian Enestvedt*1, Brian S. Diggs1, Brett C. Sheppard1, Susan L. Orloff2, Kevin G. Billingsley3
1Surgery, Oregon Health & Science University, Portland, OR; 2Abdominal Organ Transplantation, Oregon Health & Science University, Portland, OR; 3Surgical Oncology, Oregon Health & Science University, Portland, OR
BACKGROUND: Recent reports demonstrate the feasibility of laparoscopic liver resection for patients with benign and malignant conditions. We hypothesized that patients who underwent laparoscopic resections for lesions of the left liver would have short term outcomes similar to those who had open surgery.METHODS: A retrospective review compared laparoscopic left liver resections for both benign and malignant diseases to open controls for the years 2007-2010. Demographic information, pathology, tumor characteristics, procedure related factors, complications and mortality were assessed. Univariate analysis was performed with significance of p<0.05.RESULTS: Seventeen patients had laparoscopic resection during the study period, with 1 case converted to open (5.9%), and there were 22 open cases. Three anatomic left hepatectomies, 11 left lateral segmentectomies, and 3 lesser segmentectomies were performed in the laparoscopic group versus 15, 7 and 0 in the open group, respectively. There were no differences in demographics, margin status, or major complications (TABLE). The laparoscopy group had significantly lower intraoperative blood loss and shorter length of stay compared to the open group. Median tumor size was significantly larger in the open group. There was one death in the open group and none in the laparoscopic group. CONCLUSIONS: In this select group of patients undergoing resection of the left hemi-liver, short-term outcomes favored the laparoscopic approach. The open approach was used more often for larger, benign tumors. Long-term data regarding disease recurrence and survival are needed in this group of patients. These results suggest that laparoscopic resection is safe and for appropriately selected patients may be the optimal technical approach.
| Lap (n=17) | Open (n=22) | Total (n=39) | P value | |
| Male | 10 (59%) | 9 (41%) | 19 (49%) | 0.267 |
| Age (years) | 64 (55-70) | 58 (46-69) | 61 (51-69) | 0.256 |
| Tumor Size (cm) | 3.2 (1.9-5.3) | 5.5 (4.0-10.0) | 4.05 (3.0-8.0) | 0.016 |
| Margins negative | 15 (88%) | 17 (77%) | 32 (82%) | 0.425 |
| EBL (mL) | 200 (100-212) | 300 (200-500) | 200 (150-350) | 0.027 |
| LOS (days) | 4 (3-6) | 6 (5-7) | 6 (4-7) | 0.041 |
| ASA Class 1 2 3 | 0 4 (25%) 12 (75%) | 2 (9%) 6 (27%) 14 (64%) | 2 (5%) 10 (26%) 26 (68%) | 0.439 |
| BMI | 27.7 (25.2-30.3) | 30.7 (26.3-33.7) | 28.4 (25.4-33.4) | 0.335 |
| Major complications | 2 (12%) | 4 (18%) | 6 (15%) | 0.583 |
| Malignant | 14 (82%) | 10 (46%) | 24 (62%) | 0.778 |
| Disease CRC Metastases HCC Intrahepatic Cholangiocarcinoma Adenoma FNH Hemangioma | 11 (65%)3 (18%)01 (6%)2 (12%)0 | 1 (5%)5 (23%)2 (9%)2 (9%)4 (18%)3 (14%) | 21 (55%)8 (21%)2 (5%)3 (5%)6 (11%)3 (8%) | 0.012 |
()Medians with inter-quartile range or % EBL=estimated blood loss, LOS=length of stay, ASA=American Society of Anesthesiologists BMI=body mass index CRC=colorectal cancer, HCC=hepatocellular carcinoma, FNH=focal nodular hyperplasia
Back to 2011 Program
