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Technical feasibility and safety of laparoscopic right hepatectomy for hepatocellular carcinoma following sequential TACE–PVE: a comparative study

Abstract

Background

Major liver resection for hepatocellular carcinoma (HCC) ideally involves preoperative portal venous embolization (PVE) coupled with preoperative transarterial chemoembolization (TACE) to improve postoperative course and oncological results. Laparoscopic right hepatectomy (RH) following sequential TACE–PVE for HCC, although challenging, may help improve both immediate and long-term patient outcomes. This study is the first to describe and compare laparoscopic to open RH following sequential TACE–PVE for HCC in terms of feasibility, safety, and patient outcomes.

Study design

All patients who underwent laparoscopic RH following successful TACE–PVE sequence (video provided) were retrospectively reviewed from a prospective database maintained at our center. Preoperative characteristics, operative data, and postoperative outcomes were analyzed and compared with those of patients who underwent open RH after TACE–PVE sequence during the same period.

Results

The laparoscopic and open RH groups each included 16 patients. F3 or F4 fibrosis was present in 81 % of patients. The conversion rate was 25 %. The 90-day postoperative complication rate was 25 % in the laparoscopic group versus 50 % in the open group (p = 0.27). The incidence of postoperative liver failure grade B was higher in the open group than in the laparoscopic group (5 vs. 0 patients, p = 0.043). Severe complications, Clavien grade ≥ IIIb, only occurred in the open group and included one postoperative death. Hospital stay was significantly shorter in the laparoscopic group than in the open group (7 vs. 12 days, p = 0.001). R0 resection was accomplished in 93.8 % of laparoscopic patients.

Conclusion

Laparoscopic approach seems technically feasible and safe. This modern approach may optimize the surgical strategy in the future of HCC management.

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Author information

Correspondence to Claire Goumard.

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Disclosures

Drs. Claire Goumard, Shohei Komatsu, Raffaele Brustia, Laëtitia Fartoux, Olivier Soubrane, and Olivier Scatton declare they have no conflict of interest or any financial ties to disclose.

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Laparoscopic right hepatectomy following TACE–PVE: video selection (MOV 381432 kb)

Laparoscopic right hepatectomy following TACE–PVE: video selection (MOV 381432 kb)

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Goumard, C., Komatsu, S., Brustia, R. et al. Technical feasibility and safety of laparoscopic right hepatectomy for hepatocellular carcinoma following sequential TACE–PVE: a comparative study. Surg Endosc 31, 2340–2349 (2017) doi:10.1007/s00464-016-5225-y

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Keywords

  • Hepatocellular carcinoma
  • Laparoscopic liver resection
  • Right hepatectomy
  • Transarterial chemoembolization