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Surgical Endoscopy

, Volume 32, Issue 10, pp 4314–4320 | Cite as

Laparoscopic surgery for large left lateral liver tumors: safety and oncologic outcomes

  • Tsung-Han Yang
  • Jen-Lung Chen
  • Yih-Jyh Lin
  • Ying-Jui Chao
  • Yan-Shen Shan
  • Hui-Ping Hsu
  • Zhe-Min Su
  • Chung-Ching Chou
  • Yi-Ting YenEmail author
2018 SAGES Oral

Abstract

Background

Although laparoscopic hepatectomy has been proven to be safe and reliable, the influence of tumor size on the feasibility of laparoscopic left lateral segmentectomy (LLLS) is unclear. We retrospectively reviewed our surgical results focusing on hepatic tumor located in the left lateral segment.

Methods

From January 2003 to June 2016, patients who underwent left lateral segmentectomy were retrospectively reviewed, and data were collected on patient characteristics, peri-operative outcomes, and pathologic results. Patients with intrahepatic stone, cystic lesion, or unmeasurable tumor size were excluded. The continuous variables were compared using the Mann–Whitney U test and categorical variables using the Chi square or Fisher’s exact test. The overall and disease-free survival rates were computed using the Kaplan–Meier method and compared using the log-rank test.

Results

A total of 103 patients were enrolled for analysis. Among the patients with tumors larger than 5 cm in the left lateral segment, those who underwent laparoscopic surgery had significantly shorter hospital stay and larger resection margin than those who underwent open surgery. The surgical results of the patients who underwent LLLS were not significantly different from those of the patients with tumors larger than 5 cm. Specifically, the 5-year overall survival and disease-free survival rates of the patients with hepatocellular carcinoma (HCC) larger than 5 cm who underwent LLLS were comparable to those of the patients who underwent open left lateral segmentectomy.

Conclusions

LLLS is safe and also feasible for hepatic tumors larger than 5 cm. For HCCs larger than 5 cm, the laparoscopic approach yields satisfying oncologic outcomes as the open approach.

Keywords

Laparoscopic hepatectomy Left lateral lobe Large tumor Hepatocellular carcinoma 

Notes

Acknowledgements

The authors are grateful to Editage for the revisions of grammar, sentence construction, word choice, and syntax.

Author contributions

Dr. T-HY: contributed to patient care, study design, data management, data analysis and writing, revision and approval of the manuscript. Dr. J-LC: contributed to performance of surgery and patient care, study design, and approval of the manuscript. Dr. Y-JL: contributed to performance of surgery and patient care, study design, and approval of the manuscript. Dr. Y-JC: contributed to performance of surgery and patient care. Dr. Y-SS: contributed to performance of surgery and patient care. Dr. H-PH: study design and data analysis. Dr. Z-MS: contributed to performance of surgery and patient care, study design, and approval of the manuscript. Dr. C-CC: contributed to performance of surgery and patient care, data collection, data analysis, study design, and approval of the manuscript. Dr. Y-TY: study design, data management, data analysis, and revision and approval of the manuscript.

Funding

This study is granted by the National Cheng Kung University Hospital Research Grant No. NCKUH-10603054.

Compliance with ethical standards

Disclosures

The authors Tsung-Han Yang, Jen-Lung Chen, Yih-Jyh Lin, Ying-Jui Chao, Yan-Shen Shan, Hui-Ping Hsu, Zhe-Min Su, Chung-Ching Chou, Yi-Ting Yen have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Goh BK, Tan YH, Yip SK, Eng PH, Cheng CW (2004) Outcome of patients undergoing laparoscopic adrenalectomy for primary hyperaldosteronism. JSLS: J Soc Laparoendosc Surg 8(4):320–325Google Scholar
  2. 2.
    Purkayastha S, Tilney HS, Georgiou P, Athanasiou T, Tekkis PP, Darzi AW (2007) Laparoscopic cholecystectomy versus mini-laparotomy cholecystectomy: a meta-analysis of randomised control trials. Surg Endosc 21(8):1294–1300.  https://doi.org/10.1007/s00464-007-9210-3 CrossRefPubMedGoogle Scholar
  3. 3.
    Pugliese R, Maggioni D, Sansonna F, Scandroglio I, Ferrari GC, Di Lernia S, Costanzi A, Pauna J, de Martini P (2007) Total and subtotal laparoscopic gastrectomy for adenocarcinoma. Surg Endosc 21(1):21–27.  https://doi.org/10.1007/s00464-005-0409-x CrossRefPubMedGoogle Scholar
  4. 4.
    Law WL, Lee YM, Choi HK, Seto CL, Ho JW (2007) Impact of laparoscopic resection for colorectal cancer on operative outcomes and survival. Ann Surg 245(1):1–7.  https://doi.org/10.1097/01.sla.0000218170.41992.23 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Reich H, McGlynn F, DeCaprio J, Budin R (1991) Laparoscopic excision of benign liver lesions. Obstet Gynecol 78(5 Pt 2):956–958PubMedGoogle Scholar
  6. 6.
    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 C-G, 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 J-N, 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 (2009) The international position on laparoscopic liver surgery. Ann Surg 250(5):825–830.  https://doi.org/10.1097/SLA.0b013e3181b3b2d8 CrossRefPubMedGoogle Scholar
  7. 7.
    Hasegawa Y, Nitta H, Sasaki A, Takahara T, Ito N, Fujita T, Kanno S, Nishizuka S, Wakabayashi G (2013) Laparoscopic left lateral sectionectomy as a training procedure for surgeons learning laparoscopic hepatectomy. J Hepato-Biliary Pancreat Sci 20(5):525–530.  https://doi.org/10.1007/s00534-012-0591-x CrossRefGoogle Scholar
  8. 8.
    Ratti F, Barkhatov LI, Tomassini F, Cipriani F, Kazaryan AM, Edwin B, Abu Hilal M, Troisi RI, Aldrighetti L (2016) Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases. Surg Endosc 30(8):3618–3629.  https://doi.org/10.1007/s00464-015-4665-0 CrossRefPubMedGoogle Scholar
  9. 9.
    Troisi RI, Van Huysse J, Berrevoet F, Vandenbossche B, Sainz-Barriga M, Vinci A, Ricciardi S, Bocchetti T, Rogiers X, de Hemptinne B (2011) Evolution of laparoscopic left lateral sectionectomy without the Pringle maneuver: through resection of benign and malignant tumors to living liver donation. Surg Endosc 25(1):79–87.  https://doi.org/10.1007/s00464-010-1133-8 CrossRefPubMedGoogle Scholar
  10. 10.
    Goh BK, Chan CY, Lee SY, Lee VT, Cheow PC, Chow PK, Ooi LL, Chung AY (2016) Laparoscopic liver resection for tumors in the left lateral liver section. JSLS: J Soc Laparoendosc Surg.  https://doi.org/10.4293/JSLS.2015.00112 CrossRefGoogle Scholar
  11. 11.
    Im C, Cho JY, Han HS, Yoon YS, Choi Y, Jang JY, Choi H, Jang JS, Kwon SU, Kim H (2016) Laparoscopic left lateral sectionectomy in patients with histologically confirmed cirrhosis. Surg Oncol 25(3):132–138.  https://doi.org/10.1016/j.suronc.2016.05.001 CrossRefPubMedGoogle Scholar
  12. 12.
    Cheung TT, Poon RT, Dai WC, Chok KS, Chan SC, Lo CM (2016) Pure laparoscopic versus open left lateral sectionectomy for hepatocellular carcinoma: a single-center experience. World J Surg 40(1):198–205.  https://doi.org/10.1007/s00268-015-3237-8 CrossRefPubMedGoogle Scholar
  13. 13.
    Sahay SJ, Fazio F, Cetta F, Chouial H, Lykoudis PM, Fusai G (2015) Laparoscopic left lateral hepatectomy for colorectal metastasis is the standard of care. J BUON 20(4):1048–1053PubMedGoogle Scholar
  14. 14.
    Ai JH, Li JW, Chen J, Bie P, Wang SG, Zheng SG (2013) Feasibility and safety of laparoscopic liver resection for hepatocellular carcinoma with a tumor size of 5–10 cm. PLoS ONE 8(8):e72328.  https://doi.org/10.1371/journal.pone.0072328 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Shelat VG, Cipriani F, Basseres T, Armstrong TH, Takhar AS, Pearce NW, AbuHilal M (2015) Pure laparoscopic liver resection for large malignant tumors: does size matter? Ann Surg Oncol 22(4):1288–1293.  https://doi.org/10.1245/s10434-014-4107-6 CrossRefPubMedGoogle Scholar
  16. 16.
    Halls MC, Cipriani F, Berardi G, Barkhatov L, Lainas P, Alzoubi M, D’Hondt M, Rotellar F, Dagher I, Aldrighetti L, Troisi RI, Edwin B, Hilal MA (2017) Conversion for unfavorable intraoperative events results in significantly worst outcomes during laparoscopic liver resection: lessons learned from a multicenter review of 2861 cases. Ann Surg.  https://doi.org/10.1097/SLA.0000000000002332 CrossRefPubMedGoogle Scholar
  17. 17.
    Rao A, Rao G, Ahmed I (2011) Laparoscopic left lateral liver resection should be a standard operation. Surg Endosc 25(5):1603–1610.  https://doi.org/10.1007/s00464-010-1459-2 CrossRefPubMedGoogle Scholar
  18. 18.
    Abu Hilal M, McPhail MJ, Zeidan B, Zeidan S, Hallam MJ, Armstrong T, Primrose JN, Pearce NW (2008) Laparoscopic versus open left lateral hepatic sectionectomy: a comparative study. Eur J Surg Oncol 34(12):1285–1288.  https://doi.org/10.1016/j.ejso.2008.01.018 CrossRefPubMedGoogle Scholar
  19. 19.
    Aldrighetti L, Pulitano C, Catena M, Arru M, Guzzetti E, Casati M, Comotti L, Ferla G (2008) A prospective evaluation of laparoscopic versus open left lateral hepatic sectionectomy. J Gastrointest Surg 12(3):457–462.  https://doi.org/10.1007/s11605-007-0244-6 CrossRefPubMedGoogle Scholar
  20. 20.
    Zhang Y, Chen XM, Sun DL (2015) Comparison of laparoscopic versus open left lateral segmentectomy. Int J Clin Exp Med 8(1):904–909PubMedPubMedCentralGoogle Scholar
  21. 21.
    Twaij A, Pucher PH, Sodergren MH, Gall T, Darzi A, Jiao LR (2014) Laparoscopic vs open approach to resection of hepatocellular carcinoma in patients with known cirrhosis: systematic review and meta-analysis. World J Gastroenterol 20(25):8274–8281.  https://doi.org/10.3748/wjg.v20.i25.8274 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Yoon SY, Kim KH, Jung DH, Yu A, Lee SG (2015) Oncological and surgical results of laparoscopic versus open liver resection for HCC less than 5 cm: case-matched analysis. Surg Endosc 29(9):2628–2634.  https://doi.org/10.1007/s00464-014-3980-1 CrossRefPubMedGoogle Scholar
  23. 23.
    Cheung TT, Dai WC, Tsang SH, Chan AC, Chok KS, Chan SC, Lo CM (2016) Pure laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma in 110 patients with liver cirrhosis: a propensity analysis at a single center. Ann Surg 264(4):612–620.  https://doi.org/10.1097/SLA.0000000000001848 CrossRefPubMedGoogle Scholar
  24. 24.
    Zhong JH, Peng NF, Gu JH, Zheng MH, Li LQ (2017) Is laparoscopic hepatectomy superior to open hepatectomy for hepatocellular carcinoma? World J Hepatol 9(4):167–170.  https://doi.org/10.4254/wjh.v9.i4.167 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kwon Y, Han HS, Yoon YS, Cho JY (2015) Are large hepatocellular carcinomas still a contraindication for laparoscopic liver resection? J Laparoendosc Adv Surg Tech A 25(2):98–102.  https://doi.org/10.1089/lap.2014.0226 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical CollegeNational Cheng Kung UniversityTainanTaiwan
  2. 2.Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical CollegeNational Cheng Kung UniversityTainanTaiwan
  3. 3.Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical CollegeNational Cheng Kung UniversityTainanTaiwan

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