Laparoscopic surgery for large left lateral liver tumors: safety and oncologic outcomes
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.
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.
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.
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.
KeywordsLaparoscopic hepatectomy Left lateral lobe Large tumor Hepatocellular carcinoma
The authors are grateful to Editage for the revisions of grammar, sentence construction, word choice, and syntax.
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.
This study is granted by the National Cheng Kung University Hospital Research Grant No. NCKUH-10603054.
Compliance with ethical standards
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.
- 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
- 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
- 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.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.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.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
- 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
- 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
- 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