Totally laparoscopic resection of solid hepatic lesions: analysis of a single-centre series of 71 cases
Rotellar F, Bueno A, Benito A, Martí-Cruchaga P, Zozaya G, Pedano N, Pardo F.
Servicio de Cirugía HPB y Trasplante, Departamento de Cirugía General y Digestiva, Clínica Universidad de Navarra, Pamplona, España
To assess the results of a single-centre series of solid hepatic lesion resections using a totally laparoscopic approach.
PATIENTS AND METHOD
A total of 71 solid hepatic lesion resections using a totally laparoscopic approach were performed from November 2002 to February 2012. Of these, 65 were due to malignant disease, and 6 due to benign diseases. A total of 21 hepatocellular carcinomas were removed, 16 on a cirrhotic liver. Limited resections were performed in 52 (73.2%) cases, as well as 14 sectionectomies (3 right posterior and 11 left laterals). Finally, there were 5 major liver resections: 3 left and 2 right hepatectomies. In 14 cases (19.7%) it was combined with some other surgical procedure (cholecystectomy not included). The lesions were located in the anterior segments (SA) in 41 cases (57.7%) and in postero-superior segments (PSS) in 30 cases.
There were 2 (2.8%) conversions to open surgery. Five (7%) patients required transfusions during surgery. The median hospital stay was 4 (3-5) days. There was one (1.4%) death, and one patient required further surgery due to esophagojejunal anastomotic leak. The resection margins were tumour-free in 100% of the cases. Combined surgery showed a significant increase in the morbidity rate (35.7 compared to 7%, p=.012). There were no differences in regards to complication rate (p=.28), transfusions (p=.69) or hospital stay (p=.44) with PSS resections when compared to AS resections.
The totally laparoscopic approach is feasible and safe in the resection of solid liver lesions. Combined surgery can significantly increase the morbidity rate. Resections of lesions situated in PSS can be performed with similar safety to those in SA.
CITATION Cir Esp. 2012 Jul 25