A multicenter cohort study of laparoscopic segment 1 resections: feasibility, techniques and outcomes

Abstract

Introduction: Laparoscopic liver resection (LLR) has been widely adopted. Nevertheless, laparoscopic segment 1 resection requires a high level of expertise due to its challenging anatomical area, even in the open approach. Only case series and single center cohort studies were published. Through this multicenter retrospective cohort study, we assessed the safety and feasibility of this laparoscopic procedure, described its outcomes, and determined interinstitutional differences. Methods: Between 2000-2018, 32 patients underwent LLR of segment 1 in 4 high-volume hepatobiliary units for colorectal liver metastasis (CRLM) (n=22, 68.8%), cholangiocarcinoma (n=1, 3.1%), other malignancies (n=4, 12.5%), and symptomatic benign lesions (n=5, 15.6%). Simultaneous colorectal and/or additional liver resection was performed in 20 (62,5%) patients. Perioperative and long-term outcomes were reviewed. Postoperative complications were stratified according to the Clavien-Dindo classification with severe complications defined by grade 3 or more. The median (range) follow-up time for the CRLM group was 14 (3-114) months. Results: The median operative time was 155 (29-440) minutes and estimated blood loss was 100 (10-1000) ml. No blood transfusions were required. Three conversions needed to be executed (9.4%), none procedure-related. Severe complications were observed in 2 cases (6.3%) without need for surgery. No postoperative mortality was noticed. In total 32 tumors were resected with a median size of 22 (0-58) mm. The median hospital length was 4 (1-40) days. Cancer recurrence was observed in 12 patients (54.5%) of the CRLM group with a median recurrence-free survival of 10 months. One recurrence occurred at the resection site. Overall survival 5 years after surgery was 82% in this subgroup. Only small interinstitutional differences were observed without major impact on surgical outcomes. Conclusion: LLR of segment 1 is safe and feasible when performed in high-volume centers. Therefore, profound anatomical knowledge, advanced laparoscopic skills and mastering intraoperative ultrasound is required. No major interinstitutional differences were ascertained.