Application of laparoscopic hepatectomy in hepatocellular carcinoma

Abstract

Objective To investigate the clinical application value of laparoscopic hepatectomy (LH) in hepatocellular carcinoma (HCC). Methods Clinical data of 159 patients with HCC undergoing LH in the Southwest Hospital of the Third Military Medical University between January 2010 and January 2012 were retrospectively analyzed. Among the patients, 135 were males and 24 were females with the average age of (52±12) years old. One hundred and forty-seven cases were with liver function of Child-Pugh Class A and 12 with Class B. The informed consents of all patients were obtained and the local ethical committee approval was received. Measures such as fully liver exposure, controlled low central venous pressure, first hepatic portal occlusion or regional hepatic vascular inflow occlusion, and hepatectomy with harmonic scalpel were used for bleeding control during the surgery. The rate of conversion to laparotomy, duration of operation, intraoperative blood loss, blood transfusion rate, hepatic inflow occlusion and postoperative complications of the patients were observed. The survival analysis was conducted using Kaplan-Meier survival curves. Results The rate of conversion to laparotomy was 6.3%(10/159) including 1 case of right hepatic vein injury, 4 of middle hepatic vein injury, 3 of bleeding from liver dissection surface and 2 of positive incisal margin. The duration of operation, the median intraoperative blood loss and the perioperative blood transfusion rate were respectively (228±64) min, 450(50-1600) ml and 8.8%(14/159). Hepatic inflow occlusion was applied on 92 cases, and the inflow occlusion time was (37±15) min. The postoperative recovery time of gastrointestinal function was (2.5±0.6) d and the hospital stay was (10±3) d. The postoperative complication incidence was 12.6% (20/159), including 1 case died of liver failure 1 week after surgery. The postoperative 1-, 3-year overall survival rates were respectively 94%, 80%, and the 1-, 3-year disease-free survival rates were respectively 85%, 64%. Conclusion With appropriate bleeding control techniques, LH is safe and feasible for HCC, and can achieve good curative efficacy. Key words: Carcinoma, hepatocellular; Hepatectomy; Laparoscopes