Application value of laparoscopic right-posterior lobe hepatectomy using the technique of regional blood flow occlusion

Abstract

Objective To explore the application value of laparoscopic right-posterior lobe hepatectomy using the technique of regional blood flow occlusion. Methods The retrospectively cross-sectional study was conducted. The clinicopathological data of 27 patients who received laparoscopic right-posterior lobe hepatectomy in the Sir Run Run Shaw Hospital of Zhejiang University from May 2007 to June 2017 were collected. The hepatocellular carcinoma, intrahepatic bile duct stone, hepatic hemangioma, focal nodular hyperplasia, cholangiocarcinoma and metastatic hepatic carcinoma were respectively detected in 13, 4, 4, 4, 1 and 1 patients. The laparoscopic right-posterior lobe hepatectomy were performed after regional blood flow occlusion. Observation indicators: (1) intra- and post-operative recovery situations; (2) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative recurrence of patients with benign liver diseases and survival of patients with malignant liver tumors up to August 2017. Measurement data with skewed distribution were described as M (range). Results (1) Intra- and post-operative recovery situations: 27 patients underwent successful laparoscopic right-posterior lobe hepatectomy after regional blood flow occlusion, including 24 undergoing laparoscopic surgery and 3 undergoing conversion to open surgery due to difficult exposure under laparoscopy. Operation time, volume of intraoperative blood loss, recovery time of postoperative gastrointestinal function and time of postoperative abdominal drainage-tube removal were respectively 205 minutes (range, 125-455 minutes), 400 mL (range, 50-2 000 mL), 1 day (range, 1-3 days) and 3 days (range, 2-24 days). There was no postoperative hepatic failure, bile leakage and bleeding-induced reoperation. Of 4 patients with postoperative complications, 1 with wound infection was improved by regular dressing, 1 with deep venous thrombosis of the lower extremity was improved by anticoagulant therapy and 2 with pulmonary infection were improved by anti-infective supporting treatment. The duration of postoperative hospital stay in 27 patients was 9 days (range, 5-26 days). (2) Follow-up situations: 26 of 27 patients were followed up for 2-121 months, with a median time of 17 months, and 1 patient with benign liver disease lost to follow-up. During the follow-up, 11 patients with benign liver disease had no recurrence, the tumor-free and overall survival times of 15 patients with malignant liver tumors were respectively 13 months (range, 5-57 months) and 14 months (range, 5-57 months). Conclusion Laparoscopic right-posterior lobe hepatectomy using the technique of regional blood flow occlusion is safe and feasible, with a lower risk of liver failure and better clinical efficacies. Key words: Liver neoplasms; Carcinoma hepatocellular; Hepatolithiasis; Right-posterior lobe hepatectomy; Regional blood flow occlusion; Laparoscopy