Clinical efficacy and experiences of laparoscopic hepatectomy: a report of 2 048 cases

Abstract

Objective To investigate the clinical efficacy of laparoscopic hepatectomy and summarize its experiences. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 2 048 patients who underwent laparoscopic hepatectomy in the Southwest Hospital of the Third Military Medical University from March 2007 to October 2016 were collected. The resectability of lesions and liver functional reserve were preoperatively evaluated, and then laparoscopic hepatectomy was conducted. Observation indicators: (1)surgical and intraoperative situations; (2) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the patients′ postoperative survival up to June 2017. Measurement data with normal distribution were represented as ±s. Count data were evaluated by the percentage. The survival rate was calculated by the Kaplan-Meier method. Results (1) Surgical and intraoperative situations: all the 2 048 patients received successful laparoscopic hepatectomy, including 1 985 undergoing traditional laparoscopic hepatectomy and 63 undergoing Da Vinci robot-assisted and laparoscopic hepatectomy. Non-anatomical and anatomical hepatectomies were respectively applied to 1 052 and 996 patients. The rate of conversion to open surgery of 2 048 patients was 6.738%(138/2 048). Operation time, volume of intraoperative blood loss and rate of intraoperative blood transfusion in 2 048 patients were (225±27)minutes, (455±152)mL and 5.615%(115/2 048), respectively. The incidence of postoperative complications was 11.816%(242/2 048), 42.149%(102/242) of postoperative complications included reactive pleural effusion and effusion in the resection margin, and other postoperative complications included peritoneal effusion, pulmonary infection, abdominal infection, bile leakage, bleeding, incision liquefied, thrombus and acute liver injury. The incidence of postoperative severe complications was 0.488%(10/2 048), including 6 with intraperitoneal bleeding, 1 with acute respiratory distress syndrome, 1 with cardiac failure, 1 with hepatic failure and 1 with renal failure. Of 242 patients with postoperative complications, 6 with intraperitoneal bleeding received reoperations and were improved, 1 died of extensive thrombus of portal vein system induced liver failure, and 235 were improved by conservative treatment. Duration of hospital stay in 2 048 patients was (10.7±1.0)days. (2) Follow-up situations: 912 of 1 070 patients with malignant liver tumors were followed up for 8-120 months, with a median time of 51 months. The 1-, 3- and 5- year overall survival rates and 1-, 3- and 5- year tumor-free survival rates in 912 patients with malignant liver tumors and follow-up were 94.1%, 82.2%, 53.6% and 82.3%, 61.3%, 32.8%, respectively. Conclusions Laparoscopic hepatectomy is safe and feasible, with definite effects. In the premise of breakthroughs of technical bottlenecks in the bleeding control and exposure of special liver segment, the indications for laparoscopic hepatectomy have been expanded and there is no restricted area. Key words: Hepatic neoplasms; Hepatolithiasis; Hepatectomy; Laparoscopy