Feasibility of laparoscopic liver resection for caudate lobe: technical strategy and comparative analysis with anteroinferior and posterosuperior segments.

Abstract

Although laparoscopic liver resection (LLR) is now considered a standard procedure in peripheral segments, there are few reports on laparoscopic segment 1 (Sg1) resection. The aim of this study was to assess both safety and feasibility of Sg1 LLR. From 2000 to 2014, all patients who underwent LLR were identified from a prospective database. Patients with resection of Sg1 (Sg1 group) were compared with those with resection of anteroinferior segments (AI group: segments 3, 4b, 5, 6) or posterosuperior segments (PS group: segments 4a, 7, 8), in terms of tumor characteristics, surgical treatment, and short-term outcomes. There were 15, 151, and 67 patients in Sg1, AI, and PS groups. Tumor size and tumor number were similar between the three groups (p=0.139, p=0.102). Operative time was significantly shorter in Sg1 (150min) and AI group (135min) compared with PS group (180min) (p=0.021). Median blood loss was notably higher in PS group (140ml) compared with Sg1 group (75ml) and AI group (10ml) (p=0.001). No mortality was observed in all groups. Postoperative complication rate was 20.0% with Sg1 group, 14.6% with AI group, and 20.9% with PS group (p=0.060). The rate of major complication was significantly higher in Sg1 group (13.3%) and PS group (11.9%) compared with AI group (4.0%) (p=0.042). Resection margins were clear in all Sg1 and PS group patients, whereas two (1.3%) patients in AI group had R1 margins (p=0.586). The laparoscopic approach of isolated resection located in the caudate lobe is a feasible and curative surgical option in selected patients.