Improved outcomes of laparoscopic liver resection for hepatocellular carcinoma located in posterosuperior segments of the liver

Abstract

Introduction: We compared outcomes of laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) located in posterosuperior (PS) segments before and after the adaptation of technological improvements. LLR is widely adapted for HCC, while LLR in PS segments is still challenging. However, with recent improvement of techniques and accumulation of experiences, LLR in PS segments is feasible. Method: We retrospectively analyzed 149 patients who underwent LLR for HCC located in PS segments from September 2003 to December 2016. The patients were divided into group 1 (n=43) and group 2 (n=106) who underwent LLR before and after 2012, when advanced techniques including use of intercostal trocars, Pringle maneuver, and semi-lateral position of patient were adapted. We also compared these patients with those who underwent open liver resection (OLR; n=124) for HCC in PS segments at the same period. Result: Mean operative time (395 minutes vs 331 minutes; P=0.013), intraoperative blood loss (1545 ml vs 1219 ml; P=0.020), and hospital stay (12 days vs 9, P<0.001) were significantly less in group 2. Postoperative complication rate (18.6% vs 18.9%; P=0.970), open conversion rate (23% vs 17%; P=0.374), 5-year overall survival (79% vs 89%; P=0.607) and 5-year disease free survival (52% vs 53%; P=0.657) rates were not significantly different between the groups. The proportion of LLR increased (36% vs 69%, P<0.001). Compared to OLR group, complication rate (40.3% vs 18.8%; P< 0.001) and hospital stay (18 days vs 10 days; P< 0.001) were significantly lower in LLR group. Conclusion: The complexity of LLR for HCC in PS segments has been gradually overcoming by the adaptation of advanced techniques.