Laparoscopic liver resection of the segments 7 and 8

Abstract

Introduction: Laparoscopic liver resection (LLR) of the Segments 7 and 8 (S78) is still difficult. The present study elucidates safety and appropriate approach of LLR for S78 tumors. Methods: Between June 2010 and December 2017, 170 patients underwent LLR at our hospital, and 57 (33.5%) hepatectomies were for S78 tumors. These were divided in 2 groups: those patients with subsegmentectomy or more (Group S, n=37) and partial or limited resection (Group P, n=20), and analyzed retrospectively. Results: Indicated diseases were HCC in 44, metastases in 11, cholangiocarcinoma in 1 and benign tumor in 1. Median age (Group S, 69 years vs. Group P 68.5 years), male: female ratio (25:12 vs. 12:8), BMI (22.9 vs.24.2 kg/m2), history of abdominal surgery (48.6% vs.55.0%), tumor size (2cm vs. 1.5cm, p=0.092), number of tumors (1 vs. 1), and ICG R15 rate (12.5% vs. 17.5%, p=0.081) were not different. Surgical duration (217 min vs. 178 min, p=0.192), blood loss (215 g vs. 300g, p=0.632), number of ports (6 vs. 6), wound length (5cm vs. 5cm), morbidity (>Clavien-Dindo classification,Grade 2) (8.1% vs. 25%, p=0.081), and hospital stay (13 days vs. 12.5 days) were not different. However, open conversion rate (2.7% vs. 15%, p=0.031) and positive surgical margin (0% vs. 20%, p=0.026) were significantly different. Conclusion: LLR for S78 tumors is feasible with acceptable morbidity and mortality rates. Anatomical subsegmentectomy or more extensive liver resection is preferable when liver function reserve is in a tolerable range.