Postero-superior liver segments resection for benign tumors. Short-term results

Abstract

Introduction: Indication for laparoscopic postero-superior liver segments resection in patients with benign tumors remains controversial. We aimed to evaluate the short-term results of minimally invasive resections (MILR) for benign tumors of postero-superior liver segments. Method: Data were accumulated since 2014 to 2018. Indications for liver resection were giant (>8 cm) growing lesions with clinical signs (abdominal pain on physical activity) and suspicion for malignancy. Result: Liver resection were performed in 75 patients. MILR were applied in 68 (91%), including 55 lap and 13 robotic resections. The benign lesions were presented by hemangioma (36), adenoma (13), FNH (12) and cystadenoma (7). Mean tumor size 8,8 cm (max 20 cm). Tumor size in 62% of cases was more than 8 cm. In 32 (47%) cases tumor adjoining to vessels. Partial resection of postero-superior segments and caudate lobe was performed in 25 (37%) patients. Robotic system was used in 8 of them. Open approach was applied only for 7 major hepatectomy (9%). Major morbidity after MILR of postero-superior segments was observed in 2 (2,9%) patient (IIIA, Clavien-Dindo): hematoma, after lap S6,7 resection and biloma after lap S3,4,8 resection, requiring additional drainage. There was no mortality. After major open liver resections bile leakage took place in 3 patients and required additional drainage. Mean operation time of MILR and open resection was comparable: 273 (160-490) min and 324 (260-395) min, respectively. The mean blood loss for MILR and open procedures was 300 (10-1000) ml and 1542 (100-4500) ml, respectively. The mean postoperative hospital stay after MILR and open resection was 6 (4-12) and 7(6-10) days, respectively. Conclusion: MILR for benign lesions located in postero-superior segments is the safe option for treatment of symptomatic and large benign tumors and may be considered as the first choice approach if surgery is indicated.