Resecciones hepáticas videolaparoscópicas: estudio descriptivo de nuestra experiencia en 16 años

Abstract

Background: Improvements in laparoscopic surgery have led to more rapid progress in laparoscopic liver resections. The indications of this approach are still matter of debate. Objectives: The aim of the present study is to describe the results obtained in series of patients undergoing laparoscopic liver resections. Material and methods: We conducted a descriptive, observational and analytical study. We evaluated a series of patients undergoing laparoscopic liver resection categorized by Iwate criteria between January 2005 and October 2021. The demographic variables, diagnosis, type of approach, intraoperative findings, clinical and technical aspects and complications, were analyzed. Results: Of 159 patients undergoing hepatectomies, 120 procedures were performed laparoscopically (applicability rate 75%) and were divided into four groups according to the Iwate scoring system: low (difficulty index 0–3), 23 patients (19%); intermediate (difficulty index 4–6), 48 patients (40%); advanced (difficulty index 7–9), 33 patients (28%); and expert (difficulty index 10–12). 16 patients (13%). Median age was 62 years. The rate of Clavien-Dindo complications ≥ grade 3 was 14.28% and mortality rate was 2.5%. In resections of colorectal liver metastases disease-free survival was 75%, 59%, 46% at 1, 3 and 5 years, respectively, and overall survival was 93%, 79% and 69%, at 1, 3 and 5 years, respectively. Conclusions: Laparoscopic liver resection resulted a feasible and safe technique and should be performed by trained surgeons, in specialized centers and with long learning curves to increase the applicability rate from the simplest resections to the most complex ones. Careful selection of patients is required to ensure their safety.