Safety and Feasibility of Laparoscopic Major Hepatectomy after Portal Vein Embolization

Abstract

Background and Aim: The operative safety and feasibility of laparoscopic major hepatectomy in patients after portal vein embolization is unknown, prompting our investigation of its safety and feasibility in patients at our center. Methods: Fifteen patients (male=13, female=2, with median age of 58 years), underwent laparoscopic major hepatectomy after portal vein embolization. Ten patients had hepatocellular carcinoma, two had combined hepatocellular carcinoma and cholangiocarcinoma, and 2 colorectal liver metastases, and 1 cholangiocarcinoma. Results: All patients were Child-Turcotte-Pugh score, 10 had liver fibrosis, and 10 had viral hepatitis. The median interval between portal vein embolization and laparoscopic major hepatectomy was 21 days. The median operative time was 324 min, estimated blood loss was 100 mL. White (2.5 mm) and blue (3.5 mm) cartridges were used in one patient each and Tri-Staple tan (2–3 mm) in 11 patients, and two patients required a combination of tan and purple cartridges (3–4 mm). There was one biliary leak and stricture after using a white cartridge, one transient hepatic insufficiency, and three minor complications. One patient died from a stroke on postoperative day 37. The mortality rate was 6.6% (1/15), and the morbidity rate was 33% (5/15). Conclusions: Laparoscopic major hepatectomy after portal vein embolization seems relatively safe and feasible. We advise against using a white cartridge and recommend a thicker cartridge for a more secure staple line.