Short-term Outcomes of Laparoscopic Anatomical Liver Resections with Glissonian Approach

Abstract

Background: Anatomical liver resections (ARs) have been shown to improve oncological outcomes in patients with liver malignancies. Few experiences on laparoscopic ARs (Lap-ARs) have been reported. This study aimed to evaluate the feasibility of Lap-ARs with Glissonian approach. Method: A total of 111 patients who underwent Lap-ARs with Glissonian approach from April 2016 to December 2019 were retrospectively reviewed. Results: Median age was 73 (19-91). 67 patients had hepatocellular carcinoma (HCC) while 30 had colorectal liver metastasis (CRLM) and 14 had others. 13 anatomical subsegmentectomies (HrS-), 48 segmentectomies (HrS), and 50 sectionectomies (Hr1, 2, and 3) were performed. Median difficulty score (IWATE criteria) was 7 (5-11). Surgical time was 342 min (102-639) and blood loss was 130 ml (5-1523). Conversion rate was 1.8%. Resected liver volume was 192 g (23-974). 13 patients (11.7%) experienced morbidities (≥ Clavien-Dindo IIIa) and 90-day mortality rate was 0.9%. Negative surgical margin was achieved in 94.2%. IWATE criteria ≥8 was associated with increased operative time, blood loss and postoperative morbidities. Conclusions: Lap-ARs with Glissonian approach are feasible procedures that integrate radicality and safety with the parenchymal-sparing principle.