Abstract
BackgroundLaparoscopic liver resection has been regarded as the standard treatment for liver tumors located at the left lateral liver sector. However, few studies have reported the results of laparoscopic left lateral sectionectomy (LLS) for HCC, not to mention the feasibility of this emerging technique for the less experienced liver surgeons. The current study would reappraise the Louisville statement by examining the outcome of LLS performed by a young liver surgeon.MethodsWe retrospectively reviewed two separate groups of patients who underwent open or laparoscopic left lateral sectionectomies at Chung Gung Memorial Hospital, Linkou. All laparoscopic hepatectomies were performed by the index young surgeon following a stepwise stapleless LLS. The surgical results and oncological outcomes of laparoscopic vs. open hepatectomies (LH and OH, respectively) with the surgical indication of HCC at left lateral liver sector were further compared and analyzed.Results18 of 29 patients in the laparoscopic group and 75 patients in the conventional open group had primary HCC. The demographic data was essentially the same for the two groups. Statistical analysis revealed that the LH group had smaller tumor size, higher blood transfusion requirement, longer duration of inflow control and parenchymal transection, and longer operation time. However, no significant difference was observed in terms of complication rate, mortality rate, and hospital stay between the two groups. After adjusting for tumor size, LH and OH showed no statistical difference in the amount of blood transfusion, operation time and patient survival.ConclusionsThis study demonstrated that stapleless LLS is a safe and feasible procedure for less experienced liver surgeons to resect HCC located at the left lateral liver sector. This stepwise stapleless LSS can not only achieve surgical results comparable to OH but also can provide a platform for liver surgeons to apply laparoscopic technique before conducting more complicated liver resections.
Highlights
Laparoscopic liver resection has been regarded as the standard treatment for liver tumors located at the left lateral liver sector
The fact that hepatocellular carcinoma (HCC) may arise in the context of liver cirrhosis while most of the series published so far were based on evidence from colorectal liver metastasis or benign liver lesions leaves the status of laparoscopic liver resection for HCC undetermined
The current study demonstrated that our stapleless laparoscopic liver resection is a safe and feasible procedure for less experienced liver surgeons to resect HCC located at the left lateral liver sector, even for HCC in cirrhotic livers
Summary
Laparoscopic liver resection has been regarded as the standard treatment for liver tumors located at the left lateral liver sector. Few studies have reported the results of laparoscopic left lateral sectionectomy (LLS) for HCC, not to mention the feasibility of this emerging technique for the less experienced liver surgeons. In an attempt to guide liver surgeons worldwide, the first International Consensus Conference on Laparoscopic Liver Resections was convened and a statement formulated. In this so-called “Louisville Statement”, laparoscopic liver resection was considered a standard practice for liver tumors located in the left lateral liver sector [7]. The fact that HCC may arise in the context of liver cirrhosis while most of the series published so far were based on evidence from colorectal liver metastasis or benign liver lesions leaves the status of laparoscopic liver resection for HCC undetermined
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