Laparoscopic liver resection in the cirrhotic patient

Abstract

Aim: The adoption of laparoscopic liver resection has been expansive in the last 2 decades with the exception of cirrhotic patients. The current study examines the outcomes of our cirrhotic resections to determine the potential limitations of this technique.

Methods: Retrospective analysis of 114 cirrhotic patients. Seventy-five (65.8%) laparoscopic resections were compared to 39 open resections. Seventy-six (66.7%) resections in the series were minor resections (less than 3 segments). Surgical approach and extent of resection were analyzed using student’s t-test and regression multivariate analysis with SAS.

Results: The laparoscopic group had lower operative times (2.4 vs. 4.8 h; P < 0.001), blood loss (250 vs. 609 mL; P < 0.001), length of stay (4.4 vs. 10.1 days; P = 0.013) and complications (28% vs. 48%; P = 0.028). Subset analysis by technique and extent of resection identified the laparoscopic group lost the advantage in blood loss and lengths of stay when utilized in major resections. Multivariate regression analysis for blood loss further confirmed open resection (P = 0.014) and major resection (P = 0.026) as significant indicators of bleeding and transfusion.

Conclusion: Laparoscopic liver resection in cirrhotic patients is safe and efficacious. However, the significant variability in outcomes for major resections in cirrhotics leads us to recommend further examination of the learning curve and significant caution in the selection of cirrhotics requiring major hepatic resections.

Keywords

Laparoscopic liver resection / cirrhosis / complications / outcomes

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