Laparoscopic resection of hepatocellular carcinoma in patients with and without cirrhosis: the Brisbane experience

Abstract

Aim: Laparoscopic liver resection for hepatocellular carcinoma (HCC) is increasingly common around the world. There may be significant advantages over open resections. However, due to technical difficulties, they are performed in few centers with expertise in liver and advanced laparoscopic surgery. In this study the authors summarize the experience to date.

Methods: A retrospective analysis of consecutive patients undergoing laparoscopic liver resection for HCC in 2 tertiary academic hepatobiliary units in Brisbane, Australia, between 1999 and 2015 was performed. Operative characteristics, perioperative morbidity, and pathological data were described. Patients with and without cirrhosis were analyzed and compared.

Results: Fifty-two patients underwent resection of 79 HCCs. Sixty-five percent of patients had cirrhosis. Fourteen percent of patients underwent a major hepatectomy. There was a trend towards more parenchyma-sparing resections for cirrhotic patients. Blood loss was higher in cirrhotics. Conversion to an open procedure occurred in 9%. There was one 90-day mortality due to liver failure (1.9%), and 7 patients (13%) experienced a complication. R0 resection was achieved in 92%. Overall survival at 1, 3, and 5 years was 88%, 81%, and 61%, respectively.

Conclusion: Laparoscopic liver resection for HCC, particularly in cirrhotic patients, is technically challenging. It can be performed with acceptable morbidity and adequate surgical margins.

Keywords

Hepatocellular carcinoma / hepatoma / hepatectomy / laparoscopic surgery / liver cirrhosis

References

[1] El-Serag HB.Hepatocellular carcinoma: epidemiology and molecular carcinogenesis..Gastroenterology2007;132:2557-76

[2] Lai EC,Ha JP.Laparoscopic liver resection for hepatocellular carcinoma: ten-year experience in a single center..Arch Surg2009;144:143-7; discussion 148

[3] Venook AP,Furuse J.The incidence and epidemiology of hepatocellular carcinoma: a global and regional perspective..Oncologist2010;15 Suppl 4:5-13

[4] Altekruse SF,Cucinelli JE.Changing hepatocellular carcinoma incidence and liver cancer mortality rates in the United States..Am J Gastroenterol2014;109:542-53 PMCID:PMC4148914

[5] Lau WY.Management of hepatocellular carcinoma..J R Coll Surg Edinb2002;47:389-99

[6] Lai EC.The continuing challenge of hepatic cancer in Asia..Surgeon2005;3:210-5

[7] Gigot JF,Santiago Azagra J,Ceuterick M,Etienne J,Mutter D,Descottes B,Lachachi F,Mansvelt B,Saey JP,Hepatobiliary .Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study..Ann Surg2002;236:90-7

[8] Tang CN.Laparoscopic-assisted liver resection..J Hepatobiliary Pancreat Surg2002;9:105-10

[9] Gagner M,Selzer D.Laparoscopic liver resection: benefits and controversies..Surg Clin North Am2004;84:451-62

[10] Cherqui D,Tayar C,Van Nhieu JT,Karoui M,Dhumeaux D.Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives..Ann Surg2006;243:499-506 PMCID:PMC1448957

[11] Tang CN,Ha JP,Li MK.A single-centre experience of 40 laparoscopic liver resections..Hong Kong Med J2006;12:419-25

[12] Dagher I,Carloni A,Champault A,Franco D.Laparoscopic liver resection for hepatocellular carcinoma..Surg Endosc2008;22:372-8

[13] Li N,Wu B.Surgical and oncologic outcomes following laparoscopic versus open liver resection for hepatocellular carcinoma: a meta-analysis..Hepatol Res2012;42:51-9

[14] Shimada M,Maehara S,Rikimaru T,Tanaka S,Sugimachi K.Laparoscopic hepatectomy for hepatocellular carcinoma..Surg Endosc2001;15:541-4

[15] Belli G,D'Agostino A,Langella S.Laparoscopic hepatic resection for completely exophytic hepatocellular carcinoma on cirrhosis..J Hepatobiliary Pancreat Surg2005;12:488-93

[16] Kaneko H,Otsuka Y,Tamura A,Maeda T.Laparoscopic liver resection of hepatocellular carcinoma..Am J Surg2005;189:190-4

[17] Belli G,Belli A.Laparoscopic liver resection for hepatocellular carcinoma in cirrhosis: long-term outcomes..Dig Surg2011;28:134-40

[18] Buell JF,Geller DA,Iannitti D,Koffron AJ,Gayet B,Wakabayashi G,Kaneko H,Scatton O,Abdalla EK,Dutson E,D'Angelica M,Testa G,Manas D,Nelson H,Clary B,Martinie J,Goldstein R,Barlet D,Abecassis M,Fong Y,Broelsch C,Belghiti J,Chari RS,Chari RS.World Consensus Conference on Laparoscopic Surgery. The international position on laparoscopic liver surgery: the Louisville Statement, 2008..Ann SurgAnn Surg2009;250:825-30

[19] Nguyen KT,Geller DA.World review of laparoscopic liver resection - 2,804 patients..Ann Surg2009;250:831-41

[20] O'Rourke N.Laparoscopic right hepatectomy: surgical technique..J Gastrointest Surg2004;8:213-6

[21] Chiow AK,Manoharan B,Bryant R.Intercostal and transthoracic trocars enable easier laparoscopic resection of dome liver lesions..HPB (Oxford)2015;17:299-303 PMCID:PMC4368392

[22] Cucchetti A,Ercolani G,Torzilli G.A comprehensive meta-regression analysis on outcome of anatomic resection versus nonanatomic resection for hepatocellular carcinoma..Ann Surg Oncol2012;19:3697-705

[23] Eguchi S,Arii S,Okita K,Ikai I,Kojiro M,Monden M,Nakanuma Y.Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey..Surgery2008;143:469-75

[24] Regimbeau JM,Farges O,Sauvanet A.Extent of liver resection influences the outcome in patients with cirrhosis and small hepatocellular carcinoma..Surgery2002;131:311-7

[25] Guglielmi A,Conci S,Vitali M,De Angelis M,Iacono C.Hepatocellular carcinoma: surgical perspectives beyond the barcelona clinic liver cancer recommendations..World J Gastroenterol2014;20:7525-33 PMCID:PMC4069284

[26] Garancini M,Nespoli S,Gianotti L.Hepatic resection beyond barcelona clinic liver cancer indication: when and how..World J Hepatol2016;8:513-9 PMCID:PMC4832093

[27] Belli G,D'Agostino A,Langella S,Belli A.Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results..Surg Endosc2007;21:2004-11

[28] Zhou YM,Zhao YF,Li B.Meta-analysis of laparoscopic versus open resection for hepatocellular carcinoma..Dig Dis Sci2011;56:1937-43

[29] Xiong JJ,Javed MA,Mukherjee R,Sutton R,Hu WM.Meta-analysis of laparoscopic vs. open liver resection for hepatocellular carcinoma..World J Gastroenterol2012;18:6657-68 PMCID:PMC3516221

[30] Memeo R,Compagnon P,Cherqui D,Azoulay D.Laparoscopic vs. open liver resection for hepatocellular carcinoma of cirrhotic liver: a case-control study..World J Surg2014;38:2919-26

[31] Simillis C,Tekkis PP,Lovegrove R,Antoniou A.Laparoscopic versus open hepatic resections for benign and malignant neoplasms--a meta-analysis..Surgery2007;141:203-11

[32] Rahusen FD,Borgstein PJ,Barkhof F,Meijer S.Selection of patients for resection of colorectal metastases to the liver using diagnostic laparoscopy and laparoscopic ultrasonography..Ann Surg1999;230:31-7 PMCID:PMC1420841

[33] John TG,Crosbie JL,Garden OJ.Superior staging of liver tumors with laparoscopy and laparoscopic ultrasound..Ann Surg1994;220:711-9 PMCID:PMC1234471

[34] Cherqui D,Hammoud R,Stephan F,Rotman N.Laparoscopic liver resections: a feasibility study in 30 patients..Ann Surg2000;232:753-62 PMCID:PMC1421268

[35] Laurent A,Lesurtel M,Tayar C.Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease..Arch Surg2003;138:763-9; discussion 769

[36] Dulucq JL,Stabilini C,Mahajna A.Laparoscopic liver resections: a single center experience..Surg Endosc2005;19:886-91