Author/Authors :
ettorre, giuseppe maria san camillo hospital - division of general surgery and liver transplantation, Rome, Italy , sandri, giovanni battista levi san camillo hospital - division of general surgery and liver transplantation, Rome, Italy , sandri, giovanni battista levi sapienza university - department of surgical sciences, Rome, Italy , santoro, roberto san camillo hospital - division of general surgery and liver transplantation, Rome, Italy , vennarecci, giovanni san camillo hospital - division of general surgery and liver transplantation, Rome, Italy , lepiane, pasquale san camillo hospital - division of general surgery and liver transplantation, Rome, Italy , colasanti, marco san camillo hospital - division of general surgery and liver transplantation, Rome, Italy , felli, emanuele san camillo hospital - division of general surgery and liver transplantation, Rome, Italy , de werra, edoardo san camillo hospital - division of general surgery and liver transplantation, Rome, Italy , colace, lidia san camillo hospital - division of general surgery and liver transplantation, Rome, Italy , d’offizi, gianpiero national institute for infectious diseases “l. spallanzani” - hepatology and infectious diseases unit, Rome, Italy , montalbano, marzia national institute for infectious diseases “l. spallanzani” - hepatology and infectious diseases unit, Rome, Italy , visco, ubaldo national institute for infectious diseases “l. spallanzani” - hepatology and infectious diseases unit, Rome, Italy , maritti, michela national institute for infectious disease “l. spallanzani” - anesthesiology and intensive care unit, Rome, Italy , antonini, mario national institute for infectious disease “l. spallanzani” - anesthesiology and intensive care unit, Rome, Italy , santoro, eugenio san camillo hospital - division of general surgery and liver transplantation, Rome, Italy
Abstract :
Background: Hepatocellular carcinoma (HCC) with or without underlying liver disease can be treatedby surgical resection. The aim of this study was to evaluate the feasibility, morbidity and mortality of alaparoscopic approach in cirrhotic patients with HCC.Methods: From 2004 to September 2014, 90 patients underwent a laparoscopic liver resection (LLR) forHCC. Data were collected in a prospectively maintained database since 2001. Preoperative patient evaluationwas based on a multidisciplinary team meeting assessment.Results: Median age was 63 years; 67 (74.4%) patients were male. Median body mass index (BMI) was26.7. Underlying liver disease was known in 68 patients: in 46 patients’ hepatitis C virus (HCV)-related, in15 patients to hepatitis B virus (HBV)-related, in 5 patients alcohol-related. Child-Pugh Score was of gradeA in 85 patients and of grade B in 5 patients; 63 patients had a Model for End-stage Liver Disease (MELD) 10 and 27 patients MELD 10. A total of 18 left lateral sectionectomies, 1 left hepatectomy and 71 wedgeresections or segmentectomies were performed. Conversion to laparotomy was necessary in 7 (7.7%) patients(five cases for bleeding and two cases for oncological reasons). In 90 patients, 98 HCC nodules were resected:79 patients had one nodule, 8 patients had two nodules and 1 patient had three nodules. HCC nodulesmedium diameter was 29 mm (range, 4-100 mm) with median value of 25 mm. Tumor margins distance was16 mm (range, 0-35 mm) with a median of 5 mm. Seventy nodules were located within the anterior sectorsand 28 nodules within the posterior sectors.Conclusions: LLR for HCC can be performed with acceptable morbidity in patients with underlying liverdisease. The use of laparoscopic surgery in cirrhotic patients may be proposed as the first-line treatment forHCC or as bridge treatment before liver transplantation.
