Author/Authors :
teo, jin yao singapore general hospital - department of hepatopancreatobiliary and transplantation surgery, Singapore , kam, juinn huar singapore general hospital - department of hepatopancreatobiliary and transplantation surgery,, Singapore , chan, chung yip duke-nus graduate medical school, Singapore , chan, chung yip singapore general hospital - department of hepatopancreatobiliary and transplantation surgery,, Singapore , goh, brian k. p. singapore general hospital - department of hepatopancreatobiliary and transplantation surgery, Singapore , goh, brian k. p. duke-nus graduate medical school, Singapore , wong, jen-san singapore general hospital - department of hepatopancreatobiliary and transplantation surgery, Singapore , lee, victor t. w. duke-nus graduate medical school, Singapore , lee, victor t. w. singapore general hospital - department of hepatopancreatobiliary and transplantation surgery, Singapore , cheow, peng chung singapore general hospital - department of hepatopancreatobiliary and transplantation surgery, Singapore , cheow, peng chung duke-nus graduate medical school, Singapore , chow, pierce k. h. duke-nus graduate medical school - office of clinical sciences, Singapore , chow, pierce k. h. national cancer center singapore - division of surgical oncology, Singapore , chow, pierce k. h. singapore general hospital - department of hepatopancreatobiliary and transplantation surgery, Singapore , ooi, london l. p. j. duke-nus graduate medical school, Singapore , ooi, london l. p. j. singapore general hospital - department of hepatopancreatobiliary and transplantation surgery, Singapore , chung, alexander y. f. singapore general hospital - department of hepatopancreatobiliary and transplantation surgery, Singapore , chung, alexander y. f. duke-nus graduate medical school, Singapore , lee, ser yee duke-nus graduate medical school, Singapore , lee, ser yee singapore general hospital - department of hepatopancreatobiliary and transplantation surgery, Singapore
Abstract :
Background: Minimally invasive surgery has been one of the recent developments in liver surgery,laparoscopic liver resection (LLR) was initially performed for benign lesions at easily accessible locations.As the surgical techniques, technology and experience improved over the past decades, LLR surgery hadevolved to tackle malignant lesions, major resections and even in difficult locations without compromisingsafety and principles of oncology. It was also shown to be beneficial in cirrhotic patients. We describe ourinitial experience with LLR in a population with significant proportion having cirrhosis, emphasising ourapproach for lesions in the posterosuperior (PS) segments of the liver (segments 1, 4a, 7, and 8).Methods: A review of patients undergoing LLR in single institution from 2006 to 2015 was performedfrom a prospective surgical database. Clinicopathological, operative and perioperative parameters wereanalyzed to compare outcomes in patients who underwent LLR for PS vs. anterolateral lesions (AL).Results: LLR was performed in consecutive 197 patients, with a mean age of 60 years. The indicationsfor resection were hepatocellular carcinoma (HCC) (n=105; 53%), colorectal cancer liver metastasis (n=31;16%), other malignancies (n=19; 10%) and benign lesions (n=42; 21%). A significant proportion had livercirrhosis (25.9%). More females underwent surgery in the AL group and indications for surgery were similarbetween both groups. Major liver resection was performed more frequently for the PS group than for theAL group (P 0.001) and significantly more PS resections was performed in our latter experience (P=0.02).The mean operative time and the conversion rate were significantly greater in the PS group than in the ALgroup (P≤0.001 and 0.03, respectively). However, the estimated blood loss (EBL), rate of blood transfusionand mean postoperative stay were similar in the two groups (P=0.04, 0.88 and 0.92, respectively). The overall90-day morbidity and mortality rate was 21.3% and 0.5% respectively, with no differences between the twogroups. Surrogates of difficulty such as operative time, blood loss, conversion and outcomes e.g., morbidityand mortality, were similar in patients who underwent PS resections with or without cirrhosis.Conclusions: LLR in selected patients is technically feasible and safe including cirrhotic patients withlesions in the PS segments.
