Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study.
OBJECTIVE
To assess the feasibility, safety, and outcome of laparoscopic liver resection for malignant liver tumors.


BACKGROUND
The precise role of laparoscopy in resection of liver malignancies (hepatocellular carcinoma [HCC] and liver metastases) remains controversial despite an increasing number of publications reporting laparoscopic resection of benign liver tumors.


METHODS
A retrospective study was performed in 11 surgical centers in Europe regarding their experience with laparoscopic resection of liver malignancies. Detailed questionnaires were sent to each surgeon focusing on patient characteristics, clinical data, type and characteristics of the tumor, technical details of the operation, and early and late clinical outcome. All patients had radiologic investigations at follow-up to exclude disease recurrence.


RESULTS
From February 1994 to December 2000, 37 patients with malignant liver tumors were included in this study. Ten patients had HCC, including 9 with cirrhotic liver, and 27 patients had liver metastases. The mean tumor size was 3.3 cm, and 89% of the tumors were located in the left lobe or in the anterior segments of the right liver. Liver procedures included 12 wedge resections, 9 segmentectomies, 14 bisegmentectomies (including 13 left lateral segmentectomies), and 2 major hepatectomies. The transfusion rate, the use of pedicular clamping, the conversion rate (13.5% in the whole series), and the complication rate were significantly greater in patients with HCC. There were no deaths. Postoperative complications occurred in eight patients (22%). The surgical margin was less than 1 cm in 30% of the patients. During a mean follow-up of 14 months, the 2-year disease-free survival was 44% for patients with HCC and 53% for patients having hepatic metastases from colorectal cancer. No port-site metastases were observed during follow-up.


CONCLUSIONS
In patients with small malignant tumors, located in the left lateral segments or in the anterior segments of the right liver, laparoscopic resection is feasible and safe. The complication rate is low, except in patients with HCC on cirrhotic liver. By using laparoscopic ultrasound, a 1-cm free surgical margin should be routinely obtained. The late outcome needs to be evaluated in expert centers.
Saint-Luc University Hospital, Brussels, Belgium. gigot@chir.ucl.ac.be
Jean-François
JF
Gigot
David
D
Glineur
Juan
J
Santiago Azagra
Martine
M
Goergen
Marc
M
Ceuterick
Mario
M
Morino
José
J
Etienne
Jacques
J
Marescaux
Didier
D
Mutter
Ludo
L
van Krunckelsven
Bernard
B
Descottes
Dominique
D
Valleix
François
F
Lachachi
Claude
C
Bertrand
Baudouin
B
Mansvelt
Guy
G
Hubens
Jean-Pierre
JP
Saey
Romain
R
Schockmel
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome