Laparoscopic hepatectomy for liver tumors: proposals for standardization.
OBJECTIVE
We draw on our experience with laparoscopic hepatectomy (LH) to present recommendations for standardization of LH for the treatment of liver tumors.


METHODS
At our center, 90 LHs were performed from April 1993 to January 2008. These were divided equally into early cases and late cases, and short-term postoperative results were compared. Forty-nine of the LH procedures were total-laparoscopic procedures, 16 were hand-assisted procedures, and 25 were laparoscopy-assisted procedures. The tumors were malignant in 76 cases and benign in 14 cases.


RESULTS
Among late cases, the numbers of malignant tumors and tumors located in the posterosuperior region of the liver (Segments VII, VIII, and IVb) were significantly higher than among early cases; however, operative blood loss and postoperative hospital stay were significantly lower in the late cases (158.9 +/- 213.4 vs. 377.6 +/- 421.2 cc, P = 0.007; and 8.7 +/- 3.6 vs. 15.3 +/- 8.7 days, P = 0.0001, respectively). No operative deaths occurred in either group.


CONCLUSIONS
Although LH does have a steep learning curve, we believe that it can be standardized and provide a less invasive surgical option--with no reduction in disease curability--for the treatment of liver tumors in selected patients.
Otsuka
Yuichiro
Y
Division of General and Gastroenterological Surgery, Department of Surgery (Omori), Toho University School of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan. yotsuka@wa2.so-net.ne.jp
Tsuchiya
Masaru
M
Maeda
Tetsuya
T
Katagiri
Toshio
T
Isii
Jun
J
Tamura
Akira
A
Yamazaki
Kunihiro
K
Kubota
Yoshihisa
Y
Suzuki
Takashi
T
Suzuki
Takayuki
T
Kagami
Satoru
S
Kaneko
Hironori
H
D000368:Aged; D005260:Female; D006498:Hepatectomy / Q000379:methods / Q000592:standards*; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000592:standards*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications