title: Laparoscopic liver resection for lesions adjacent to major vasculature: feasibility, safety and oncological efficiency.
abstract: OBJECTIVE
  Laparoscopic liver resection for lesions adjacent to major vasculature can be challenging, and many would consider it a contraindication. Recently, however, laparoscopic liver surgeons have been pushing boundaries and approached some of these lesions laparoscopically. We assessed feasibility, safety and oncological efficiency of this laparoscopic approach for these lesions.
  
  
  METHODS
  This is a monocenter study (2003-2013) describing technique and outcomes of laparoscopic liver resection for lesions adjacent to major vasculature: <2 cm from the portal vein (main trunk and first division), hepatic arteries or inferior vena cava.
  
  
  RESULTS
  Thirty-seven patients underwent laparoscopic liver resection (LLR) for a lesion adjacent to major vasculature. Twenty-four (65%) resections were for malignant disease and 92% R0 resections. Conversion occurred in three patients (8%). Mean operative time was 313 min (standard deviation (SD) ± 101) and intraoperative blood loss 400 ml (IQR 213-700). Clavien-Dindo complications > II occurred in two cases (5%), with no mortality. Lesions at <1 cm were larger (7.2 cm (2.7-14) vs. 3 cm (2.5-5), p = 0.03) and operation time was longer (344 ± 94 vs. 262 ± 92 min, p = 0.01) than lesions at 1-2 cm from major vasculature.
  
  
  CONCLUSIONS
  Lesions <2 cm from major hepatic vasculature do not represent an absolute contraindication for LLR when performed by experienced laparoscopic liver surgeons in selected patients.
authors.affiliation: Hepatobiliary and Pancreatic Surgical Unit, Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 2YD, UK, abuhilal9@gmail.com.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abu Hilal
authors.forename: Marcel J
authors.initials: MJ
authors.lastname: van der Poel
authors.forename: Morsal
authors.initials: M
authors.lastname: Samim
authors.forename: Marc G H
authors.initials: MG
authors.lastname: Besselink
authors.forename: David
authors.initials: D
authors.lastname: Flowers
authors.forename: Brian
authors.initials: B
authors.lastname: Stedman
authors.forename: Neil W
authors.initials: NW
authors.lastname: Pearce
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D018579:Patient Selection; D011169:Portal Vein; D014682:Vena Cava, Inferior; D055815:Young Adult