title: Safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma in the posterosuperior liver segments.
abstract: BACKGROUND
  Laparoscopic hepatectomy (LH) is mostly performed to treat solitary tumors in the anterolateral liver segments (II, III, IVb, V, and VI). Few reports are available on LH for the treatment of hepatocellular carcinoma (HCC) in the posterosuperior liver segments (I, IVa, VII, and VIII), especially in association with cirrhosis. The purpose of this study was to investigate the safety and feasibility of LH in this clinical setting.
  
  
  METHODS
  From January 2008 to January 2011, LH was conducted in 56 patients with HCC in the posterosuperior liver segments (PS group) and 70 patients with HCC in the anterolateral liver segments (AL group) who were admitted to Southwest Hospital of the Third Military Medical University, Chongqing, China. The clinical data and follow-up results in the two groups of patients were retrospectively analyzed.
  
  
  RESULTS
  No patient in either group died during the perioperative period. Statistically significant differences were found between the PS and AL groups in terms of the operation time (217.5 ± 63.7 vs 176.8 ± 48.4 min, P = 0.000), volume of blood loss (295.5 ± 186.8 vs 220.4 ± 164.2 ml, P = 0.001), conversion rate from laparoscopy to laparotomy (17.9 vs 7.1 %, P = 0.031), transfusion rate (16.1 vs 4.3 %, P = 0.025), cases of hepatic inflow occlusion (38/18 vs 28/42, P = 0.002), and duration of inflow occlusion (41.3 ± 16.3 vs 31.3 ± 12.2 min, P = 0.005). Parameters with no significant differences between the two groups of patients included tumor size (4.0 ± 1.5 vs 3.9 ± 1.7 cm, P = 0.894), resection margin (1.7 ± 0.7 vs 1.8 ± 0.6 cm, P = 0.102), postoperative complication rate (16.1 vs 17.1 %, P = 0.873), postoperative anal exhaust time (3.2 ± 0.6 vs 3.0 ± 0.6 days, P = 0.361), and postoperative hospital stay (10.5 ± 2.7 vs 10.0 ± 0.6 days, P = 0.102). The serum alanine transaminase (ALT) and aspartate aminotransferase (AST) levels on postoperative days 1 and 3 were significantly higher in the PS group than in the AL group. There were no significant differences in the postoperative levels of the serum total bilirubin, albumin, ALT, or AST levels on postoperative days 5 and 7. After 2-48 months of follow-up, no significant differences in the 1- and 3-year overall survival rates (92.9 vs 95.7 %, P = 0.487 and 76.0 vs 76.8 %, P = 0.878, respectively) or 1- and 3-year disease-free survival rates (85.7 vs 87.1 %, P = 0.797 and 57.6 vs 56.4 %, P = 0.806, respectively) were noted between the two groups.
  
  
  CONCLUSIONS
  LH is safe and feasible for selected patients with HCC in the posterosuperior segments of the liver.
authors.affiliation: Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
authors.forename: Lunjian
authors.initials: L
authors.lastname: Xiang
authors.forename: Le
authors.initials: L
authors.lastname: Xiao
authors.forename: Jianwei
authors.initials: J
authors.lastname: Li
authors.forename: Jian
authors.initials: J
authors.lastname: Chen
authors.forename: Yudong
authors.initials: Y
authors.lastname: Fan
authors.forename: Shuguo
authors.initials: S
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D061887:Conversion to Open Surgery; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D012709:Serum Albumin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin