title: Evolution of laparoscopic liver surgery as standard procedure for HCC in cirrhosis?
abstract: Patients with hepatocellular carcinoma (HCC) in cirrhosis have an increased risk for postoperative complications including liver failure. However, there is some evidence that the use of laparoscopy markedly decreases this risk.PatientsBetween 2010 - 2015, a total of 21 laparoscopic liver resections were performed for HCC in Child-A cirrhosis at our center. Mean MELD score was 9 (6 - 12), and the mean LiMAx was 261 µg/h/kg (101 - 489). All resections were performed by conventional laparoscopy using 4 - 6 trocars. Liver parenchyma was transected using ultrasonic shears. Hilar occlusion was used on demand. In the earlier years, laparoscopic resections were performed occasionally and mainly if tumors were easily accessible. With increasing experience, currently most HCC in cirrhosis are resected laparoscopically. Likewise, 12 out of the 21 resections were performed within the last 12 months, including 2 anatomic left hemihepatectomies.ResultsConversion rate, postoperative mortality, and operative revision rate were all 0 %. Four patients (19 %) developed mild complications Clavien-Dindo grade 1 or 2 (ascites, transfusion, pneumonia, renal impairment). One patient (4.8 %) developed a grade 3 event (bile leak, percutaneous drainage). All but 1 early patient underwent R0 resection (95 %). The mean duration of hospital stay was 10.5 days (5 - 21), and the mean duration of ICU stay was 1.8 days (1 - 7). No case of decompensation of liver cirrhosis was observed. In 1 case, a prolonged production of ascites evolved.ConclusionEven in patients with severely impaired liver function, no severe complications and especially no decompensation of cirrhosis was observed. Therefore, in accordance with other single center experiences, liver resection for HCC in cirrhosis should be performed preferentially by laparoscopy.
authors.affiliation: Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin.
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
authors.affiliation: Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin.
authors.forename: Robert
authors.initials: R
authors.lastname: Sucher
authors.affiliation: Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin.
authors.forename: Moritz
authors.initials: M
authors.lastname: Schmelzle
authors.affiliation: Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin.
authors.forename: Robert
authors.initials: R
authors.lastname: Öllinger
authors.affiliation: Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin.
authors.forename: Andri
authors.initials: A
authors.lastname: Lederer
authors.affiliation: Klinik für Radiologie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin.
authors.forename: Timm
authors.initials: T
authors.lastname: Denecke
authors.affiliation: Klinik für Gastroenterologie und Hepatologie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin.
authors.forename: Eckart
authors.initials: E
authors.lastname: Schott
authors.affiliation: Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin.
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome