Recent data have confirmed the safety and efficacy of minimally invasive liver surgery.
Despite these reports, no programmatic approach to minimally invasive liver surgery has been proposed.
Dr Joseph Buell and colleagues evaluated more than 500 minimally invasive hepatic procedures.
The team retrospectively reviewed all patients who underwent a minimally invasive procedure for the management of hepatic tumors between 2001 and 2008.
Patients were divided into 3 groups.
Group 1 included laparoscopy with intraoperative ultrasound and biopsy only, Group 2 evaluated laparoscopic radiofrequency ablation, and minimally invasive resection was assessed in Group 3.
|Conversion rates to open surgery for the resection group were 2%|
|Annals of Surgery|
The team compared the various forms of surgery, the incidence of complications, tumor recurrence, mortality, and cost.
Statistical analysis was performed using chi-squared analysis, Student t test, Kaplan-Meier survival analysis with the log-rank test, and multivariable Cox models.
The researchers performed a total of 590 minimally invasive hepatic procedures during 489 operative interventions.
The representative tumor histologies included hepatocellular carcinoma, colorectal carcinoma, miscellaneous liver metastases, biliary cancer, and benign tumors.
The team found 35 patients underwent laparoscopic ultrasound and confirmatory biopsy alone, 201 patients underwent 240 laparoscopic radiofrequency ablations, and 253 patients underwent 306 minimally invasive resections.
Conversion rates to open surgery for the radiofrequency ablation and resection group were 2% overall.
The team noted that 41% patients were cirrhotic, of which 31 resections were performed in cirrhotic patients.
The research team observed complication and mortality rates for radiofrequency ablation and resection were comparable.
However, complication rates and mortality rates were higher in the cirrhotic versus noncirrhotic resection group.
Overall recurrence rates for radiofrequency ablation and resection groups were 24% and 23%, respectively.
The researchers found that local recurrence rates were higher in the radiofrequency ablation group.
The team found overall patient survival differed between hepatocellular carcinoma patients receiving radiofrequency ablation alone and those receiving radiofrequency ablation and orthotropic liver transplantation.
Overall survival for cancer patients receiving radiofrequency ablation versus resection differed significantly when unadjusted for other covariates, and remained marginally significant in a multivariable model.
Dr Buell‘s team concluded, “Minimally invasive hepatic surgery has become a viable alternative to open hepatic surgery.”
“Our present data are equivalent or superior to those encountered in any large open series.”
“Our experience with radiofrequency ablation confirms a low local recurrence rate and an excellent technique for bridging patients to transplantation.”
“Morbidity and mortality rates for minimally invasive hepatic resections in cirrhotics, is similar to other reported open resection series.”
“This series confirmed excellent interim survival rates after laparoscopy and superiority over radiofrequency ablation in the treatment of cancer, with significantly lower local tumor recurrence rate.”