Researchers from several centers in Europe assessed the feasibility, safety, and outcome of laparoscopic liver resection for malignant liver tumors.
In the retrospective study, 11 surgical centers were questioned regarding their experience with laparoscopic resection of liver malignancies.
Detailed questionnaires were sent to each surgeon focusing on patient characteristics, clinical data, type and characteristics of the tumor, technical details of the operation, and early and late clinical outcome.
In addition, all patients had radiologic investigations at follow-up to exclude disease recurrence.
Between 1994 and 2000, 37 patients with malignant liver tumors were included in the study.
Of these, 10 had hepatocellular carcinoma (HCC, including 9 with cirrhotic liver) and 27 patients had liver metastases.
The mean tumor size was 3.3 cm, and 89% of the tumors were located in the left lobe or in the anterior segments of the right liver.
Liver procedures included 12 wedge resections, 9 segmentectomies, 14 bisegmentectomies (including 13 left lateral segmentectomies), and 2 major hepatectomies.
The authors found that the transfusion rate, the use of pedicular clamping, the conversion rate (13.5% in the whole series), and the complication rate were significantly greater in patients with HCC.
|2-year disease-free survival after surgery:|
Hepatic metastases: 53%
| Annals of Surgery |
There were no deaths reported.
However, postoperative complications occurred in 8 patients (22%).
The surgical margin was found to be less than 1 cm in 30% of the patients.
During a mean follow-up of 14 months, the 2-year disease-free survival was 44% for patients with HCC and 53% for patients having hepatic metastases from colorectal cancer.
No port-site metastases were observed during follow-up.
Dr Jean-François Gigot, of Saint-Luc University Hospital, Brussels, Belgium, said on behalf of his group, "In patients with small malignant tumors, located in the left lateral segments or in the anterior segments of the right liver, laparoscopic resection is feasible and safe."
"The complication rate is low, except in patients with HCC on cirrhotic liver.
"By using laparoscopic ultrasound, a 1-cm free surgical margin should be routinely obtained," he added.
"The late outcome needs to be evaluated in expert centers," he concluded.