M. Huang1, C. Chin-An1 1Taipei Medical University – Shuang Ho Hospital,Surgery,New Taipei City, SELECT A STATE/PROVINCE, Taiwan
Introduction:
We started to performed laparoscopic technique to treat liver tumor in 2001. After a series of modifications during surgical procedures, laparoscopic liver resection became the first choice for HCC, if the tumor is not large in size or near the hilar region in our hospital. For major or difficult area resection, the technique of approach was started with hand-assisted laparoscopic method then shift to laparoscopic assisted (hybrid) method and changed to pure laparoscopic method in 2009. Furthmore, we developed a unique technique, “ Transumbilical single incision laparoscopic approach” for tumor in superficial portion of liver in 2011.
Method:
Between Oct 2006 and Sep 2011 (period I), 54 patients with HCCunderwent LLH and 37with HCC compatible patients received open method. Laparoscopic approaches included 26 laparoscopic partial resections, 18 laparoscopic left lateral segmentectomies , 10 received one or two segmentectomies and one received right lobectomy. From Oct 2011 to Dec. 2015 (Perioid II), 142 patients with HCC received pure LLH and expanded to advanced stage. The pathology group was 71 patients in stage I, 48 patients in stage II and 23 pateints in stageIII. BIn the period II, there were 19 patients underwent SILH for HCC in the peripheral portion of liver and 48 compatible patients received LLH. The short and long term results of various stage LLH was analysted with open hepatectomy.
Results:
The short-term outcom of LLH for HCC :
In the period I, the laparoscopic group has the advantage of less operating time (142 min VS 193 min), less intraoperative blood loss (359 ml VS 580 ml) and shorter hospital stay (7.3 days VS 10.3 days). There is no difference in surgery-related complication rate. In the period II, the SILH group posed less operating time (86 min VS 139 min), less intraoperative blood loss (94 ml VS 120 ml) and shorter hospital stay (4.0 days VS 6.5 days).
The long-term effect of LLH for HCC
In the period I, the 1-year, 3-year and 5-year survival rates was comparative in these two group, 98%, 77%, and 72% in the laparoscopic group and 94%, 82 % and 70% in the open group, respectively, and the 1-year, 3-year and 5-year disease free rates were 94%, 70% and 60% in the laparoscopic group and 72%, 53% and 23% in the open group. In the period II, The 1-year, 3-year and 5-year survival rates was comparative 90%, 81%, and 79%; and the 1-year, 3-year and 5-year disease free rates were 73.5%, 58.5% and 47.6%.
Conclusion
LLH can be performed safely and seems to offer at least short-term benefits for patients with HCC and achieve comparable results and acceptable oncological outcomes as open procedure. SILH a safe procedures and takes more advantages over LLH in term of less operation time, fewer blood loss and shorter hospital stay. SILH is also an alternative choice for patients with small HCC in the peripheral segment of liver requiring limited resection.