David A. Geller, MD
Department of Surgery, UPMC Liver Cancer Center
University of Pittsburgh
Pittsburgh, PA 15213-2582, USA
Ann Surg. 2009 Nov;250(5):831-41
Abstract
Objective
To provide a review of the world literature on laparoscopic liver resection.
Background Data
Initially described for peripheral, benign tumors resected by nonanatomic wedge resections, minimally invasive liver resections are now being performed more frequently — even for larger, malignant tumors located in challenging locations. Although a few small review articles have been reported, a comprehensive review on laparoscopic liver resection has not been published.
Methods
- Conducted a literature search using PubMed, screening all English publications on laparoscopic liver resections.
- Analyzed all data and excluded apparent case duplications in updated series from the total number of patients.
- Tabulated data by:
- Tumor type
- Operative characteristics
- Perioperative morbidity
- Oncologic outcomes
Results
A total of 127 published articles of original series on laparoscopic liver resection were identified, and accounted for 2,804 reported minimally invasive liver resections.
Tumor Type
- Malignant tumors: 50%
- Benign lesions: 45%
- Live donor hepatectomies: 1.7%
- The rest were indeterminate
Operative Characteristics
How resections were performed
- 75% were performed totally laparoscopically
- 17% were hand-assisted
- 2% were laparoscopic-assisted open hepatic resection (hybrid) technique
- Remainder used other techniques or conversions to open hepatectomies
Types of resections performed
- Wedge resection or segmentectomy (most common): 45%
- Anatomic left lateral sectionectomy: 20%
- Right hepatectomy: 9%
- Left hepatectomy: 7%
Conversion from laparoscopy
- To open laparotomy: 4.1%
- To hand-assisted approach: 0.7%
Perioperative Morbidity
Overall mortality
- 9 of 2,804 patients (0.3%)
Overall morbidity
- 10.5%
- No intraoperative deaths reported
Postoperative complications
- Most common cause of postoperative death: liver failure
- Postoperative bile leak: 1.5% of cases
Oncologic Outcomes
For cancer resections
- Negative surgical margins were achieved in 82 to 100% of reported series
Overall and disease-free survival rates after laparoscopic liver resection
- 5-year overall: 50 to 75%
- 5-year disease-free: 31 to 38.2%
- 3-year overall: 80% to 87%
- 3-year disease-free: 51%
Conclusion
In experienced hands, laparoscopic liver resections are safe with acceptable morbidity and mortality for both minor and major hepatic resections.
Oncologically, 3- and 5-year survival rates reported for hepatocellular carcinoma and colorectal cancer metastases are comparable to open hepatic resection, albeit in a selected group of patients.
