Laparoscopic Liver Resection for Lesions Adjacent to Major Vasculature: Feasibility, Safety and Oncological Efficiency

Laparoscopic liver resection for lesions adjacent to major vasculature can be challenging, and many would consider it a contraindication. Recently, however, laparoscopic liver surgeons have been pushing boundaries and approached some of these lesions laparoscopically. We assessed feasibility, safety and oncological efficiency of this laparoscopic approach for these lesions. This is a monocenter study (2003-2013) describing technique and outcomes of laparoscopic liver resection for lesions adjacent to major vasculature: < 2 cm from the portal vein (main trunk and first division), hepatic arteries or inferior vena cava. Thirty-seven patients underwent laparoscopic liver resection (LLR) for a lesion adjacent to major vasculature. Twenty-four (65 %) resections were for malignant disease and 92 % R0 resections. Conversion occurred in three patients (8 %). Mean operative time was 313 min (standard deviation (SD) +/- 101) and intraoperative blood loss 400 ml (IQR 213-700). Clavien-Dindo complications > II occurred in two cases (5 %), with no mortality. Lesions at < 1 cm were larger (7.2 cm (2.7-14) vs. 3 cm (2.5-5), p = 0.03) and operation time was longer (344 +/- 94 vs. 262 +/- 92 min, p = 0.01) than lesions at 1-2 cm from major vasculature. Lesions < 2 cm from major hepatic vasculature do not represent an absolute contraindication for LLR when performed by experienced laparoscopic liver surgeons in selected patients.