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

被引:23
作者
Abu Hilal, Mohammad [1 ]
van der Poel, Marcel J. [1 ,2 ]
Samim, Morsal [1 ,3 ]
Besselink, Marc G. H. [1 ,2 ]
Flowers, David [4 ]
Stedman, Brian [4 ]
Pearce, Neil W. [1 ]
机构
[1] Univ Hosp Southampton NHS Fdn Trust, Hepatobiliary & Pancreat Surg Unit, Dept Surg, Southampton SO16 2YD, Hants, England
[2] Univ Amsterdam, Acad Med Ctr, Dept Surg, NL-1105 AZ Amsterdam, Netherlands
[3] Univ Med Ctr Utrecht, Dept Surg, Utrecht, Netherlands
[4] Univ Hosp Southampton NHS Fdn Trust, Dept Radiol, Southampton SO16 2YD, Hants, England
关键词
Laparoscopic liver resection; Major vasculature; Adjacent; POSTEROSUPERIOR SEGMENTS; HEPATOCELLULAR-CARCINOMA; HEPATIC VEINS; CAUDATE LOBE; TUMORS; HEPATECTOMY; EXPERIENCE; SURGERY;
D O I
10.1007/s11605-014-2739-2
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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.
引用
收藏
页码:692 / 698
页数:7
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