PurposeWe evaluate the operative outcome and oncologic outcome of laparoscopic liver resection for hepatocellular carcinoma (HCC), and compare with open liver resection.MethodsFrom January 2004 to December 2012, clinical data of 70 patients who underwent laparoscopic liver resection for HCC (laparoscopic liver resection group, lapa-group) were collected and analyzed retrospectively. Control group (open liver resection group, open-group) were retrospectively matched, and compared with lapa-group.ResultsLaparoscopic major liver resections were performed in 4 patients. Laparoscopic anatomical resections and nonanatomical resections were performed in 39 patients, and 31 patients, respectively. Mean operative time was shorter in lapa-group (215.5 ± 121.84 minutes vs. 282.30 ± 80.34 minutes, P = 0.001), mean intraoperative transfusion rate and total amount were small in lapa-group (24.28%, 148.57 ± 3,354.98 mL vs. 40.78%, 311.71 ± 477.01 mL). Open conversion occurred in 6 patients (8.57%) because of bleeding, inadequate resection, invisible mass on intraoperative ultrasonography, and tumor rupture. In lapa-group and open-group, 3-year disease-free survival rates were 58.3% ± 0.08%, and 62.6% ± 0.06%, respectively (P = 0.773). In lapa-group and open-group 3-year overall survival rates were 65.3% ± 0.8%, and 65.7% ± 0.6%, respectively (P = 0.610).ConclusionLaparoscopic liver resection for HCC is feasible and safe in a large number of patients, with reasonable operative and oncologic results.

PurposeLaparoscopic left lateral sectionectomy (LLLS) has been widely accepted due to benefits of minimally invasive surgery. Some surgeons prefer to isolate glissonian pedicles to segments II and III and to control individual pedicles with surgical clips, whereas opt like to control glissonian pedicles simultaneously using endoscopic stapling devices. The aim of this study was to find the rationale of LLLS using endoscopic staples.MethodsWe retrospectively analyzed and compared the clinical outcomes (operation time, drainage length, transfusion, hospital stay, and complication rate) of 35 patients that underwent LLLS between April 2004 and February 2012. Patients were dichotomized by surgical technique based on whether glissonian pedicles were isolated and controlled (the individual group, n = 21) or controlled using endoscopic staples at once (the batch group, n = 14).ResultsMean operation time was 265.3 ± 21.3 minutes (mean ± standard deviation) in the individual group and 170 ± 22.9 minutes in the batch group. Operation time in the batch group was significantly shorter than the individual group (P = 0.007). Mean drainage length was 4.8 ± 1.6 and 2.6 ± 1.5 days in the individual and the batch group. There was significantly shorter in the batch group, also (P = 0.006). No transfusion was required in the batch group, but 4 patients in the individual group needed transfusion. Mean hospital stay was 10.7 ± 1.1 and 9.4 ± 0.8 days in the individual and the batch groups (P = 0.460). There were no significant complications or mortality in both groups.ConclusionLLLS using endoscopic staples (batch group) was found to be an easier and safer technique without morbidity or mortality.

The lung, followed by regional lymph node and bone, is the most common site for extrahepatic metastasis of hepatocellular carcinoma (HCC). Metastatic skin lesion of HCC is rare, and it is a sign of poor prognosis, indicating the strong possibility of metastases in other regions of the body. We report the case of a 52-year-old male with multiple metastases, including skin metastasis of HCC, which were treated with multidisciplinary therapy.

Background: Right posterior section (RPS) graft for living donor liver transplantation (LDLT) is an alternative graft in a live liver donor with insufficient remnant left lobe (LL) volume and portal vein anomaly. Although there have been some reports regarding pure laparoscopic donor right posterior sectionectomy (PLDRPS), there is no comparative study of PLDRPS versus pure laparoscopic donor right hemihepatectomy (PLDRH). The aim of our study is to compare surgical outcomes of PLDRPS vs. PLDRH at centers achieving complete transition from open to laparoscopic approach in liver donor surgery. Methods: From March 2019 to March 2022, a total of 351 LDLTs, 16 and 335 donors underwent PLDRPS and PLDRH, respectively. We reviewed the selection process for RPS grafts and evaluated postoperative outcomes of donors and recipients. Results:There was no open conversion or perioperative blood transfusion in donors. In the donor cohort, there was no significantly different major complication (grade III) rate and comprehensive complication index (CCI) between PLDRPS versus PLDRH group (6.3% vs. 4.8%, P=0.556 and 2.1±8.4 vs. 1.7±6.4, P=0.788). Furthermore, in the recipient cohort, there was significantly different major complication (grade III) rate (62.5% vs. 35.2%, P=0.034), but no significantly different CCI (18.3±14.9 vs. 15.2±24.9, P=0.623) between PLDRPS vs. PLDRH group. Conclusions: PLDRPS in liver donors with portal vein anomaly and insufficient LL was technically feasible and safe with experienced surgeons. PLDRPS group might be comparable with PLDRH group based on surgical outcomes of donors and recipients. However, in terms of recipient outcomes, more careful selection of donor of the RPS graft and further researches in a large number of cases are necessary to evaluate the usefulness of PLDRPS.

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