Critical Evaluation of Long-Term Results of Malignant Hepatic Tumors Treated by Means Curative Laparoscopic Hepatectomy

Abstract

Background:Laparoscopic hepatectomy has presented great importance for treating malignant hepatic lesions. Aim:To evaluate its impact in relation to overall survival or disease free of the patients operated due different hepatic malignant tumors. Methods:Thirty-four laparoscopic hepatectomies were performed in 31 patients with malignant neoplasm. Patients were distributed as: Group 1 - colorectal metastases (n=14); Group 2 - hepatocellular carcinoma (n=8); and Group 3 - non-colorectal metastases and intrahepatic cholangiocarcinoma (n=9). The conversion rate, morbidity, mortality and tumor recurrence were also evaluated. Results:Conversion to open surgery was 6%; morbidity 22%; postoperative mortality 3%. There was tumor recurrence in 11 cases. Medians of overall survival and disease free survival were respectively 60 and 46 m; however, there was no difference among studied groups (p>0,05). Conclusion:Long-term outcomes of laparoscopic hepatectomy for treating hepatic malignant tumors are satisfactory. There is no statistical difference in relation of both overall and disease free survival among different groups of hepatic neoplasms.

Laparoscopic hepatectomy for benign hepatic lesions: short and long-term outcomes including quality-of-life evaluation

“…Major hepatectomy was defined as resection of three or more hepatic segments. The surgical techniques used for LH were either the intra-hepatic Glissonian approach [ Figures 1 and 2] or the extra-hepatic Glissonian approach [ Figures 3 and 4], in accordance with previous standardization [7,[11][12][13] . Intraoperative ultrasonography was performed whenever available.…”

“…Given that LH is a complex laparoscopic procedure, laparoscopic left lateral sectionectomy has been considered by many experts the ideal anatomical resection for initial training because of its anatomical accessibility and the possibility of using the aid of staplers [18][19][20][21][22] . Therefore, laparoscopic left lateral sectionectomy has been one of the most performed types of LH along the learning curve of many authors [8,10,12] . Even though laparoscopic left lateral sectionectomy and right posterior sectionectomy were the most frequent LHs performed in the present series, more complex LHs including left hepatectomy, right hepatectomy and even mesohepatectomy were also performed, reflecting the strong trend in the literature towards performing more complex procedures for treating hepatic lesions [2][3][4][5][6][7][8][9][10][11][12][13]15,23] .…”

“…Many studies, including meta-analyses, have confirmed the benefits of LH in comparison with open hepatectomy, namely: lower levels of postoperative pain, fewer peritoneal adhesions, shorter hospital stay, earlier return to daily activities, lower blood loss, reduced morbidity, fewer operative complications and less mortality [2][3][4][5][6][7][8][9][10][11][12][13][14][15][18][19][20][21][22][23][24][25][26][27][28][29] . Among the short-term outcomes from our study, a low blood loss (mean 125 mL), short hospital stay, low morbidity (6.4%) and no mortality are clearly in accordance with the many advantages reported in previous studies.…”

“…Even though LH has been shown to be both safe and effective; the restricted indications for resection in the case of benign liver lesions have resulted in poorly reported longterm outcomes. In addition, there is a need to know whether LH might improve the overall postoperative quality of life (QoL) of patients with benign lesions [8][9][10][11][12][13][14][15] .…”

Reverse surgery (“first-liver approach”) for hepatic metastases from breast cancer

“…[1][2][3][4] Theseresults seem similar the most recent series published by our team for the surgical treatment of LMCRC. 12 Since for LMBC that were treated by means HR, long term survival or even cure can be attained. Ercolani et al, 1 in a large Italian series have observed 8,9% of 10-year survival rates without recurrence.…”