Laparoscopic Liver Surgery Safe for HCC With Cirrhosis

Laparoscopic Liver Surgery Safe for HCC With Cirrhosis

BY DIANA MAHONEY

Elsevier Global Medical News

SAN ANTONIO – Laparoscopic liver resection is a safe and effective option for hepatocellular carcinoma in patients with cirrhosis, according to a recent study.

Multiple meta-analyses, case-cohort matched series, and single-center series have shown that laparoscopic hepatic resection significantly reduces operative blood loss, risk of postoperative complications,
duration of hospital stay, days of narcotic use, and days until oral intake, Kanazawa Akishige, Ph.D., said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

However, cirrhotic patients with hepatocellular carcinoma (HCC) are at increased risk for complications such as perioperative hemorrhage and postoperative ascites, and as a result, they may have longer hospital stays.

To determine whether laparoscopic hepatic resection is safe, effective, and
feasible in these patients, Dr. Akishige and his colleagues at Osaka City General Hospital in Japan identified 245 patients who underwent liver resection for HCC between February 2006 and August 2010.

The investigators then proceeded to study the 90 patients in the series who
had been diagnosed with liver cirrhosis

Laparoscopic liver resection is a safe and effective option for
hepatocellular carcinoma in patients with cirrhosis, according to a recent
study.

Multiple meta-analyses, case-cohort matched series, and single-center series have shown that laparoscopic hepatic resection significantly reduces operative blood loss, risk of postoperative complications,
duration of hospital stay, days of narcotic use, and days until oral intake, Kanazawa Akishige, Ph.D., said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

However, cirrhotic patients with hepatocellular carcinoma (HCC) are at increased risk for complications such as perioperative hemorrhage and postoperative ascites, and as a result, they may have longer hospital stays.

To determine whether laparoscopic hepatic resection is safe, effective, and
feasible in these patients, Dr. Akishige and his colleagues at Osaka City General Hospital in Japan identified 245 patients who underwent liver resection for HCC between February 2006 and August 2010.

The investigators then proceeded to study the 90 patients in the series who
had been diagnosed with liver cirrhosis and underwent a partial hepatectomy.

Of the 90 patients, 62 underwent hepatectomy via laparotomy and the remaining 28 patients had laparoscopic hepatic resection, Dr. Akishige said, noting that both approaches employed an ultrasonic surgical aspirator and coagulation.

Preoperatively, the two patient groups had comparable liver reserve function,as assessed via indocyanine green retention rate at 15 minutes (ICG R15).

The results showed no significant difference in procedure time between the two groups, however, “There was significantly less blood loss during surgery in the laparoscopy group than in the laparotomy group,” Dr. Akishige said, reporting that 16 patients in the open group and no patients in the minimally invasive group required transfusion of
red cell concentrates.

Additionally, rates of postoperative mortality and morbidity were significantly higher in the laparotomy group.

“Two patients in the open group died,and 29 [46.8%] experienced postoperative morbidity, whereas there was no mortality or morbidity in the laparoscopy group,” he said.

The specific causes of postoperative morbidity in the patients who underwent the open procedure included ascites (9 patients), biliary collection (9 patients), surgical site infection (6 patients),intra-abdominal abscess (4 patients),and respiratory complications (1 patient), Dr. Akishige reported.

Due in large part to the increased postoperative morbidity, the mean duration of hospital stay in the laparotomy group was 35 days, compared with 12 days in patients who underwent the laparoscopic procedure, he said.

Among the specific advantages of laparoscopic hepatic resection that contributed to earlier recovery and shorter hospital stays in cirrhotic patients are the fact that the minimally invasive approach minimizes abdominal injury, improves diaphragmatic kinetics, preserves collateral venous drainage, and typically leads to less postoperative ascites,
according to Dr. Akishige.

“Our results show that the procedure is safe and feasible for the treatment of hepatocellular carcinoma in patients with cirrhosis, and [it] is associated with good short-term outcomes,” Dr. Akishige concluded.

http://www.gastro.org/journals-publications/gi-hepatology-news/GI_-_Hepatology_News_-_June_2011.pdf