World Review of Laparoscopic Liver Resection: 2,804 Patients

David A. Geller, MD
Department of Surgery, UPMC Liver Cancer Center
University of Pittsburgh
Pittsburgh, PA 15213-2582, USA

Ann Surg. 2009 Nov;250(5):831-41

Abstract

Objective

To provide a review of the world literature on laparoscopic liver resection.

Background Data

Initially described for peripheral, benign tumors resected by nonanatomic wedge resections, minimally invasive liver resections are now being performed more frequently — even for larger, malignant tumors located in challenging locations. Although a few small review articles have been reported, a comprehensive review on laparoscopic liver resection has not been published.

Methods

• Conducted a literature search using PubMed, screening all English publications on laparoscopic liver resections.
• Analyzed all data and excluded apparent case duplications in updated series from the total number of patients.
• Tabulated data by:
  • Tumor type
  • Operative characteristics
  • Perioperative morbidity
  • Oncologic outcomes

Results

A total of 127 published articles of original series on laparoscopic liver resection were identified, and accounted for 2,804 reported minimally invasive liver resections.

Tumor Type

• Malignant tumors: 50%
• Benign lesions: 45%
• Live donor hepatectomies: 1.7%
• The rest were indeterminate

Operative Characteristics

How resections were performed

• 75% were performed totally laparoscopically
• 17% were hand-assisted
• 2% were laparoscopic-assisted open hepatic resection (hybrid) technique
• Remainder used other techniques or conversions to open hepatectomies

Types of resections performed

• Wedge resection or segmentectomy (most common): 45%
• Anatomic left lateral sectionectomy: 20%
• Right hepatectomy: 9%
• Left hepatectomy: 7%

Conversion from laparoscopy

• To open laparotomy: 4.1%
• To hand-assisted approach: 0.7%

Perioperative Morbidity

Overall mortality

• 9 of 2,804 patients (0.3%)

Overall morbidity

• 10.5%
• No intraoperative deaths reported

Postoperative complications

• Most common cause of postoperative death: liver failure
• Postoperative bile leak: 1.5% of cases

Oncologic Outcomes

For cancer resections

• Negative surgical margins were achieved in 82 to 100% of reported series

Overall and disease-free survival rates after laparoscopic liver resection

For hepatocellular carcinoma

• 5-year overall: 50 to 75%
• 5-year disease-free: 31 to 38.2%

For colorectal metastasis to the liver

• 3-year overall: 80% to 87%
• 3-year disease-free: 51%

Conclusion

In experienced hands, laparoscopic liver resections are safe with acceptable morbidity and mortality for both minor and major hepatic resections.

Oncologically, 3- and 5-year survival rates reported for hepatocellular carcinoma and colorectal cancer metastases are comparable to open hepatic resection, albeit in a selected group of patients.