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Laparoscopic liver resection for centrally located tumors close to the hilum, major hepatic veins, or inferior vena cava.

Abstract：

BACKGROUND:Despite the accumulation of favorable results from laparoscopic liver resection (LLR), centrally located tumors close to the hilum, major hepatic veins, or inferior vena cava (IVC) are still considered contraindications for LLR. We evaluated the feasibility and safety of LLR for centrally located tumors. METHODS:Of the 182 patients who underwent LLR for benign or malignant tumors between September 2003 and June 2010, the clinical outcomes of 13 patients with tumors within 1 cm or less of the major vascular structures, including the hilum, major hepatic veins, and IVC, were retrospectively analyzed. The perioperative outcomes of the patients were compared with those of the 23 patients who underwent open liver resection for tumors with similar criteria in terms of location and size during the same period. RESULTS:Anatomic liver resection, including left and right hepatectomy, central bisectionectomy, right anterior and posterior sectionectomy, and extended S4 segementectomy, was performed in 10 patients. The remaining 3 patients underwent subsegmentectomy for tumors located in the Spiegel lobe of the caudate. There was no open conversion or postoperative mortality. Compared with the open group, the laparoscopic group showed similar rates of intraoperative transfusion, postoperative complications, and operative time. However, the laparoscopic group spent less time in the hospital postoperatively and had shorter resection margins. After a median follow-up of 34.3 months, there were no statistically significant differences between the 2 groups in reference to the overall survival rates and the disease-free survival rates. CONCLUSION:This study shows that LLR can be safely performed in selected patients with centrally located tumors close to the liver hilum, the major hepatic veins, or the IVC that were previously considered to be contraindications for LLR. Recent technical developments in the performance of laparoscopic major liver resection may have contributed to the successful application of LLR for centrally located tumors.

journal_name

Surgery

journal_title

Surgery

authors

Yoon YS,Han HS,Cho JY,Kim JH,Kwon Y

doi

10.1016/j.surg.2012.10.004

subject

Has Abstract

pub_date

2013-04-01 00:00:00

pages

502-9

issue

eissn

0039-6060

issn

1532-7361

pii

S0039-6060(12)00622-8

journal_volume

153

pub_type

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Laparoscopic liver resection for centrally located tumors close to the hilum, major hepatic veins, or inferior vena cava.