Author/Authors :
piardi, tullio université de strasbourg - pôle hépatodigestif, nouvel hôpital civil, hôpitaux universitaires de strasbourg, Strasbourg, France , piardi, tullio université de reims champagne-ardenne - hôpital robert debré, centre hospitalier universitaire de reims - service de chirurgie générale, digestive et endocrinienne, Reims, France , sommacale, daniele université de reims champagne-ardenne - hôpital robert debré, centre hospitalier universitaire de reims - service de chirurgie générale, digestive et endocrinienne, Reims, France , baumert, thomas université de strasbourg - pôle hépatodigestif, nouvel hôpital civil, hôpitaux universitaires de strasbourg, Strasbourg, France , baumert, thomas universitaire de strasbourg (ihu mix-surg) - institut de recherche sur les cancers de l’appareil digestif (ircad) institut hospitalo, Strasbourg, france , baumert, thomas qqqqq , baumert, thomas université de strasbourg, Strasbourg, france , mutter, didier universitaire de strasbourg (ihu mix-surg) - institut de recherche sur les cancers de l’appareil digestif (ircad)-institut hospitalo, strasbourg, france , mutter, didier université de strasbourg - pôle hépatodigestif, nouvel hôpital civil, hôpitaux universitaires de strasbourg, Strasbourg, France , marescaux, jacques université de strasbourg - pôle hépatodigestif, nouvel hôpital civil, hôpitaux universitaires de strasbourg, Strasbourg, France , marescaux, jacques universitaire de strasbourg (ihu mix-surg) - institut de recherche sur les cancers de l’appareil digestif (ircad)-institut hospitalo, Strasbourg, France , pessaux, patrick université de strasbourg, Strasbourg, France , pessaux, patrick universitaire de strasbourg - pôle hépatodigestif, nouvel hôpital civil, hôpitaux universitaires de strasbourg, Strasbourg, France , pessaux, patrick universitaire de strasbourg (ihu mix-surg) - institut de recherche sur les cancers de l’appareil digestif (ircad)-institut hospitalo, Strasbourg, France
Abstract :
Background: Laparoscopic liver resection (LLR) is growing in popularity, but the short- and long-termoutcome of patients undergoing LLR for hepatocellular carcinoma (HCC) has not yet been established.Methods: A literature search was performed using PubMed, Scopus, and Web of Science (WoS) fromcited English and Chinese publications. Clinical and survival parameters were extracted. The search was lastconducted in October 2013. After application of selective criteria, 24 remaining original studies with morethan 15 patients were analyzed.Results: In the Western experience, mean operative time was between 150 to 300 minutes, and meanblood loss ranged from 55 to 452 mL. Transfusion was required in all series, ranging from 2.8% to 50%.The conversion rate ranged from 5% to 19.4%. Three cases of death were reported. General morbidity rateranged from 1.5% to 25%. Specific complications were divided into hemorrhage (2.4% to 25%), ascites (3.7%to 15.3%), and biliary collection (0.6% to 5%). Liver insufficiency was reported in two cases. Mean hospitalstay ranged from 5.4 to 15 days. In all case-matched studies, LLR was statistically associated with a shorterhospital stay. The 5-year overall survival rate ranged from 55% to 70%. No trocar-site recurrence wasobserved. The recurrence rate ranged from 21.4% to 50%. Comparative studies did not demonstrate anysignificant difference in terms of recurrence between LLR and open liver resection (OLR). In the MiddleEastern experience, mean operative time ranged from 147 to 325 minutes, and mean blood loss ranged from 88 to 808 mL. Transfusion was required, ranging from 1.8% to 19.2%. The conversion rate rangedfrom 1.8% to 18.6%, and four series reported no conversion. There was no mortality. The main specificcomplication was ascites (1.7% to 26.6%). A biliary collection was reported in only two series (10.7% and13.3%), and only one case of postoperative liver insufficiency was reported. Mean hospital stay ranged from4 to 11.5 days. Statistically, three comparative studies reported a shorter postoperative hospital stay followingLLR versus OLR. The 5-year overall survival rate ranged from 50% to 76.6%. Comparative studies did notdemonstrate any significant difference in terms of overall survival and recurrence rate between LLR andOLR. No trocar-site recurrence was reported. The recurrence rate ranged from 26.9% to 45.5%, and twoseries reported no recurrence.Conclusions: Laparoscopic surgery should be considered an acceptable alternative for the treatment of HCC.
