Abstract: Objective:To investigate the clinical efficacy and experiences of laparoscopic hepatectomy (LH) for segment Ⅶ and Ⅷ liver tumors.
Methods:The retrospective crosssectional study was conducted. The clinicopathological data of 94 patients who underwent LH for segment Ⅶ or Ⅷ liver tumors in the Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from June 2010 to August 2016 were collected. The operating space for operation was built under laparoscopy. According to liver cirrhosis grading, tumor size, adjacent relationship with major blood vessels and residual liver volume, nonanatomical and anatomical hepatectomies were selected by patients. During the operation, tumors were precisely pinpointed and plane of liver resection was determined, and then proper instruments of liver partition and techniques of hepatic inflow occlusion were selected. Observation indicators: (1) surgical and postoperative recovery situations; (2) postoperative pathological examination; (3) followup and survival situation. Followup using outpatient examination and telephone interview was performed to detect the patients′ survival up to July 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (interquartile range). Survival rate was caculated by the KaplanMeier method.
Results:(1) Surgical and postoperative recovery situations: all 94 patients received successful operations, without perioperative death, including 73 undergoing nonanatomical hepatectomy and 21 undergoing anatomical hepatectomy. Fourteen patients had conversion to open surgery and 27 received hepatic inflow occlusion. The median operation time, median volume of intraoperative blood loss and cases with intraoperative blood transfusion were respectively 187.5 minutes (75.0 minutes), 200 mL (200 mL) and 15. Eighteen patients had postoperative complications, including 6 with pleural effusion, 6 with abdominal effusion, 1 with wound infection, 1 with abdominal infection, 1 with venous thrombosis, 1 with bleeding, 1 with coagulation disorders and 1 with hepatic insufficiency. ClavienDindo classification of complications: 11, 1, 5 and 1 patients were detected in gradeⅠ, Ⅱ, Ⅲ and Ⅳ, respectively. All complications were improved by symptomatic treatment. The median duration of hospital stay was 7 days ( 6 days). (2) Postoperative pathological examination: results of tumor pathological examination showed that 45, 5, 9 and 35 patients were respectively confirmed as hepatocellular carcinoma, cholangiocarcinoma, metastatic hepatic carcinoma and benign liver tumor. (3) Followup and survival situation: 59 patients with malignant tumors were followed up for 6.0-52.0 months, with a median time of 42.6 months. Postoperative 1 and 3year overall survival rates of 59 patients with malignant tumors were 98.3% and 84.7%, respectively.
Conclusions: LH for segment Ⅶ and Ⅷ liver tumors which is conducted in experienced medical center is safe and feasible, with definite effects. Building operating space for operation under laparoscopy, determining precise positioning of the tumor and plane of liver resection, and selecting proper instruments of liver partition and techniques of hepatic inflow occlusion are the key points of successful operation.