Application of laparoscopic guided selective portal vein ligation in the two stage hepatectomy for patients with primary hepatocellular carcinoma

Objective To investigate laparoscopicguided selective portal vein ligation in the twostage hepatectomy for patients with primary hepatocellular carcinoma (HCC). Methods Twentythree patients with HCC who were not suitable for onestage hepatectomy were admitted to the Sichuan Provincial People′s Hospital from March 2009 to February 2012. Their clinical data were retrospectively analyzed. Laparoscopicguided selective portal vein ligation was firstly performed, dynamic changes of hepatic volume and predicted volume of liver to be resected were detected by computed tomography. Twostage open hepatectomy was performed after assessment of resectability of HCC. All data were analyzed using the analysis of variance or q test. Results Laparoscopicguided selective portal vein ligation was successfully performed on 22 patients (2 patients received concomitant cholecystectomy because the right branch of portal vein was difficult to expose), 1 patient was converted to open surgery because of hemorrhage during portal vein separation. Three patients with multiple  lesions received transcatheter arterial chemoembolization at 1 week after selective portal vein ligation. Dull pain in the hepatic region, low fever, nausea and vomiting were observed in the 23 patients, while no severe complications including peritoneal hemorrhage, bile leakage, hepatapostema was observed. The levels of aspartate aminotransferase, alanine aminotransferase and total bilirubin were back to normal at 1 week after the surgery. The right liver volume at postoperative week 3 was (590±154)cm3, which was significantly smaller than (698±135)cm3 before surgery. Compared with right liver volume at postoperative week 1, 2, 3, the right liver volume before operation was significantly smaller F=15.62, P<0.05). The left hepatic volume at postoperative week 3 was (408±149)cm3, which was significantly bigger than (331±68)cm3 before operation. The left liver volume before operation was significantly different from those at postoperative week 1, 2, 3 (F=17.48, P0.05). The predicted ratio of liver to be resected was 60%±18% at postoperative week 3, which was significantly smaller than 67%±15% before operation (F=12.35, P<0.05). Two patients with insufficient hyperplasia of offside liver, 2 patients with intrahepatic metastasis at postoperative week 3, 2 patients were lost to follow up and 3 patients gave up hepatectomy, 14 patients received hepatectomy at 24 weeks after laparoscopicguided selective portal vein ligation. The resection rate was 60.9%(14/23). There were 2 patients received extended right hepatectomy, 8 received right hepatectomy, 4 received nonanatomical hepatectomy. All the 14 patients recovered well, and no hepatic failure, severe peritoneal effusion and infection was observed. Conclusion Laparoscopicguided selective portal vein ligation is easy to perform, and it extends the indication of hepatectomy, increases the safety of twostage hepatectomy.