Laparoscopic versus open left lateral hepatic sectionectomy: A comparative study

Abstract 

Background

Laparoscopic liver surgery has been difficult to popularize. High volume liver centres have identified left lateral sectionectomy (LLS) as a procedure with potential for transformation into a primarily laparoscopic procedure where surgeons can safely gain proficiency.

Methods

Forty-four patients underwent either laparoscopic (LLLS) or open (OLLS) left lateral sectionectomy (of segments II/III) for focal lesions at Southampton General Hospital.

Results

OLLS and LLLS groups were matched for age, sex and tumour types resected. Median operative time in the LLLS group was 180 (40–340) min and 155 (110–330) min in the OLLS group (p=0.885) with median intra-operative blood loss in the LLLS group 80 (25–800) ml versus a larger 470 (100–3000) ml; p=0.002 for patients receiving OLLS. Post-operative stay was also shorter in the LLLS group (3.5 (1–6) days) compared to the OLLS group (7 (3–12) days; p<0.001). Resection margin was not different in the two groups (11 (1.5–30) mm (LLLS) versus 12 (4–40) mm (OLLS); p=1) and neither was the complication rate (13% for LLLS versus 25% for OLLS; p=0.541). There were no conversions to open in the LLLS group and no deaths in either group at 90 days. Between the first and second 12 LLLS the median operative time fell from 240 (70–340) min to 120 (40–120) min; p=0.005 as well as median post-operative hospital stay from 4.5 (2–6) days to 2 (1–4) days, p=0.001.

Conclusion

LLLS is a viable alternative to OLLS with potential improvements in intra-operative blood loss and shorter hospital stay without adversely affecting successful resection or complication rates. Larger prospective studies are required to explore this new avenue in laparoscopic liver surgery.

Keywords: Laparoscopic liver surgery, Left lateral secienectomy, Laparoscopic vs open

Abbreviations: LLR, laparoscopic liver resection, LLLS, laparoscopic left lateral sectionectomy, OLLS, open left lateral sectionectomy, CRM, colorectal metastases, HCC, hepatocellular carcinoma, FNH, focal nodular hyperplasia, AFP, alpha-feto protein, CEA, carcinoembryonic antigen, CA19-9, carbohydrate antigen 19-9