Laparoscopic Liver Resection for Malignant Liver Tumors: Preliminary Results of a Multicenter European Study

Jean-François Gigot, MD, PhD, David Glineur, MD, Juan Santiago Azagra, MD, Martine Goergen, MD, Marc Ceuterick, MD, Mario Morino, MD, PhD, José Etienne, MD, Jacques Marescaux, MD, FACS, Didier Mutter, MD, PhD, Ludo van Krunckelsven, MD, Bernard Descottes, MD, PhD, Dominique Valleix, MD, François Lachachi, MD, Claude Bertrand, MD, Baudouin Mansvelt, MD, Guy Hubens, MD, FAC, Jean-Pierre Saey, MD, Romain Schockmel, MD


Annals of Surgery. 2002;236(1) 

In This Article

Abstract and Introduction

Objective: To assess the feasibility, safety, and outcome of laparoscopic liver resection for malignant liver tumors.
Summary Background Data: The precise role of laparoscopy in resection of liver malignancies (hepatocellular carcinoma [HCC] and liver metastases) remains controversial despite an increasing number of publications reporting laparoscopic resection of benign liver tumors.
Methods: A retrospective study was performed in 11 surgical centers in Europe regarding their experience with laparoscopic resection of liver malignancies. Detailed questionnaires were sent to each surgeon focusing on patient characteristics, clinical data, type and characteristics of the tumor, technical details of the operation, and early and late clinical outcome. All patients had radiologic investigations at follow-up to exclude disease recurrence.
Results: From February 1994 to December 2000, 37 patients with malignant liver tumors were included in this study. Ten patients had HCC, including 9 with cirrhotic liver, and 27 patients had liver metastases. The mean tumor size was 3.3 cm, and 89% of the tumors were located in the left lobe or in the anterior segments of the right liver. Liver procedures included 12 wedge resections, 9 segmentectomies, 14 bisegmentectomies (including 13 left lateral segmentectomies), and 2 major hepatectomies. The transfusion rate, the use of pedicular clamping, the conversion rate (13.5% in the whole series), and the complication rate were significantly greater in patients with HCC. There were no deaths. Postoperative complications occurred in eight patients (22%). The surgical margin was less than 1 cm in 30% of the patients. During a mean follow-up of 14 months, the 2-year disease-free survival was 44% for patients with HCC and 53% for patients having hepatic metastases from colorectal cancer. No port-site metastases were observed during follow-up.
Conclusions: In patients with small malignant tumors, located in the left lateral segments or in the anterior segments of the right liver, laparoscopic resection is feasible and safe. The complication rate is low, except in patients with HCC on cirrhotic liver. By using laparoscopic ultrasound, a 1-cm free surgical margin should be routinely obtained. The late outcome needs to be evaluated in expert centers.

Since the event of laparoscopic cholecystectomy,[1] minimally invasive surgery has been applied to solid organs such as the spleen,[2] kidney,[3] adrenal glands,[4] and more recently the liver.[5,6,7,8] The first anatomic liver resection was reported by Azagra et al[9] in 1996; they performed a left lateral segmentectomy. An increasing number of publications have been reported concerning laparoscopic treatment of benign liver tumors by resection[10,11,12,13,14] or local ablation.[15,16] However, laparoscopic resection of liver malignancies remains controversial.[17] Indeed, the usual benefits of minimally invasive therapy (e.g., cosmetic aspect, rapid recovery, short postoperative hospital stay) are challenged by the paramount oncologic objective, which is the long-term disease-free survival. Similar to the situation in other gastrointestinal malignancies,[18] there are also concerns regarding potential tumor cell exfoliation and port-site metastases during laparoscopic procedures. The purpose of the present study was to analyze the feasibility, safety, and late outcome of patients undergoing laparoscopic resection for liver malignancies in a multicenter setting.