David A. Geller, MD
Department of Surgery, UPMC Liver Cancer Center
University of Pittsburgh
Pittsburgh, PA 15213-2582, USA
Ann Surg. 2009 Nov;250(5):831-41
To provide a review of the world literature on laparoscopic liver resection.
Initially described for peripheral, benign tumors resected by nonanatomic wedge resections, minimally invasive liver resections are now being performed more frequently — even for larger, malignant tumors located in challenging locations. Although a few small review articles have been reported, a comprehensive review on laparoscopic liver resection has not been published.
- Conducted a literature search using PubMed, screening all English publications on laparoscopic liver resections.
- Analyzed all data and excluded apparent case duplications in updated series from the total number of patients.
- Tabulated data by:
- Tumor type
- Operative characteristics
- Perioperative morbidity
- Oncologic outcomes
A total of 127 published articles of original series on laparoscopic liver resection were identified, and accounted for 2,804 reported minimally invasive liver resections.
- Malignant tumors: 50%
- Benign lesions: 45%
- Live donor hepatectomies: 1.7%
- The rest were indeterminate
How resections were performed
- 75% were performed totally laparoscopically
- 17% were hand-assisted
- 2% were laparoscopic-assisted open hepatic resection (hybrid) technique
- Remainder used other techniques or conversions to open hepatectomies
Types of resections performed
- Wedge resection or segmentectomy (most common): 45%
- Anatomic left lateral sectionectomy: 20%
- Right hepatectomy: 9%
- Left hepatectomy: 7%
Conversion from laparoscopy
- To open laparotomy: 4.1%
- To hand-assisted approach: 0.7%
- 9 of 2,804 patients (0.3%)
- No intraoperative deaths reported
- Most common cause of postoperative death: liver failure
- Postoperative bile leak: 1.5% of cases
For cancer resections
- Negative surgical margins were achieved in 82 to 100% of reported series
Overall and disease-free survival rates after laparoscopic liver resection
- 5-year overall: 50 to 75%
- 5-year disease-free: 31 to 38.2%
- 3-year overall: 80% to 87%
- 3-year disease-free: 51%
In experienced hands, laparoscopic liver resections are safe with acceptable morbidity and mortality for both minor and major hepatic resections.
Oncologically, 3- and 5-year survival rates reported for hepatocellular carcinoma and colorectal cancer metastases are comparable to open hepatic resection, albeit in a selected group of patients.