Laparoscopic Hepatic Resection Found Safe For HCC Patients With Cirrhosis

SAN ANTONIO – Laparoscopic liver resection is a safe and effective option for hepatocellular carcinoma in patients with cirrhosis, a study has shown.

Multiple meta-analyses, case-cohort matched series, and single-center series have shown that laparoscopic hepatic resection (LHR) significantly reduces operative blood loss, risk of postoperative complications, duration of hospital stay, days of narcotic use, and days until oral intake, Kanazawa Akishige, Ph.D., said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

However, cirrhotic patients with hepatocellular carcinoma (HCC) are at increased risk for complications such as perioperative hemorrhage and postoperative ascites; as a result, they may have longer hospital stays. To determine whether LHR is safe, effective, and feasible in these patients, Dr. Akishige and colleagues at Osaka City General Hospital in Japan identified 245 patients who underwent liver resection for HCC between February 2006 and August 2010.

The investigators then studied the 90 patients in the series who had complete liver cirrhosis and underwent a partial hepatectomy. Of the 90 patients, 62 underwent hepatectomy via laparotomy and 28 had LHR, Dr. Akishige said, noting that both approaches employed an ultrasonic surgical aspirator and soft coagulation. Preoperatively, the two groups had comparable liver reserve function, assessed via indocyanine green retention rate at 15 minutes (ICG R15).

The results showed no significant difference in procedure time between the two groups, however "there was significantly less blood loss during surgery in the laparoscopy group than in the laparotomy group," Dr. Akishige said, reporting that 16 patients in the open group and no patients in the minimally invasive group required transfusion of red cell concentrates.

Additionally, rates of postoperative mortality and morbidity were significantly higher in the laparotomy group. "Two patients in the open group died, and 29 [46.8%] experienced postoperative morbidity, whereas there was no mortality or morbidity in the laparoscopy group," he said.

The specific causes of morbidity in the patients who underwent the open procedure included ascites (9), biliary collection (9), surgical site infection (6), intraabdominal abscess (4), and respiratory complications (1), Dr. Akishige reported. Due in large part to the increased morbidity, the mean duration of hospital stay in the laparotomy group was 35 days, compared with 12 days in patients who underwent the laparoscopic procedure, he said.

Among the specific advantages of LHR that contributed to earlier recovery and shorter hospital stays in cirrhotic patients are the fact that the minimally invasive approach minimizes abdominal injury, improves diaphragmatic kinetics, preserves collateral venous drainage, and leads to less postoperative ascites, according to Dr. Akishige.

"Our results show that the procedure is safe and feasible for the treatment of [HCC] in patients with cirrhosis and is associated with good short-term outcomes," he said.

Dr. Akishige disclosed no relevant conflicts of interest.

SAN ANTONIO – Laparoscopic liver resection is a safe and effective option for hepatocellular carcinoma in patients with cirrhosis, a study has shown.

Multiple meta-analyses, case-cohort matched series, and single-center series have shown that laparoscopic hepatic resection (LHR) significantly reduces operative blood loss, risk of postoperative complications, duration of hospital stay, days of narcotic use, and days until oral intake, Kanazawa Akishige, Ph.D., said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

However, cirrhotic patients with hepatocellular carcinoma (HCC) are at increased risk for complications such as perioperative hemorrhage and postoperative ascites; as a result, they may have longer hospital stays. To determine whether LHR is safe, effective, and feasible in these patients, Dr. Akishige and colleagues at Osaka City General Hospital in Japan identified 245 patients who underwent liver resection for HCC between February 2006 and August 2010.

The investigators then studied the 90 patients in the series who had complete liver cirrhosis and underwent a partial hepatectomy. Of the 90 patients, 62 underwent hepatectomy via laparotomy and 28 had LHR, Dr. Akishige said, noting that both approaches employed an ultrasonic surgical aspirator and soft coagulation. Preoperatively, the two groups had comparable liver reserve function, assessed via indocyanine green retention rate at 15 minutes (ICG R15).

The results showed no significant difference in procedure time between the two groups, however "there was significantly less blood loss during surgery in the laparoscopy group than in the laparotomy group," Dr. Akishige said, reporting that 16 patients in the open group and no patients in the minimally invasive group required transfusion of red cell concentrates.

Additionally, rates of postoperative mortality and morbidity were significantly higher in the laparotomy group. "Two patients in the open group died, and 29 [46.8%] experienced postoperative morbidity, whereas there was no mortality or morbidity in the laparoscopy group," he said.

The specific causes of morbidity in the patients who underwent the open procedure included ascites (9), biliary collection (9), surgical site infection (6), intraabdominal abscess (4), and respiratory complications (1), Dr. Akishige reported. Due in large part to the increased morbidity, the mean duration of hospital stay in the laparotomy group was 35 days, compared with 12 days in patients who underwent the laparoscopic procedure, he said.

Among the specific advantages of LHR that contributed to earlier recovery and shorter hospital stays in cirrhotic patients are the fact that the minimally invasive approach minimizes abdominal injury, improves diaphragmatic kinetics, preserves collateral venous drainage, and leads to less postoperative ascites, according to Dr. Akishige.

"Our results show that the procedure is safe and feasible for the treatment of [HCC] in patients with cirrhosis and is associated with good short-term outcomes," he said.

Dr. Akishige disclosed no relevant conflicts of interest.

SAN ANTONIO – Laparoscopic liver resection is a safe and effective option for hepatocellular carcinoma in patients with cirrhosis, a study has shown.

Multiple meta-analyses, case-cohort matched series, and single-center series have shown that laparoscopic hepatic resection (LHR) significantly reduces operative blood loss, risk of postoperative complications, duration of hospital stay, days of narcotic use, and days until oral intake, Kanazawa Akishige, Ph.D., said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

However, cirrhotic patients with hepatocellular carcinoma (HCC) are at increased risk for complications such as perioperative hemorrhage and postoperative ascites; as a result, they may have longer hospital stays. To determine whether LHR is safe, effective, and feasible in these patients, Dr. Akishige and colleagues at Osaka City General Hospital in Japan identified 245 patients who underwent liver resection for HCC between February 2006 and August 2010.

The investigators then studied the 90 patients in the series who had complete liver cirrhosis and underwent a partial hepatectomy. Of the 90 patients, 62 underwent hepatectomy via laparotomy and 28 had LHR, Dr. Akishige said, noting that both approaches employed an ultrasonic surgical aspirator and soft coagulation. Preoperatively, the two groups had comparable liver reserve function, assessed via indocyanine green retention rate at 15 minutes (ICG R15).

The results showed no significant difference in procedure time between the two groups, however "there was significantly less blood loss during surgery in the laparoscopy group than in the laparotomy group," Dr. Akishige said, reporting that 16 patients in the open group and no patients in the minimally invasive group required transfusion of red cell concentrates.

Additionally, rates of postoperative mortality and morbidity were significantly higher in the laparotomy group. "Two patients in the open group died, and 29 [46.8%] experienced postoperative morbidity, whereas there was no mortality or morbidity in the laparoscopy group," he said.

The specific causes of morbidity in the patients who underwent the open procedure included ascites (9), biliary collection (9), surgical site infection (6), intraabdominal abscess (4), and respiratory complications (1), Dr. Akishige reported. Due in large part to the increased morbidity, the mean duration of hospital stay in the laparotomy group was 35 days, compared with 12 days in patients who underwent the laparoscopic procedure, he said.

Among the specific advantages of LHR that contributed to earlier recovery and shorter hospital stays in cirrhotic patients are the fact that the minimally invasive approach minimizes abdominal injury, improves diaphragmatic kinetics, preserves collateral venous drainage, and leads to less postoperative ascites, according to Dr. Akishige.

"Our results show that the procedure is safe and feasible for the treatment of [HCC] in patients with cirrhosis and is associated with good short-term outcomes," he said.

Dr. Akishige disclosed no relevant conflicts of interest.