Detailed Abstract
[E-poster]
[E15] Clinical feasibility of laparoscopic liver resection for tumors in segments 7 or 8
JaRyung HAN1 , Young Seok HAN*1 , Joo Dong KIM1 , Dong Lak CHOI1
1 Liver Transplantation & Hepatobiliary Pancreas Surgery, Daegu Catholic University Medical Center, REPUBLIC OF KOREA
Background : With the advances of laparoscopic liver resection (LLR), laparoscopic surgery has been established as the standard treatment for most liver resections, but for the lesions of right posterosuperior segments 7 and 8 (PSL), LLR have been compared to open liver resection (OLR) due to technical difficulties. However, various attempts are being made for PSL resection with the step-by-step development and accumulation of experience in LLRs, and results compared with OLR are reported. We will present the clinical feasibility of various LLRs for PSL performed with the same considerations as in OLR.
Methods : This study included 76 patients who underwent LLR for PSL from September 2014 to August 2021. These LLRs were performed using 4 or 5 ports in left semi-lateral position and the flexible laparoscope and laparoscopic CUSA were routinely used. OLR cases (n=48) for the same period were also included to identify the trend pattern to LLR and to compare the considerations for determining the optimal resection type.
Results : The criteria for the selection the liver resection type were tumor location, liver function(platelet, ICG R15, CTP score), resection margin involvement of right hepatic vein and the presence of right inferior hepatic vein. In 98 LLR cases, central bisectionectomy was 10 cases, posterior(including extended posterior) and anterior sectionectomy were 19 and 12 cases. 7/8 bisegmentectomy was 2 cases, wedge and segmentectomy were 33 cases. There was no mortality and open conversion in LLR patients. Bile leakage at the cut surface was observed in 1 case after central bisectionectomy, resolved through PTBD and PCD insertion. Median overall operation time was 297minutes in LLR and 279.5minutes in OLR, there was no significant difference between two groups.
Conclusions : LLR for PSL is likely to be safe and feasible with the accumulation of experience and the advanced laparoscopic techniques and instruments. To select the optimal resection type of LLR for PSL, the degree of liver function, resection margin from tumor, the involvement of right hepatic vein, or the presence or absence of sizable RIHV are carefully considered. These considerations is the same as those in OLR, except in cases of vascular reconstruction. Additionally, liver cirrhosis is no longer a contraindication of LLR for PSL.
Methods : This study included 76 patients who underwent LLR for PSL from September 2014 to August 2021. These LLRs were performed using 4 or 5 ports in left semi-lateral position and the flexible laparoscope and laparoscopic CUSA were routinely used. OLR cases (n=48) for the same period were also included to identify the trend pattern to LLR and to compare the considerations for determining the optimal resection type.
Results : The criteria for the selection the liver resection type were tumor location, liver function(platelet, ICG R15, CTP score), resection margin involvement of right hepatic vein and the presence of right inferior hepatic vein. In 98 LLR cases, central bisectionectomy was 10 cases, posterior(including extended posterior) and anterior sectionectomy were 19 and 12 cases. 7/8 bisegmentectomy was 2 cases, wedge and segmentectomy were 33 cases. There was no mortality and open conversion in LLR patients. Bile leakage at the cut surface was observed in 1 case after central bisectionectomy, resolved through PTBD and PCD insertion. Median overall operation time was 297minutes in LLR and 279.5minutes in OLR, there was no significant difference between two groups.
Conclusions : LLR for PSL is likely to be safe and feasible with the accumulation of experience and the advanced laparoscopic techniques and instruments. To select the optimal resection type of LLR for PSL, the degree of liver function, resection margin from tumor, the involvement of right hepatic vein, or the presence or absence of sizable RIHV are carefully considered. These considerations is the same as those in OLR, except in cases of vascular reconstruction. Additionally, liver cirrhosis is no longer a contraindication of LLR for PSL.
SESSION
E-poster
E-Session 09/16 ALL DAY