Stapleless laparoscopic left lateral sectionectomy for hepatocellular carcinoma: reappraisal of the Louisville statement by a young liver surgeon

Abstract

Background: Laparoscopic liver resection has been regarded as the standard treatment for liver tumors located at the left lateral liver sector. However, few studies have reported the results of laparoscopic left lateral sectionectomy (LLS) for HCC, not to mention the feasibility of this emerging technique for the less experienced liver surgeons. The current study would reappraise the Louisville statement by examining the outcome of LLS performed by a young liver surgeon.

Methods: We retrospectively reviewed two separate groups of patients who underwent open or laparoscopic left lateral sectionectomies at Chung Gung Memorial Hospital, Linkou. All laparoscopic hepatectomies were performed by the index young surgeon following a stepwise stapleless LLS. The surgical results and oncological outcomes of laparoscopic vs. open hepatectomies (LH and OH, respectively) with the surgical indication of HCC at left lateral liver sector were further compared and analyzed.

Results: 18 of 29 patients in the laparoscopic group and 75 patients in the conventional open group had primary HCC. The demographic data was essentially the same for the two groups. Statistical analysis revealed that the LH group had smaller tumor size, higher blood transfusion requirement, longer duration of inflow control and parenchymal transection, and longer operation time. However, no significant difference was observed in terms of complication rate, mortality rate, and hospital stay between the two groups. After adjusting for tumor size, LH and OH showed no statistical difference in the amount of blood transfusion, operation time and patient survival.

Conclusions: This study demonstrated that stapleless LLS is a safe and feasible procedure for less experienced liver surgeons to resect HCC located at the left lateral liver sector. This stepwise stapleless LSS can not only achieve surgical results comparable to OH but also can provide a platform for liver surgeons to apply laparoscopic technique before conducting more complicated liver resections.

Keywords: Hepatectomy; Hepatocellular carcinoma; Hepatoma; Laparoscopic hepatectomy; Laparoscopic surgery; Left lateral sectionectomy; Liver resection; Louisville statement; Stapleless; Young surgeon.

Fig. 1

Kaplan–Meier disease-free survival (DFS) curves and overall survival (OS) curves for hepatocellular carcinoma treated by LH or OH. (a and b, all HCC) The mean DFS was 49.25 months for the LH group and 39.24 months for the OH group (P = 0.110). The mean OS was 60.73 months for the LH group and 61.58 months for the OH group (P = 0.400). Laparoscopic liver resection for HCC located at left lateral liver sector can achieve satisfactory oncological outcome when compared to the conventional open surgery. (c and d, HCC less than 5 cm in diameter). The mean DFS was 45.80 months for the LH group and 42.46 months for the OH group (P = 0.266). The mean OS was 60.02 months for the LH group and 62.51 months for the OH group (P = 0.962). Laparoscopic hepatectomy can achieve comparable oncological outcome when compared to the conventional open surgery, especially for smaller HCC