Evaluation of a laparoscopic liver resection in the setting of cirrhosis

Abstract Introduction Patients presenting with cirrhosis and hepatic tumours represent a fragile group that have typically been avoided in early series of laparoscopic liver resection. This study was undertaken to evaluate the results of a laparoscopic hepatectomy in the setting of cirrhosis. Method...

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Bibliographic Details
Published in:HPB (Oxford, England) England), 2014-02, Vol.16 (2), p.164-169
Main Authors: Cannon, Robert M, Saggi, Bob, Buell, Joseph F
Format: Article
Language:English
Subjects:
Adult
Aged
Gastroenterology and Hepatology
Hepatectomy - mortality
Humans
Laparoscopy - methods
Laparoscopy - mortality
Liver cirrhosis
Liver Cirrhosis - mortality
Liver Cirrhosis - pathology
Liver Cirrhosis - surgery
Middle Aged
Mortality
Original
Retrospective Studies
Severity of Illness Index
Treatment Outcome
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Summary:Abstract Introduction Patients presenting with cirrhosis and hepatic tumours represent a fragile group that have typically been avoided in early series of laparoscopic liver resection. This study was undertaken to evaluate the results of a laparoscopic hepatectomy in the setting of cirrhosis. Methods Subgroup analysis of patients with cirrhosis within a series of 327 patients undergoing a laparoscopic resection was performed. Comparisons were made with patients without cirrhosis where appropriate to highlight differences in patient selection and outcomes. Specific variables assessed included operative details and short‐term outcomes including length of stay (LOS), morbidity and mortality. Outcomes specific to hepatocellular carcinoma (HCC) were also assessed. Results There were 52 patients with cirrhosis undergoing a laparoscopic hepatic resection. Ninety per cent of patients were Childs class A, with a median model for end‐stage liver disease (MELD) score of 8. Hepatitis C was the most common cause of cirrhosis (88.5%), whereas the most common indication for an operation was HCC (71.2%). Resections were generally limited, with the median number of segments resected being 2 (range: 1–4). Complications occurred in 13 (25%) patients, with a 90‐day mortality of 5.8%. The median LOS was 3 days. Conclusions A laparoscopic hepatectomy is safe in the setting of cirrhosis, provided the application of appropriate selection criteria and sufficient experience with the procedure.
ISSN:1365-182X
1477-2574
DOI:10.1111/hpb.12098