Laparoscopic liver resection for malignant liver tumors, why not more?

PURPOSE: The precise role of laparoscopic liver resection in liver malignancies remains controversial despite an increasing number of publications that have used the laparoscopic resection of benign liver tumors. This study was performed to assess the feasibility, safety, and outcome of laparoscopic liver resection for malignant liver tumors. METHODS: This study is a retrospective review of the profiles, pathology, surgery and outcome performed on 61 patients who had undergone laparoscopic liver resection for liver malignancies between January 2004 and March 2011. RESULTS: Among the 61 patients, 34 patients had hepatocellular carcinoma (HCC), 24 patients had liver metastasis. The mean tumor size was 2.8 ± 2.0 cm (mean ± standard deviation). Tumors located at Couinaud segment number 2 to 8. The resection included 36 anatomical resections, 25 wedge resections. The mean surgical time was 209.7 ± 108.9 minutes. There was one operation that resulted in death. Postoperative complications occurred in 9 patients (14%). There were 2 conversions to laparotomy (3%). The mean postoperative hospital stay was 9.0 ± 4.4 days. Blood transfusion was needed in 11 patients (18%). The mean surgical margin was 1.3 ± 1.2 cm. The mean follow-up period was 18.1 ± 11.1 months. The three-year overall survival rate was 87% for patients with HCC and 95% for patients having liver metastases from colorectal cancer. CONCLUSION: Even though laparoscopic liver resection requires a learning curve, it produced acceptable outcomes even in patients who had a malignant liver tumor. This study provides evidence to support further investigation and the establishment of laparoscopic liver resection for malignant liver tumors.