gms | German Medical Science

133. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

26.04. - 29.04.2016, Berlin

Article

Send article

Evolution of laparoscopic liver surgery as standard procedure for HCC in cirrhosis?

Meeting Abstract

Search Medline for

  • Daniel Seehofer - Charité, Allgemein-, Visceral- und Transplantationschirurgie, Berlin, Deutschland
  • Robert Sucher - Charité, Allgemein-, Visceral- und Transplantationschirurgie, Berlin, Deutschland
  • Moritz Schmelzle - Charité, Allgemein-, Visceral- und Transplantationschirurgie, Berlin, Deutschland
  • Martin Stockmann - Charité, Allgemein-, Visceral- und Transplantationschirurgie, Berlin, Deutschland
  • Sven Christian Schmidt - Charité, Allgemein-, Visceral- und Transplantationschirurgie, Berlin, Deutschland
  • Andri Lederer - Charité, Allgemein-, Visceral- und Transplantationschirurgie, Berlin, Deutschland
  • Timm Denecke - Charité-Campus Virchow, Radiologie, Berlin, Deutschland
  • Eckart Schott - Charité - Campus Virchow, Gastroenterologie und Hepatologie, Berlin, Deutschland
  • Johann Pratschke - Charité, Allgemein-, Visceral- und Transplantationschirurgie, Berlin, Deutschland

Deutsche Gesellschaft für Chirurgie. 133. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 26.-29.04.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. Doc16dgch195

doi: 10.3205/16dgch195, urn:nbn:de:0183-16dgch1954

Published: April 21, 2016

© 2016 Seehofer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Background: Patients with HCC in cirrhosis have an increased risk for postoperative complications including liver failure. However, there is some evidence, that the use of laparoscopy markedly decreases this risk.

Materials and methods: Between 2010-2015 a total of 21 laparoscopic liver resections were performed for HCC in Child A cirrhosis at our center. Mean MELD-score was 9 (6-12), mean LiMAx 278 µg/h/kg (101-489). All resections were performed by conventional laparoscopy using 4-5 trocars. Liver parenchyma was transected using ultrasonic shears (Harmonic ACE). The dissection was guided by repeated intraoperative ultrasound investigations. Hilar occlusion was used on demand. In the earlier years laparoscopic resections were performed occasionally and mainly if tumors were easily accessible (left lateral and caudal segments). With an increasing experience, currently most HCC in cirrhosis are resected laparoscopically. Likewise 12 out of the 21 resections were performed within the last 12 months including two anatomic left hemihepatectomies.

Results: Conversion rate, postoperative mortality and operative revision rate were all 0%. Four patients (19%) developed mild complications Clavien-Dindo grade 1 or 2 (ascites, transfusion, pneumonia, renal impairment). One patient (4,8%) developed a grade 3 event (bile leak, percutaneous drainage). All but one early patient underwent R0 resection (95%). The mean duration of hospital stay was 10,5 days (5-21), the mean duration of ICU-stay 1,8 days (1-7). No case of decompensation of liver cirrhosis was observed.

Conclusion: Even in patients with severely impaired liver function no severe complications and especially no decompensation of cirrhosis was observed. Therefore, in accordance with other single center experiences liver resection for HCC in cirrhosis should be performed preferentially by laparoscopy.