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Pure laparoscopic hepatectomy for hepatocellular carcinoma patients with severe liver cirrhosis
Author(s) -
Morise Z,
Sugioka A,
Kawabe N,
Umemoto S,
Nagata H,
Ohshima H,
Kawase J,
Arakawa S,
Yoshida R
Publication year - 2011
Publication title -
asian journal of endoscopic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.372
H-Index - 18
eISSN - 1758-5910
pISSN - 1758-5902
DOI - 10.1111/j.1758-5910.2011.00081.x
Subject(s) - medicine , cirrhosis , hepatocellular carcinoma , hepatectomy , perioperative , ascites , indocyanine green , laparotomy , surgery , gastroenterology , resection
Hepatocellular carcinoma often arises in cirrhotic livers. Patients with severe liver cirrhosis who undergo hepatectomy often develop postoperative liver failure, even if the hepatectomy is limited. Here, we report six patients with severe liver cirrhosis (Child–Pugh B/C and indocyanine green retention rate at 15 min ≥40%) who underwent pure laparoscopic hepatectomy. Their perioperative course was favorable and comparable to that of other hepatocellular carcinoma patients with mild‐moderate liver cirrhosis. In patients with severe liver cirrhosis, pure laparoscopic hepatectomy minimizes the disturbance in collateral blood and lymphatic flow caused by laparotomy and liver mobilization, as well as the mesenchymal injury caused by compression of the liver. It limits complications such as massive ascites, which can lead to severe postoperative liver failure. Good candidates for the procedure include patients with severe liver cirrhosis who have tumors on the liver surface and in whom adaptation to ablation therapy is difficult and/or who experience local recurrence after repeat treatments.