Laparoscopic liver surgery

Aim: Even though laparoscopic hepatectomy (LH) has proved to be both safe and effective in specialized centers; the restricted indications for resection in the case of benign liver lesions has resulted in poorly reported outcomes. Our aim was to describe the short and long-term results of LH to treat benign hepatic lesions, including quality of life (QoL) evaluation.

Methods: Thirty-one LHs were performed between 2007 and 2018 in 30 patients. We evaluated QoL with the SF-36 test and a body image satisfaction questionnaire by personal interview before surgical treatment and at 1 month, 3 months, 6 months and 1 year after surgery.

Results: Median age was 38 years (range 21-71) and the majority were females (68%). The most frequent etiology was hepatic adenoma in 16 patients (52%), followed by focal nodular hyperplasia (n = 4), cavernous hemangioma (n = 3), hepatic abscess (n = 3), cystadenoma (n = 5) and hepatolithiasis (n = 1). The majority of resections were minor (66%) and the conversion rate was 6.2%. Pathological examination confirmed negative margins in all patients. Postoperative mortality was nil, while morbidity was 6.2%. Median hospital stay was 4 days (range 1-32 days). In a median follow-up of 48 months (range 2-120), 2 patients experienced recurrence. QoL variables were similar between the preoperative and postoperative periods.

Conclusion: LH should be considered the main therapeutic approach for treating selected patients with benign liver lesions who require surgical resection because it presented both null mortality and low morbidity, along with rare recurrence, a good quality of life and high esthetic satisfaction.

Laparoscopic liver resection is technically challenging compared to open liver surgery and has a steep learning curve. Tumors located in the posterior sector, centrally, in proximity of major vascular pedicles or in a background of liver cirrhosis are surgically more complex with a higher risk of blood loss. There is emerging consensus about indications for laparoscopic liver resection. While laparoscopic approach is considered standard for left lateral sectionectomy and minor laparoscopic liver resections in antero-lateral segments, with increasing experience, major resections, parenchyma sparing resections and even donor hepatectomies are being performed laparoscopically with good outcomes. Laparoscopic liver surgery is feasible and safe for well selected patients by well-trained surgeons with short-term advantages and non-inferior long-term oncologic outcomes.