| IntroductionHepatectomy is an effective way for multiple hepatic diseases. Those diseases especially include hepatic carcinoma and hepatolithiasis. Hepatic carcinoma is one of the most common carcinoma in the world. Both primary and secondary hepatolithiasis are common in China. Intrahepatic duct stones should be removed completely or as much as possible, and causes of cholestasis such as biliary strictures should also be eliminated. Therefore, resection of hepatic parenchyma and bile ducts with inflammation and strictures is considered to be the best treatment option.Laparoscopic hepatectomy has become a regularly procedure in multiple centers throughout the world. Over the past two decades, laparoscopic surgery has become the standard surgery approach for many abdominal procedures. Laparoscopic left lateral liver sectionectomy is recommended as a gold standard for benign liver lesions. However, Laparoscopic left hepatectomy( LLH) hasn’t been proved to be standard surgery.ObjectiveTo evaluate the safety and feasibility of laparoscopic left hepatectomy in patients with hepatic carcinoma and hepatolithiasis. The perioperative and postoperative follow-up results were compared between the LLH group and the open left hepatectomy(OLH) g roup for hepatic carcinoma and hepatolithiasis separately.Methods and resultsPatients who fit the inclusion criteria were selected from the Southwest Hospital of the Third Military Medical University. Retrospective anal ysis was conducted of patient data of laparoscopic hepatectomy from January 2008 to December 2014, including 86 cases of hepatolithiasis and 47 cases of hepatic carcinoma for LLH, 89 cases of hepatolithiasis and 46 cases of hepatic carcinoma for OLH.Perioperative, tumor recurrence and survival data were collected to evaluate the safety and feasibility of LLH for the treatment of hepatic carcinoma and hepatolithiasis. The two groups of patients were compared in terms of the following parameters:(1) general information(age, gender, presence of cirrhosis, presence of chronic liver disease, preoperative clinical and laboratory data),(2) intraoperative parameters(lesion diameter, operation time, blood loss, transfusion rate, resection margin of the hepatic carcinoma, surgical approach, conversion rate from laparoscopy to laparotomy)(3) postoperative parameters(postoperative complications, mortality, postoperative ICU stay, postoperative hospital stay, postoperative anal exhaust time, liver function recovery).Operative outcomesNo intraoperative death occurred in either the LLH or OLH for the treatment of hepatic carcinoma or hepatolithiasis. Firstly, the hepatic carcinoma results:(1) no statistically significant differences between LLH and OLH in tumor size(56.6±24.6 vs 64.1±33.4 mm;P=0.218), resection margin(1.6 ± 0.5 vs 1.5 ± 0.7 ㎝; P=0.212),(2) There were statistically significant differences between LLH and OLH in the operation time(217.5±60.2 vs 266.8 ± 98.9 min;P=0.036), blood loss(350.2 ± 198.0 vs 556.7 ± 371.4 ml;P=0.007), blood transfusion rate(12.8% vs 32.6%, P =0.022). Secon dary the hepatolithiasis results:(1) no statistically significant differences between LLH and OLH in the operation time( 314.2 ± 82.1 vs 285.0 ± 106.5 min;P=0.269),(2)There were statistically significant differences between LLH and OLH in blood loss( 378.2±217.5 vs 507.3±324.1 ml;P=0.035), blood transfusion rate(9.3% vs 28.1%, P =0.002).LLH for hepatic carcinoma has 3 patients conversion to laparotomy, for hepatolithiasis has 9 patients conversion to laparotomy. The conversion rate was 9.0%(12/133).Postoperative outcomesLLH for hepatic carcinoma had 1 case death for Multiple Organ Disfunction Syndrome(MODS). The postoperative complication rate of hepatic carcinoma(12.8% vs 43.5%;P=0.000) and the postoperative complication rate of hepatolithiasis(23.3% vs 39.3%; P=0.024) were statistically significant different. For hepatic carcinoma, the postoperative ICU stay(1.3±0.5 vs 2.0±1.0 days; P=0.000), time for gastroentestinal function recovery(3.4±0.9 vs 5.0±1.7 days;P=0.000), time for postoperative abdominal tube(5.9±2.1 vs 10.2±7.2 days;P=0.000), and postoperative hospital stay(10.6±4.4 vs 17.4±9.0 days;P=0.000) were statistically significant different. For hepatolithiasis, the postoperative ICU stay(1.5±0.8 vs 2.3±1.3 days; P=0.000), time for gastroentestinal function recovery(3.6±0.7 vs 5.7±2.7 days;P=0.000), time for postoperative abdominal tube(5.3±2.5 vs 10.7±2.8 days;P=0.000), and postoperative hospital stay(11.3±4.8 vs 17.0±7.0 days;P=0.000) were also statistically significant different.The serum ALT, AST, TBIL and Alb levels on postoperative days 1, 3,5 and 7 were statistically significant differences between the two groups.Follow-up resultsAfter 3 to 37 months of follow-up, the median follow-up time was 18.1 months. The overal1 1- and 3-year survival rates and the 1-and 3-year tumor-free surviva1 rates of LLH for hepatic carcinoma were 91.5%, 83.0%, 74.5% and 59.6%, respectively. During the follow-up period, 3 cases in the LLH and 6 cases of OLH found stone recurrence.ConclusionsLLH is safe and feasible for some selected hepatic carcinoma or hepatolithiasis patients,the operative results and short-term effects are superior to laparotomy and the 1,3 overall and disease-free survival rates are comparable with laparotomy. |
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