Laparoscopic liver resection of benign liver tumors

Objective: The objective of this study was to assess the feasibility, safety, and outcome of laparoscopic liver resection for benign liver tumors in a multicenter setting. Background: Despite restrictive, tailored indications for resection in benign liver tumors, an increasing number of articles have been published concerning laparoscopic liver resection of these tumors. Methods: A retrospective study was performed in 18 surgical centres in Europe regarding their experience with laparoscopic resection of benign liver tumors. Detailed standardized questionnaires were used that focused on patient's characteristics, clinical data, type and characteristics of the tumor, technical details of the operation, and early and late clinical outcome. Results: From March 1992 to September 2000, 87 patients suffering from benign liver tumor were included in this study: 48 patients with focal nodular hyperplasia (55%), 17 patients with liver cell adenoma (21%), 13 patients with hemangioma (15%), 3 patients with hamartoma (3%), 3 patients with hydatid liver cysts (3%), 2 patients with adult polycystic liver disease (APLD) (2%), and 1 patient with liver cystadenoma (1%). The mean size of the tumor was 6 cm, and 95% of the tumors were located in the left liver lobe or in the anterior segments of the right liver. Liver procedures included 38 wedge resections, 25 segmentectomies, 21 bisegmentectomies (including 20 left lateral segmentectomies), and 3 major hepatectomies. There were 9 conversions to an open approach (10%) due to bleeding in 45% of the patients. Five patients (6%) received autologous blood transfusion. There was no postoperative mortality, and the postoperative complication rate was low (5%). The mean postoperative hospital stay was 5 days (range, 2–13 days). At a mean follow-up of 13 months (median, 10 months; range, 2–58 months), all patients are alive without disease recurrence, except for the 2 patients with APLD. Conclusions: Laparoscopic resection of benign liver tumors is feasible and safe for selected patients with small tumors located in the left lateral segments or in the anterior segments of the right liver. Despite the use of a laparoscopic approach, selective indications for resection of benign liver tumors should remain unchanged. When performed by expert liver and laparoscopic surgeons in selected patients and tumors, laparoscopic resection of benign liver tumor is a promising technique.

[1]  M. Stamos,et al.  A Case-Control Study of Laparoscopic versus Open Sigmoid Colectomy for Diverticulitis , 2000, The American surgeon.

[2]  Rd Dripps,et al.  New classification of physical status , 1963 .

[3]  M. Morino,et al.  Laparoscopic Management of Symptomatic Nonparasitic Cysts of the Liver Indications and Results , 1994, Annals of surgery.

[4]  D. Lubarsky,et al.  Carbon dioxide embolism during laparoscopic cholecystectomy. , 1994, Southern medical journal.

[5]  Y. Fong,et al.  Hand-Assisted Laparoscopic Liver ResectionLessons From an Initial Experience , 2000 .

[6]  Clifford Goodman,et al.  American Society of Anesthesiologists , 2020, Definitions.

[7]  T. Ong,et al.  The safety of elective liver resection in a special unit. , 1994, The Australian and New Zealand journal of surgery.

[8]  B. V. Van Beers,et al.  Laparoscopic splenectomy in adults and children: experience with 31 patients. , 1996, Surgery.

[9]  V. Vilgrain,et al.  Focal nodular hyperplasia of the liver: MR imaging and pathologic correlation in 37 patients. , 1992, Radiology.

[10]  V. Vilgrain,et al.  Hepatic adenoma: MR findings in 51 pathologically proved lesions. , 1994, Radiology.

[11]  P. Sheedy,et al.  Cavernous hemangiomas of the liver: resect or observe? , 1983, American journal of surgery.

[12]  A. Cuschieri,et al.  Laparoscopic hand-assisted surgery for hepatic and pancreatic disease , 2000, Surgical Endoscopy.

[13]  M. Intra,et al.  Gasless laparoscopic resection of hepatocellular carcinoma (HCC) in cirrhosis. , 1996, Journal of laparoendoscopic surgery.

[14]  W. Rosenberger,et al.  Comparison of open and laparoscopic live donor nephrectomy. , 1997, Annals of surgery.

[15]  S. Rossi,et al.  Laparoscopic ablation of liver adenoma by radiofrequency electrocauthery. , 1995, Gastrointestinal endoscopy.

[16]  R. Edelman,et al.  Magnetic resonance imaging of cavernous hemangioma of the liver: tissue-specific characterization. , 1985, AJR. American journal of roentgenology.

[17]  K. Kawachi,et al.  Laparoscopic hepatic resection: a new and safe procedure by abdominal wall lifting method. , 1997, Hepato-Gastroenterology.

[18]  J. Benhamou.  Diagnostic approach to a liver mass: diagnosis of an asymptomatic liver tumor in a young woman. , 1996, Journal of hepatology.

[19]  O. Yacoub,et al.  Carbon dioxide embolism during laparoscopy. , 1982, Anesthesiology.

[20]  J. Mouiel,et al.  Laparoscopic management of benign solid and cystic lesions of the liver. , 1999, Annals of surgery.

[21]  J. Mouiel,et al.  Laparoscopic resection of solid liver tumours , 1996, The British journal of surgery.

[22]  H. Bismuth,et al.  Liver Cell Adenomas: A 12‐Year Surgical Experience From a Specialist Hepato‐Biliary Unit , 1988, Annals of surgery.

[23]  S. Olmi,et al.  Laparoscopic liver tumour resection with the argon beam. , 1994, Endoscopic surgery and allied technologies.

[24]  P. Sheedy,et al.  Hepatic adenoma and focal nodular hyperplasia: Clinical, pathologic, and radiologic features , 1983 .

[25]  D. Valleix,et al.  Early Experience With Laparoscopic Approach for Solid Liver Tumors: Initial 16 Cases , 2000, Annals of surgery.

[26]  M. Hashizume,et al.  Laparoscopic hepatic resection for hepatocellular carcinoma , 1995, Surgical Endoscopy.

[27]  B. Dallemagne,et al.  Laparoscopic Nissen fundoplication: preliminary report. , 1991, Surgical laparoscopy & endoscopy.

[28]  R. Clayman,et al.  Laparoscopic versus open radical nephrectomy: a 9-year experience. , 2000, The Journal of urology.

[29]  D. Nagorney.  Benign hepatic tumors: Focal nodular hyperplasia and hepatocellular adenoma , 2004, World Journal of Surgery.

[30]  B. Descottes,et al.  Traitement laparoscopique des tumeurs solides et kystiques du foie.Étude de 33 cas*11Communication présentée à l’Académie nationale de chirurgie au cours de la séance du 23 février 2000 , 2000 .

[31]  G. Verros,et al.  Natural history of hepatic haemangiomas: clinical and ultrasound study. , 1991, Gut.

[32]  J. Mouiel,et al.  Laparoscopic liver surgery. A report on 28 patients. , 1998, Surgical endoscopy.

[33]  W. Young,et al.  Laparoscopic versus open posterior adrenalectomy: a case-control study of 100 patients. , 1997, Surgery.

[34]  D. Jacobs,et al.  Laparoscopic anatomical (hepatic) left lateral segmentectomy—technical aspects , 1996, Surgical Endoscopy.

[35]  S. Todo,et al.  Excisional therapy for benign hepatic lesions. , 1990, Surgery, gynecology & obstetrics.

[36]  A. Lefor,et al.  Laparoscopic wedge biopsy of the liver. , 1994, Journal of the American College of Surgeons.

[37]  S. Chiodini,et al.  Laparoscopic Liver Resections , 1998, Seminars in laparoscopic surgery.

[38]  F Dubais,et al.  LAPAROSCOPIC CHOLECYSTECTOMY, HISTORICAL PERSPECTIVE AND PERSONAL EXPERIENCE , 1991 .

[39]  F. Schildberg,et al.  Laparoscopic liver resection with the water-jet dissector , 1995, Surgical Endoscopy.

[40]  R. T. Woodburne,et al.  The surgical anatomy pertaining to liver resection. , 1957, Surgery, gynecology & obstetrics.

[41]  J. Cronan,et al.  Hepatic cavernous hemangiomas: lack of enlargement over time. , 1994, Radiology.

[42]  V. Vilgrain,et al.  Resection of presumed benign liver tumours , 1993, The British journal of surgery.

[43]  T. Lin,et al.  Results in 107 Hepatic Lobectomies with a Preliminary Report on the Use of a Clamp to Reduce Blood Loss , 1973, Annals of surgery.

[44]  B. Malassagne,et al.  Laparoscopic Liver Resections: A Feasibility Study in 30 Patients , 2000, Annals of surgery.

[45]  S. Takagi.  Hepatic and portal vein blood flow during carbon dioxide pneumoperitoneum for laparoscopic hepatectomy , 1998, Surgical Endoscopy.

[46]  L. Quint,et al.  MR imaging of hepatic focal nodular hyperplasia: characterization and distinction from primary malignant hepatic tumors. , 1987, AJR. American journal of roentgenology.

[47]  J. Mouiel,et al.  Possibilities of laparoscopic liver resection. , 2000, Journal of hepato-biliary-pancreatic surgery.

[48]  Goldsmith Na,et al.  The surgical anatomy pertaining to liver resection. , 1957 .

[49]  O. Farges,et al.  Cavernous hemangiomas of the liver: Are there any indications for resection , 2004, World Journal of Surgery.

[50]  P. Cooperberg,et al.  Sonographically detected hepatic hemangiomas: absence of change over time. , 1987, AJR. American journal of roentgenology.

[51]  W. Meyers,et al.  Hepatic adenoma: MR appearance mimicking focal nodular hyperplasia. , 1988, Journal of computer assisted tomography.

[52]  J. Hiatt,et al.  Laparoscopic splenectomy for ITP. The gold standard. , 1996, Surgical endoscopy.

[53]  K. Ohtomo,et al.  Noninvasive diagnosis of small cavernous hemangioma of the liver: advantage of MRI. , 1985, AJR. American journal of roentgenology.

[54]  D. Cherqui.  [Benign liver tumors]. , 2001, Journal de chirurgie.

[55]  M. Prokop,et al.  Benign Liver Tumors: Differential Diagnosis and Indications for Surgery , 1997, World Journal of Surgery.

[56]  J. Neuberger,et al.  Oral-Contraceptive-Associated Liver Tumours Occurrence of Malignancy and Difficulties in Diagnosis , 1980 .

[57]  C. Sempoux,et al.  Focal nodular hyperplasia: natural course observed with CT and MRI. , 2000, Journal of computer assisted tomography.

[58]  L. Tao.  Oral contraceptive‐associated liver cell adenoma and hepatocellular carcinoma. Cytomorphology and mechanism of malignant transformation , 1991, Cancer.

[59]  M. Gagner,et al.  Laparoscopic pancreatic resection: is it worthwhile? , 1997, Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract.

[60]  F. Schildberg,et al.  Laparoscopic liver resection compared with conventional partial hepatectomy--a prospective analysis. , 1998, Hepato-gastroenterology.

[61]  C. Scudamore,et al.  Evaluation of 50 consecutive segmental hepatic resections. , 1993, American journal of surgery.

[62]  L. Chiche,et al.  Laparoscopic anatomical hepatic resection , 1998, Surgical Endoscopy.

[63]  M. Gagner,et al.  Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. , 1997, Annals of surgery.

[64]  L. Capussotti,et al.  Colon cancer seeding after percutaneous fine needle aspiration of liver metastasis. , 1993, Journal of hepatology.

[65]  M. Fernández-Aceñero,et al.  Evaluation of ultrasonography and clinical diagnostic scoring in suspected appendicitis , 1998, The British journal of surgery.

[66]  A. Salmi,et al.  Natural history of focal nodular hyperplasia of the liver: An ultrasound study , 1996, Journal of clinical ultrasound : JCU.

[67]  P. Sheedy,et al.  Focal nodular hyperplasia and hepatic adenoma: comparison of angiography, CT, US, and scintigraphy. , 1985, Radiology.

[68]  M. Makuuchi,et al.  Benign tumors of the liver resected because of a diagnosis of malignancy. , 1992, Surgery, gynecology & obstetrics.

[69]  A. Gimson,et al.  Focal nodular hyperplasia of the liver: results of treatment and options in management. , 1991, Gut.

[70]  D. Nagorney,et al.  Trends in Morbidity and Mortality of Hepatic Resection for Malignancy A Matched Comparative Analysis , 1994, Annals of surgery.

[71]  R. Salm,et al.  Effects of the Pringle maneuver on hemodynamics during laparoscopic liver resection in the pig. , 1996, European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes.

[72]  S. Chiodini,et al.  Current position of advanced laparoscopic surgery of the liver. , 1997, Journal of the Royal College of Surgeons of Edinburgh.

[73]  O. Garden,et al.  Needle Track Seeding of Primary and Secondary Liver Carcinoma After Percutaneous Liver Biopsy , 1993, HPB surgery : a world journal of hepatic, pancreatic and biliary surgery.

[74]  J. Foster,et al.  The malignant transformation of liver cell adenomas. , 1994, Archives of surgery.

[75]  A. Rahmouni,et al.  Management of focal nodular hyperplasia and hepatocellular adenoma in young women: A series of 41 patients with clinical, radiological, and pathological correlations , 1995, Hepatology.

[76]  L. Sobin,et al.  Histological Typing of Tumours of the Liver , 1994, World Health Organization. International Histological Classification of Tumours.