Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location

Abstract

BACKGROUND: Laparoscopic liver resection is usually limited to the anterolateral segments of the liver (AL; Segments II, III, V, VI, and the inferior part of IV). We evaluated the feasibility of laparoscopic liver resection in the posterosuperior segments (PS; Segments I, VII, VIII, and the superior part of IV). METHOD: We analyzed retrospectively the clinical data of 82 patients who underwent laparoscopic liver resection for tumors from September 2003 to September 2007. Patients were classified into 2 groups according to tumor location: group AL (n=54) and group PS (n=28). RESULTS: There was no mortality, reoperation, or major complications. Four (5%) conversions to open procedures were necessary. There were no differences in tumor characteristics, including mean tumor size and number of tumors between 2 groups (P = .427 and .611); however, there was a greater proportion of deeply seated tumors in group PS than group AL (P < .001). The predominant type of resection was a minor liver resection (left lateral sectionectomy, segmentectomy, or tumorectomy) in group AL, and a major liver resection (hemihepatectomy or right posterior sectionectomy) in group PS (P < .001). The median operative time in group PS was greater than that in group AL (320 vs 210 min; P < .001). There were no differences in the conversion rate (P = .113), median blood loss (P = .214), rate of intraoperative transfusion (P = .061), median tumor-free margin (P = .613), median hospital stay (P = .166), and rate of complications (P = .148) between the 2 groups. CONCLUSION: Laparoscopic liver resection for tumors located in PS is more difficult than in AL but is feasible in selected patients.