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Treatment of Malignant Laparoscopic Liver Surgery Oncological Outcomes

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Endoscopic Technology Laparoscopic Liver Surgery

With growing experience and interesting literary reports. This has led to the spread of signs for endoscopic technology. This represents a significant increase in the number of articles on laparoscopic liver surgery since 2005. Completed only in many centers around the world. Laparoscopic Trainer Box.

For many reasons use of simulators is a careful choice like Laparoscopic Trainer Box.

Other Intraoperative Events, Conversion

The reported conversion rate for laparoscopic liver resections in the literature reports to be between 2 and 15%. The conversion rate decreases with increasing experience.

While postoperative complications well describe in the literature, so far there has been little emphasis on recording and reporting intraoperative events and complications that do not require conversion. Intestinal perforation is an example of an intraoperative event that handles without conversion in most cases.

Vascular Occlusion

Pringle’s maneuver and other methods of preoperative vascular occlusion also widely uses in laparoscopic liver resection at some centers to reduce preoperative blood loss.  However, modern transection equipment and advanced surgical techniques have made routine use of vascular occlusion unnecessary.

Postoperative Course

Laparoscopic access by liver resection is associated with reduced hospital stay, less need for painkillers, shorter time to ingest food, and shorter recovery time after surgery. The cosmetic outcome is also favorable. Postoperative length of stay is about 5-8 days on average, but this largely depends on non-medical problems. At our ward, the median postoperative length of stay is 3 days.  Laparoscopic technique combined with fast-track surgery may possibly shorten the length of stay further down to about 1-2 days.

Instrumentation By Single Port Liver Resection

Mortality, Postoperative Morbidity

Perioperative mortality in laparoscopic liver resection is less than 1%, which is comparable to the best results reported for open surgery.  Postoperative complication rate is 10-15% and reports to be equal to or lower than what reports after open liver resections. Postoperative bile leakage detects in approximately 1.5%, corresponding to the leakage rate after open surgery. Bile leakage usually treats with percutaneous drainage and stenting of the bile ducts. Postoperative intra-abdominal bleeding is very rare, but is a complication that also treats with laparoscopy. Morbidity in the form of heart-related complications, abscesses and wound complications tends to be lower with laparoscopic access, and the incidence of postoperative hernia after laparoscopic liver resection is clearly lower than with open resection.

Oncological Results

There is little doubt that laparoscopic access is preferable to open resection in benign liver lesions. Until now, however, there has been a certain restraint in relation to malignant liver lesions.  Theoretically, one would think that laparoscopy as a method could lead to improved oncological outcome. This is due to a minor surgical trauma, and consequently reduced stress response and immune activation as well as less activation of regenerative growth factors that can theoretically increase the incidence of tumor recurrence.  However, these theoretical and experimental hypotheses remain to confirms in clinical settings. For minimally invasive surgery technique, many of them have not received practical training with simulators resembling.

Treatment Of Malignant Lesions

Concerns about inadequate surgical margins and possible tumor proliferation initially prevented the spread of laparoscopic technique in the surgical treatment of malignant lesions in the liver. However, comparative studies have concluded that there is no difference in the width of the resection margin or in the occurrence of free margins between laparoscopic and open liver resections.  It also shows that macro- and microscopic tumor-free margin currently considers adequate by resection of CRC metastases.  In HCC, the development of micro metastases depends on tumor size and histological grade, necessitating the need for larger margins.  In our material, there is no occurrence of port metastases.

Long-Term Outcomes of Laparoscopic Resection

Many centers have reported results for short-term survival after laparoscopic resection of CRC liver metastases and HCC. Only a few have data that provide a basis for estimating long-term outcomes including 5 years of general, relapse-free, and disease-free survival, and relapse patterns. Reported 3- and 5-year overall survival for CRC metastases and HCC reports around 70-80% and 50-60%.

The recurrence pattern shows to be the same as in open resections of CRC liver metastases and HCC, while long-term results are at least as good as in open liver resection.  Laparoscopy has also contributed to an increased possibility of repeated liver resections in recurrence. The treatment of recurrence of primary tumor and recurrence in other organs has in recent years become more aggressive and considers when calculating disease-free and recurrence-free survival. Laparoscopic Trainer Box.

Oncological Outcomes of Study

A recent three-institutional study showed the same surgical and oncological results after repeated laparoscopic liver resection compared with results after the primary resection.  This study confirmed that a subset of patients who underwent primary surgery with laparoscopic technique had reduced median blood loss [290 vs. 400 ml). And lower transfusion rate than those who had primary open surgery. Non-resection margins report in 9% and 5-year survival in the subgroup of patients with CRC metastases was 55%. There are currently no prospective randomized controlled trials comparing oncological results after laparoscopic liver resection with open resection and our current knowledge is mainly based on small, non-randomized.

Conclusion

The indications for laparoscopic liver resection are now almost the same as for open surgery. The prevalence of the technique is increasing, which reflects in the increasing number of new publications on the topic.

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