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Robichaux et al. Hepatoma Res 2016;2:248-52                          Hepatoma Research
           DOI: 10.20517/2394-5079.2016.23
                                                                                                  www.hrjournal.net
            Topic: Advances in Minimally Invasive Cirrhotic Surgery                             Open Access

           Laparoscopic liver resection in the cirrhotic

           patient



           Ben Robichaux , Jesse Sulzer , Joseph F. Buell 1,2
                                     1
                         1
           1 Department of Surgery, Louisiana State University School of Medicine, Baton Rouge, LA 70803, USA.
           2 Tulane Transplant Institute, Departments of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA.
           Correspondence to: Prof. Joseph F. Buell, Director of Tulane Transplant Institute, Departments of Surgery, Tulane University School of Medicine,
           1415 Tulane Avenue, New Orleans, LA 70112, USA. E-mail: jbuell1@tulane.edu

           How to cite this article: Robichaux B, Sulzer J, Buell JF. Laparoscopic liver resection in the cirrhotic patient.  Hepatoma Res 2016;2:248-52.

                                         ABSTRACT
            Article history:              Aim: The adoption of laparoscopic liver resection has been expansive in the last 2 decades
            Received: 17-06-2016          with the exception of cirrhotic patients. The current study examines the outcomes of our
            Accepted: 05-07-2016          cirrhotic resections to determine the potential limitations of this technique.  Methods:
            Published: 19-09-2016         Retrospective analysis of 114 cirrhotic patients. Seventy-five (65.8%) laparoscopic resections
                                          were  compared  to  39  open  resections.  Seventy-six  (66.7%)  resections  in  the  series  were
                                          minor  resections  (less  than  3  segments).  Surgical  approach  and  extent  of  resection  were
            Key words:                    analyzed using student’s t test and regression multivariate analysis with SAS. Results: The
            Laparoscopic liver resection,   laparoscopic group had lower operative times (2.4 vs. 4.8 h; P < 0.001), blood loss (250 vs.
            cirrhosis,                    609 mL; P < 0.001), length of stay (4.4 vs. 10.1 days; P = 0.013) and complications (28%
            complications,                vs.  48%;  P  =  0.028).  Subset  analysis  by  technique  and  extent  of  resection  identified  the
            outcomes                      laparoscopic group lost the advantage in blood loss and lengths of stay when utilized in
                                          major  resections.  Multivariate  regression  analysis  for  blood  loss  further  confirmed  open
                                          resection (P = 0.014) and major resection (P = 0.026) as significant indicators of bleeding
                                          and transfusion. Conclusion: Laparoscopic liver resection in cirrhotic patients is safe and
                                          efficacious. However, the significant variability in outcomes for major resections in cirrhotics
                                          leads us to recommend further examination of the learning curve and significant caution in
                                          the selection of cirrhotics requiring major hepatic resections.


           INTRODUCTION                                       attributed to the introduction  of the laparoscopic
                                                              technique. [6,7]  However, the greatest challenge in the
           Liver resection has dramatically evolved over the last   resection of hepatic tumors remains their management
           four decades. Initial series incurred high morbidity and   in the setting of cirrhotic liver. [8,9]
           mortality rates. [1,2]   However,  with the  introduction of
           modern  anesthesia  and  improved  knowledge  of the   Despite the introduction of effective antivirals for the
           surgical anatomical segments the mortality decreased   treatment of hepatitis C, the incidence of cirrhosis is
           to acceptable  levels  lending to the proliferation  of   expected to continually rise worldwide most frequently
           resection  programs. [3-5]  In the last decade  we have   attributed to the ever increasing prevalence of obesity,
           witnessed a second proliferation of hepatic resections   fatty liver disease and non alcoholic steato hepatitis.  A
                                                                                                          [10]
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