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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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