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Robichaux et al. LLR in the cirrhotic patient

hepatitis. Multiple studies have confirmed the benefits open resection of cirrhotic tumors, these challenges
of laparoscopic liver resection in decreasing operative have resulted in greater difficulty in achieving wide
times, bleeding, complications and length of stay in resection margins and performing formal anatomical
non cirrhotic patients. [22-25] Most cirrhotic resection data resections, as well as increasing the difficulties in
has been included into larger hepatocellular cancer mobilization and in particular parenchymal transection,
reports making assessment of this data questionable at with risk of massive bleeding. These concerns and
best. However, a recent meta analysis of laparoscopic potential issues have been the major obstacles to the
resection of hepatocellular cancer in cirrhotic patients widespread adoption of laparoscopic liver resection in
confirmed this approach was associated with a reduced the management of liver tumors in cirrhotics.
risk of transfusion, decreased length of stay and wider
surgical margins but failed to identify a difference in In conclusion, laparoscopic liver resection in cirrhotic
operative times, and morbidity. This is in contrast to patients appears safe and efficacious in experienced
[26]
a smaller French case-controlled study that identified centers resulting in overall significantly shorter
laparoscopic resection resulted in shorter operative operative times, lower blood loss, and shorter hospital
times, hospital stays and lower morbidity rates. [27] stays and few complications. In subset analysis several
advantages of the laparoscopic approach are lost
Our current data presented in this study confirms including lower blood loss and few complications. Our
laparoscopic resection in cirrhotics provide shorter current experience in laparoscopic major resections
operative times, blood loss, transfusion, intensive in cirrhotics has leaded us to reconsider the learning
care utilization, length of stay, and post operative curve and temper our enthusiasm for major resection
complications. However, when operative outcomes in cirrhotics. Perhaps with increasing experience
were analyzed in regard to the extent of resection the these benefits will be realized but currently our group
laparoscopic group persisted in shorter operative times advocates a tempered and highly selective approach to
with less intensive care utilization while reduction of the laparoscopic approach to major cirrhotic resections.
blood loss and shorter lengths of stay were not realized
in the major resection group. Financial support and sponsorship
None.
Multiple studies have attributed the advantages of Conflicts of interest
laparoscopic liver resections to a less aggressive There are no conflicts of interest.
approach, minimizing peritoneal dissection, and
bleeding leading to lower incidence of ascites and post- Patient consent
hepatectomy liver failure. [19-22] Two authors have even Not involved.
suggested laparoscopic liver resection may extend
the indication of liver resection into selected Child Ethics approval
B patients. [20,28] Our experience with would support Approved by an institutional review board at authors’
this supposition in well selected Child B patients. An institution.
additional advantage of laparoscopic liver resection of
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