| IntroductionLaparoscopic heptectomy(LH)is associated with minimally invasive advantages,such as less invasive,less blood loss and earlier recovery.Caudate hepatectomy(CH)remains a surgical challenge in liver surgery.This study aims to analysis the safety and feasibility of laparoscopic caudate hepatectomy(LCH)for lesions in the caudate lobe.MethodsAll data of patients who underwent LCH was reviewed from September 2007 to December 2016 at the department of General surgery,Sir Run Run Shaw Hospital.Exclusion criteria:1)preoperative planning for open caudate lobectomy patients;2)only for laparoscopic exploration;3)for wedge resection or biopsy.Retrospectively analyzed the data of pre-operation,operation and post-operation,including demographic data,operative time(OT),estimated blood loss(EBL),30-day morbidity and mortality,length of hospital stay(LOS),and pathologic results.ResultsBetween September 2007 to December 2017,a total of 27 patients underwent laparoscopic anatomic caudate hepatectomy in our institution.Detailed demographic data was summarized.The mean age of patients was 52.2±8.5 years old with 11 male and 16 female patients.Average body mass index was 22.2±2.0 kg/m2.10 patients had a history of abdominal surgery,including 4 cases of colorectal cancer surgery,3 cases of appendectomy,2 cases of open hysterectomy,1 cases of open cholecystectomy.3 patients had a history of hepatitis B,and 2 patients had cirrhosis.All patients were Child-Pugh A grade.2 patients had been treated with chemotherapy before operation.We further divided the patients into subgroup analysis and divided into laparoscopic isolated caudate hepatectomy group(LICH)(n=11)and laparoscopic combined caudate hepatectomy(LCCH)(n=16).In LICH group,the mean age of patients was 53.5 ±8.1 years old with 6 male and 5 female patients.In the group of LCCH,14 patients underwent laparoscopic combined left hemi-hepatectomy and 2 patients underwent laparoscopic combined left lateral hepatectomy.The mean age of patients was 51.3 ± 8.8 years old with 5 male and 11 female patients.There is no difference in demographic data.In general,the OT and EBL was(224.4 ± 55.3)min,200(100-500.00)ml,respectively.2 patients(7.4%)converted to open surgery because of bleeding(one hemangioma in the LICH group and one hepatolithiasis in the LCCH group).3(11.1%)patients needed intraoperative blood transfusion,and the mean RBC is 4 U.No patients need ICU monitoring and nursing after surgery.The mean day of remove the drainage was 4.9 ± 2.6d.The average LOS was 6.7 ± 2.9d.In the subgroup,OT and EBL was(206.8 ± 64.0)min,150(100-200)mL in the LICH group,respectively.The LCCH group shows OT was(236.6 ± 46.8)min and EBL was 350(125-600)mL.The length of remove the drainage and hospital stay was(4.2 ± 1.9)d,(5.5 ± 2.3)d respectively in the LICH group.Similar,the length of removing the tube were(5.4 ± 2.9)d and(7.6 ±2.9)d.The blood loss was significant less in the LICH group(P=0.02),but there were no different in the OT and LOS.4(14.8%)patients developed morbidity.No mortality occurred in the perioperative period.Intraoperative cholangiography was routinely performed in patients with hepatolithiasis.No residual stone was found in any of 10 cases.Diagnoses of patients were hepatolithiasis(n = 10),symptomatic hemangioma(n =7),hepatocellular carcinoma(n = 4),metastases(n = 4),adenocarcinoma(n = 1)and cystadenoma(n = 1).Surgical margins were negative in all cases with tumors.The mean tumor size was(35.5 ± 34.5)mm.22 patients were follow-up and the mean follow-up time was 21.5(range 3-123)months.There was no recurrence in 6 cases of hemangioma and 1 cases of cystadenoma during follow-up.1 case of hemangioma was found duodenal papillary adenocarcinoma in 28 months after operation.After endoscopic biliary stent implantation,the patient died 4 month later.2 patients with HCC received prophylactic TACE after operation,and survived within the follow-up.1 case of recurrence of HCC was found liver metastases and pancreatic metastases 2 month after operation and survival within the follow-up.1 case of HCC was found liver metastasis within 15 months,and died 24 months later.1 case of liver metastases from rectal cancer underwent radical resection of rectal cancer 1 month later.After the operation,the intrahepatic metastasis occurred in 9 months.Radiofrequency ablation was performed and survival within follow-up.2 cases of colorectal liver metastases did not find recurrence.1 patients with hepatic adenocarcinoma was found recurrence in liver 8 months and died 13 months after the operation.No recurrence of lithiasis was found in 6 cases of hepatolithiasis during the follow-up period.4 cases of hepatolithiasis and 1 cases of liver metastases were lost to follow-up.ConclusionsLaparoscopic caudate hepatectomy is safe and feasible in selected patients,which can be performed by hepatobiliary surgeons with abundant experience in laparoscopic liver surgery. |
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