Laparoscopic Liver Resection: A Single Center Experience

BACKGROUND: An increasing number of small prospective studies have been published, since the first report of laparoscopic liver resection by Gagner et al. in 1992. They have shown encouraging results for the feasibility and safety of the procedure. This paper provides a retrospective analysis of a single center's experience with elective laparoscopic liver resections. METHODS: We did a retrospective study on laparoscopic liver resections performed from July 2005 to April 2009, undertaken in 34 patients with preoperative diagnosis of a benign lesion (7 cases, 20.6%), hepatocellular carcinoma in absence of complicated cirrhosis (18 cases, 52.9%), or liver metastasis (9 cases, 26.4%). The mean tumor size was 2.63+/-1.57 cm (range 0.55-7.5) RESULTS: We carried out 15 wedge resections (44.1%), 3 right hemi-hepatectomies (8.8%), 4 left hemi-hepatectomies (11.8%), 5 liver segmentectomies (14.7%), 7 left lateral sectionectomies (20.6%). The average duration of an operation was 175.00+/-129.12 minutes. There were 6 patients (15%) in which a conversion to laparotomy was required none of the conversions occurred under emergency situations. Intraoperative transfusion was required for 5 patients (14.7%). Postoperative complications developed in 2 patients (5.8%) (1 intraabdominal abscess, 1 bile leakage). There were no deaths and no reoperations for complications. The mean postoperative hospital stay was 9.9 days. CONCLUSION: Our experience shows that laparoscopic liver resections, including major hepatectomies, are feasible and safe. Nonetheless, a prospective randomization study with a greater number of cases and longer follow-up is needed before laparoscopic liver resection can be regarded as the gold-standard approach for hepatic lesions.

The Expression Ki-67 and p53 Protein in Intraabdominal Liposarcomas

PURPOSE: The formation of a liposarcoma is Known to be associated with a mutation of the p53 and MDM2 genes, and the histopathological subtypes of a liposarcoma are related to the prognosis of the patient. This study was performd to examine the relationship between the histopathological subtypes, the type of p53 mutation, and the proliferative rate. METHODS: Immunohistochemistry was used to measure the p53 protein and Ki-67 (Mib-1 labeling index) expression levels in 24 liposarcomas cases in which the liposarcoma developed primarily in the abdominal cavity. RESULTS: p53 expression was observed in 11.1% of the well- differentiated liposarcoma cases, 27.3% of the myxoid and round cell liposarcoma cases, and 50% of the pleomorphic liposarcoma cases. There were significant differences between the Ki-67 expression level according to the histopathological subtypes. There were significant differences between p53 positive or negative group and the Ki-67 expression level, and there was a quantitative correlation between them. CONCLUSION: The p53 protein was expressed in 25% of all liposarcomas, particularly in pleomorphic liposarcomas because it was expressed more frequently than in the other liposarcoma subtypes (in 2 cases out of 4 cases). The survival rate was much higher in the mucinous round cell liposarcomas which had high p53 and Ki-67 expression levels. The p53 expression level might be a prognostic predictor of a liposarcoma.