Laparoscopic liver resection for malignant liver tumors, why not more? / 대한외과학회지

PURPOSE: The precise role of laparoscopic liver resection in liver malignancies remains controversial despite an increasing number of publications that have used the laparoscopic resection of benign liver tumors. This study was performed to assess the feasibility, safety, and outcome of laparoscopic liver resection for malignant liver tumors. METHODS: This study is a retrospective review of the profiles, pathology, surgery and outcome performed on 61 patients who had undergone laparoscopic liver resection for liver malignancies between January 2004 and March 2011. RESULTS: Among the 61 patients, 34 patients had hepatocellular carcinoma (HCC), 24 patients had liver metastasis. The mean tumor size was 2.8 +/- 2.0 cm (mean +/- standard deviation). Tumors located at Couinaud segment number 2 to 8. The resection included 36 anatomical resections, 25 wedge resections. The mean surgical time was 209.7 +/- 108.9 minutes. There was one operation that resulted in death. Postoperative complications occurred in 9 patients (14%). There were 2 conversions to laparotomy (3%). The mean postoperative hospital stay was 9.0 +/- 4.4 days. Blood transfusion was needed in 11 patients (18%). The mean surgical margin was 1.3 +/- 1.2 cm. The mean follow-up period was 18.1 +/- 11.1 months. The three-year overall survival rate was 87% for patients with HCC and 95% for patients having liver metastases from colorectal cancer. CONCLUSION: Even though laparoscopic liver resection requires a learning curve, it produced acceptable outcomes even in patients who had a malignant liver tumor. This study provides evidence to support further investigation and the establishment of laparoscopic liver resection for malignant liver tumors.

Better Treatment Strategies for Patients with Acute Cholecystitis and American Society of Anesthesiologists Classification 3 or Greater

PURPOSE: Laparoscopic cholecystectomy is the best treatment choice for acute cholecystitis. However, it still carries high conversion and mortality rates. The purpose of this study was to find out better treatment strategies for high surgical risk patients with acute cholecystitis. MATERIALS AND METHODS: Between January 2002 and June 2008, we performed percutaneous cholecystostomy instead of emergency cholecystectomy in 44 patients with acute cholecystitis and American Society of Anesthesiologists (ASA) classification 3 or greater. This was performed in 31 patients as a bridge procedure before elective cholecystectomy (bridge group) and as a palliative procedure in 11 patients (palliation group). RESULTS: The mean age of patients was 71.6 years (range 52-86 years). The mean ASA classifications before and after percutaneous cholecystostomy were 3.3 +/- 0.5 and 2.5 +/- 0.6, respectively, in the bridge group, and 3.6 +/- 0.7 and 3.1 +/- 1.0, in the palliation group, respectively. Percutaneous cholecystostomy was technically successful in all patients. There were two deaths after percutaneous cholecystostomy in the palliation group due to underlying ischemic heart disease and multiple organ failure. Resumption of oral intake was possible 2.9 +/- 1.8 days in the bridge group and 3.9 +/- 3.5 days in the palliation group after percutaneous cholecystostomy. We attempted 17 laparoscopic cholecystectomies and experienced one failure due to bile duct injury (success rate: 94.1%). The postoperative course of all cholecystectomy patients was uneventful. CONCLUSION: Percutaneous cholecystostomy is an effective bridge procedure before cholecystectomy in patients with acute cholecystitis and ASA classification 3 or greater.