Laparoscopic liver resection for posterosuperior and XXXX -a comparison experience in an Asian centre.

@entity1 @entity82 @entity75 @entity5 @entity190 @entity14 @entity3 @entity1575 @entity157
BACKGROUND: Minimally invasive surgery has been one of the recent developments in liver surgery, laparoscopic liver resection (LLR) was initially performed for benign lesions at easily accessible locations. As the surgical techniques, technology and experience improved over the past decades, LLR surgery had evolved to tackle malignant lesions, major resections and even in difficult locations without compromising safety and principles of oncology. It was also shown to be beneficial in cirrhotic @entity1 . We describe our initial experience with LLR in a population with significant proportion having @entity82 , emphasising our approach for lesions in the posterosuperior (PS) segments of the liver (segments 1, 4a, 7, and 8). METHODS: A review of @entity1 undergoing LLR in single institution from 2006 to 2015 was performed from a prospective surgical database. Clinicopathological, operative and perioperative parameters were analyzed to compare outcomes in @entity1 who underwent LLR for PS vs. @entity75 ( @entity75 ). RESULTS: LLR was performed in consecutive 197 @entity1 , with a mean age of 60 years. The indications for resection were @entity157 ( @entity157 ) (n=105; 53%), @entity14 liver @entity3 (n=31; 16%), other @entity5 (n=19; 10%) and benign lesions (n=42; 21%). A significant proportion had @entity1575 (25.9%). More females underwent surgery in the @entity75 group and indications for surgery were similar between both groups. Major liver resection was performed more frequently for the PS group than for the @entity75 group (P<0.001) and significantly more PS resections was performed in our latter experience (P=0.02). The mean operative time and the conversion rate were significantly greater in the PS group than in the @entity75 group (P <=0.001 and 0.03, respectively). However, the estimated @entity190 (EBL), rate of blood transfusion and mean postoperative stay were similar in the two groups (P=0.04, 0.88 and 0.92, respectively). The overall 90-day morbidity and mortality rate was 21.3% and 0.5% respectively, with no differences between the two groups. Surrogates of difficulty such as operative time, @entity190 , conversion and outcomes e.g., morbidity and mortality, were similar in @entity1 who underwent PS resections with or without @entity82 . CONCLUSIONS: LLR in selected @entity1 is technically feasible and safe including cirrhotic @entity1 with lesions in the PS segments.
