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    • br Patients and methods All

    2018-11-12


    Patients and methods All patients were diagnosed with HCC after surgery between 1998 and 2006 and followed-up for at least 5 years. The laparoscopic or traditional liver resection procedures were performed following the clinical practice guidelines. The indications for laparoscopic liver resection were tumors at Segments II, III, IVb, V, and VI, with a diameter of < 5 cm. In total, based on the case-matched method, 86 patients (63 men and 23 women) underwent laparoscopic liver resection (Group I), and 91 patients (67 men and 24 women) underwent traditional open resection (Group II) during the same time period. Table 1 presents the clinical discrepancies in the demographic factors between the two patient groups. Continuous data were expressed as mean ± standard deviation, and the group data sets were compared using the Mann–Whitney U test. The cumulative survival rates were calculated using the Kaplan–Meier method (log-rank test) for survival rate; p < 0.05 was considered statistically significant.
    Results
    Discussion In addition to surgical resection, the laparoscopic approach could be used as a staging method for HCC in patients who are at a high risk of developing occult small nodules that were not evident on computed tomography, as reported in our previous study. We believe that the laparoscopic approach will reduce blood loss as well as the length of postoperative hospital stay. Intraoperative bleeding is the most crucial concern in laparoscopic liver resection. The resection margins should be carefully examined for perioperative bleeding and bile leaks through closed observations with a laparoscopic camera. The bleeding during the dissection of liver gdc-0980 must be managed with a microwave coagulator and CUSA. Usually, hemostasis can be obtained using a monopolar diathermy probe to coagulate small bleeders. Numerous factors, such as the patient\'s general condition as well as the macroscopic morphology and histopathological features of tumors, have prognostic significance. An Italian study group reported that in patients with inadequate resection margins, tumor recurrences are almost certain. In Taiwan, a resection margin of > 5 mm has been reported to adequately prevent intrahepatic recurrence after resection of HCC. However, further extension of the margin confers no additional benefit. A wide resection was essential to secure a surgical safety margin; however, because the space between the tumor and the portal or hepatic veins was limited, a wide resection was not feasible. Qin and Tang reported that an extended surgical margin may not be essential for patients with obvious liver cirrhosis. Apparently, anatomic resection confers beneficial effects on recurrence-free survival after hepatectomy in patients with HCC. When the liver functional reserve is good, the extent of surgical resection should be adequate to prolong the disease-free survival. Although an adequate surgical margin might exert a beneficial effect on the overall survival of patients with HCC, most patients with HCC suffer from concomitant liver cirrhosis, which limits the extent of surgical resection. For patients with severe liver cirrhosis undergoing major liver resections, the risk of mortality was high because of the poor remnant liver function. Achieving a wide surgical margin (> 10 mm) was not feasible for tumors located at the portal area or close to the main blood vessels and bile duct. No significant differences were observed in the survival rates between patients with HCC who received liver resection with varying surgical margins. In addition, Shimada et al reported that a surgical margin of ≥ 10 mm should be secured in young patients undergoing macroscopic curative hepatectomy for small HCCs with no concomitant hepatitis C virus infection or a tumor size of ≤ 25 mm considering the increased long-term disease-free survival in such patients. Moreover, Ueno et al strongly recommended anatomic resection to secure an extended surgical margin that was located away from the tumor margin, because this procedure favorably eradicated the micrometastases located away from the tumor margins approximately 3.1 ± 1.4 mm from the primary tumor margin in HCC.