Ann Surg Treat Res.  2018 Nov;95(5):258-266. 10.4174/astr.2018.95.5.258.

Laparoscopy of hepatocellular carcinoma is helpful in minimizing intra-abdominal adhesion during salvage transplantation

• Rhu J
• Kim JM
• Choi GS
• Kwon CH
• Joh JW
• Soubrane O

• KMID: 2422935
• DOI: http://doi.org/10.4174/astr.2018.95.5.258

Abstract

PURPOSE
This study analyzes the impact of laparoscopic liver resection on intra-abdominal adhesion.
METHODS
Patients who underwent salvage liver transplantation after liver resection for hepatocellular carcinoma from January 2012 to October 2017 at our institution were included. Information about the severity of intra-abdominal adhesions was collected from a prospectively maintained database. Intra-abdominal adhesions were graded after the agreement of 2 surgeons who participated in the salvage liver transplantation based on predetermined criteria. Adhesion severity and demographic, operative, and postoperative data were compared between the laparoscopic group and the open group. Multivariate logistic regression was performed to consider potential factors related to severe adhesion during salvage transplantation.
RESULTS
Sixty-two patients who underwent salvage liver transplantation after liver resection were included in this study. Among them, 52 patients underwent open surgery, and 10 patients underwent laparoscopy. Adhesion was significantly more severe in the open group than in the laparoscopy group (P = 0.029). A multivariate logistic regression model including potential factors related to severe adhesion showed that laparoscopy (odds ratio, 0.168; 95% confidence interval, 0.029-0.970; P = 0.048) was the only significant factor.
CONCLUSION
Laparoscopic liver resection for hepatocellular carcinoma can minimize intra-abdominal adhesion during salvage liver transplantation.

Keyword

H epatocellular carcinoma; Laparoscopy; Liver transplantation; Surgical adhesion

MeSH Terms

Carcinoma, Hepatocellular*
Humans
Laparoscopy*
Liver
Liver Transplantation
Logistic Models
Prospective Studies
Surgeons
Tissue Adhesions

Figure

• 

  Fig. 1 Among 709 liver transplantations, 62 patients were included in the study population. Eighty-six pediatric patients and 301 nonhepatocellular carcinoma were excluded. Among 322 liver transplantation patients with hepatocellular carcinoma, 260 did not have a history of liver resection before transplantation. In the end, 62 patients, 10 with laparoscopic liver resection and 52 with open liver resection, were included.

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  Fig. 2 (Aa) A 51-year-old male patient had severe adhesion of the omentum on the anterior liver surface. (Ab) After hepatectomy, injuries on the surface of the diaphragm wall occurred during adhesiolysis. (Ba) A 52-year-old male patient had severe omental adhesion covering the entire liver surface. (Bb) The patient also had severe adhesion between the liver dome area and the diaphragm. Surface injuries to the diaphragm were exposed after the liver was extracted. (C) A 51-year-old male had severe adhesion between the dome area of the liver surface and the diaphragm, which was injured during adhesiolysis. The patient underwent chest tube insertion. (D) A 61-year-old female patient had only moderate adhesion of the omentum to the peritoneum around the previous incision site, which was easily detached.

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