Malignant liver tumors are distinguished into primary and metastatic. Primary malignant tumors are hepatic carcinoma (hepatoma), cholangiocarcinoma, and less frequently mixed and mesenchymal tumors.
Hepatocellular carcinoma (HCC) most commonly develops in cirrhotic liver, mainly following an infection with hepatitis B virus. Symptoms include loss of weight, asthenia, pain, the feeling of weight in the area of the liver, jauntice, ascites (dilation of the abdomen due to fluid effusion), fever, hemorrhage, anorexia, nausea, vomiting, palpable mass.
Metastatic cancer is usually multifocal beginning at the stomach, the colon, the breast, the ovaries, the kidneys, the lung or elsewhere. It has a bad prognosis, while RadioFrequency ablation offers a survival advantage on many occasions. It is recommended to surgically remove solitary liver lesions in cases of a primary tumor occurring on the colon.
Laparoscopic hepatectomies
Laparoscopic hepatectomies are highly complicated and very demanding surgical procedures for the surgeon and require high quality training and experience (learning curve).
Liver is divided, in terms of classification into two lobes, the right and the left lobe. These lobes are further distinguished into segments (8 segments), depending on their vascularisation. There are various classification systems of the surgical anatomy of the liver, as well as many variations. They all aim at better depicting the anatomy and consequently at enabling surgeon to perform the various types of hepatectomy optimally.
The different types of hepatectomy depend on the liver lobe or segment being resected (lobectomy – segmentectomy), the main examples of which are left hepatectomy, right hepatectomy, extended right hepatectomy, and left extended hepatectomy, segmentectomies, wedge resections, and atypical hepatectomies. Tumors should be resected within healthy margins and an adequate part of the hepatic parenchyma so that to allow patients to continue their lives. It is worth noting that the liver has a remarkable capacity to regenerate after resection allowing the restoration of its parenchyma after the lapse of a period of time.
Laparoscopic surgery is involved both in diagnosis in harvesting biopsy specimens and in resecting small hepatic lesions, and in performing major hepatectomies, if deemed necessary.
Hepatectomy requires mobilisation of the liver from its surrounding ligaments (round, falciform, left and right triangular ligaments), preparation of the liver hilum and the lower vena cava – hepatic veins, resection of liver capsule and parenchyma within healthy margins with ligation of the vessels and the biliaries on the resection line. Vascular exclusion may also be useful as well as the use of technological equipment including diathermic apparatus, ultrasounds, laser, etc. The preparation is placed in a special pouch and is removed by applying a special technique. Useful aids in that procedure are also laparoscopic ultrasound probes for identifying small and deep lesions and performing transoperative cholangiography.
Laparoscopic hepatectomy is a technically challenging procedure requiring extensive expensive experience in both open liver surgery and laparoscopic surgery. Multi centre studies demonstrate comparable perioperative results and relapse rates between open and laparoscopic liver surgery. Laparoscopic approach offers additional advantages such a lower blood loss, faster recovery, less postoperative pain and shorter hospital stay.