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Laparoscopic Left Lateral Sectionectomy: Guided by the Ligamentum Teres Hepatis and the Umbilical Fissure Vein
Published on: September 27, 2024
Resection margin in laparoscopic hepatectomy: a comparative study between wedge resection and anatomic left lateral
Kit-fai Lee1, Jeff Wong, Yue-sun Cheung
1Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. leekf@surgery.cuhk.edu.hk
Summary
Laparoscopic left lateral sectionectomy (LLS) offers a wider resection margin compared to wedge resection (WR) for liver lesions. While operative outcomes are similar, LLS may be more reliable for achieving margins greater than 1 cm.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Anatomic liver resection is superior to wedge resection for achieving adequate margins in open surgery.
- Laparoscopic hepatectomy is increasingly used for liver pathologies, with wedge resection (WR) and left lateral sectionectomy (LLS) being common procedures.
- LLS represents an anatomic resection, while WR is non-anatomic.
Purpose of the Study:
- To compare laparoscopic wedge resection (WR) and left lateral sectionectomy (LLS) in terms of resection margin.
- To evaluate operative outcomes, pathological findings, recurrence patterns, and survival between WR and LLS.
Main Methods:
- Retrospective review of 44 consecutive patients undergoing laparoscopic hepatectomy between November 2003 and July 2009.
- Comparison of WR and LLS groups regarding demographics, operative outcomes, pathological findings, recurrence, and survival.
Main Results:
- No significant differences in conversion rates, blood loss, transfusion, mortality, morbidity, or length of stay between LLS and WR groups.
- LLS group had significantly larger lesions, wider resection margins, and fewer sub-centimeter margins compared to WR.
- No difference in intra-hepatic recurrence or 3-year survival for malignant lesions between the two groups.
Conclusions:
- Laparoscopic WR and LLS demonstrate similar operative outcomes.
- LLS is more reliable than WR in achieving resection margins exceeding 1 cm.
- Further research with larger cohorts and longer follow-up is needed to clarify the impact of margin status on recurrence and survival.
