To evaluate the safety and efficacy of laparoscopic anatomical left liver resection via cranial-dorsal approach in the treatment of hepatocellular carcinoma (HCC).

Clinical data of 20 HCC patients who underwent laparoscopic anatomical left liver resection in the Fifth Medical Center of PLA General Hospital from March 1, 2017 to March 1, 2019 were retrospectively analyzed. Among them, 11 patients were male and 9 female, aged (53±7) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. According to different surgical approaches, all patients were divided into the conventional group (n=10) and cranial-dorsal approach group (n=10). In the cranial-dorsal approach group, the left hepatic vein was severed from the cranial side, the Arantius ligament was incised from the dorsal side, the middle hepatic vein trunk was exposed throughout the procedure and the hepatic parenchyma was severed from the cranial-dorsal side to the foot side to complete the anatomical left liver resection. Perioperative condition, postoperative complications and survival rate were compared between two groups. The operation time and normal distribution data between two groups were compared by t test. The incidence of complications between two groups was statistically compared by Chi-square test. Survival analysis was conducted by Kaplan-Meier method and Log-rank test.

The operation time, intraoperative blood loss and the length of postoperative hospital stay in the cranial-dorsal approach group were (97±19) min, (104±21) ml and (5.5±1.2) d, significantly less than (139±24) min, (155±26) ml and (8.0±1.9) d in the conventional group (t=-9.837, -11.429, -7.362; P<0.05). In the cranial-dorsal approach group, the levels of ALT, AST, TB, WBC and CRP at postoperative 1 d were (232±26) U/L,(267±33) U/L, (28±3) μmol/L, (8.3±1.1)×10⁹/L and (54±16) mg/L, significantly lower compared with (302±31) U/L, (328±36) U/L, (34±5) μmol/L, (11.5±2.3)×10⁹/L and (73±18) mg/L in the conventional group (t=-12.362, -14.151, -9.370, -7.633, -8.641; P<0.05). The ALB in the cranial-dorsal approach group was (35.2±1.1) g/L, significantly higher than (32.9±1.5) g/L in the conventional group (t=8.016, P<0.05). The incidence of postoperative complications in the cranial-dorsal approach group was 2/10, significantly lower than 6/10 in the conventional group (χ²=6.387, P<0.05). The recurrence-free survival rate in the cranial-dorsal approach group was significantly better than that in the conventional group (χ²=4.532, P<0.05).

Laparoscopic anatomical left liver resection via the cranial-dorsal approach can sever the liver parenchyma along the middle hepatic vein trunk throughout the whole procedure. It is a safe and efficacious anatomical left liver resection, which can enhance the postoperative recurrence-free survival rate.