CAUSES, PREDICTIVE FACTORS AND MANAGEMENT OF CONVERSIONS IN 223 CONSECUTIVE LAPAROSCOPIC LIVER RESECTIONS

Background. As a consequence of continuous technical developments in liver surgery, laparoscopic liver resection (LLR) is increasingly performed worldwide, especially for malignancies. We report herein a single institution 7-year experience in LLR, focusing on causes of conversion, technical issues and outcomes. Method: Between January 2004 and December 2010, 223 LLR were performed in 200 patients for benign, live donation, primary and metastatic liver disease. Repeat LLR and two-stage hepatectomy were performed in 19 (8.5%) and 3 (1.3%) cases, respectively. Simultaneous resection of colo-rectal primary cancer and synchronous liver metastases was done in 6 (2.7%) patients. Results: Overall conversion rate was 17/223 (7.6%), mainly due to bleeding episodes (52.9%). Conversions were equally distributed over time and statistically significant factors for conversion were found to be LLR of P-S segments in the converted vs. the non-converted group (14.5% vs. 4.1%, p=0.012 respectively) and major vs. minor hepatectomy (17.5% vs. 5.5%, p=0.017). In malignancy, R0 resection was obtained in 91% of cases. Complication rates were scored as: n=15 grade I; n=9 grade II; n=7 grade III and n=1 grade IV. Multivariate analysis revealed resections involving P-S segments as an independent risk factor for conversion (p=0.036, OR=3.2, CI=1.1-9.4). Conclusion: LLR can be safely performed accounting for low overall morbidity and a favourable outcome. LLR in P-S segments most likely lead to conversion to open approach irrespective from the learning curve, needing careful intraoperative management.