Safety and Feasibility of Laparoscopic Liver Resection in Antiplatelet-Burdened Patients with Arterial Thromboembolic Risks

Abstract

AIM: The aim of the study was to assess the safety and feasibility of laparoscopic liver resection (LLR) using two-surgeon technique in patients with preoperative antiplatelet therapy (APT) for arterial thromboembolic risks.

METHODS: Patients who had undergone LLR using two-surgeon technique in a tertiary care setting from 2010 to 2016 were retrospectively reviewed. Our perioperative antithrombotic management of patients with high thromboembolic risks included continuation of aspirin monotherapy for APT patients and bridging heparin substitution for patients with anticoagulation. Outcome variables, including bleeding and thromboembolic complications, were compared between the APT patients with high thromboembolic risks (APT-HR group), those with low risks (APT-LR group), and those without APT (non-APT group).

RESULTS: A total of 73 LLRs were performed, including partial resection in 54, left lateral sectionectomy in 13, S5 sub-sectionectomy in 4, right anterior sectionectomy in 1 and left hepatectomy in 1. APT-HR group showed significantly high frequency of history of congestive heart failure, percutaneous coronary intervention and cerebral infarction, although tumor characteristics and the type of operation were similar between the groups. Only one patient was converted to open surgery due to massive bleeding in non-APT group but none was converted in APT-HR or APT-LR groups. In the current cohort, neither bleeding nor thromboembolic complications occurred postoperatively, but one postoperative mortality case due to unknown cause was experienced in APT-HR group.

CONCLUSION: LLR using two-surgeon technique can be performed safely and satisfactorily even under continuation of aspirin monotherapy for patients with high thromboembolic risks, although this challenging group needs to be carefully managed to prevent fatal postoperative complications.