Laparoscopic liver resection for hepatocellular carcinoma: review of current status

Despite initial skepticism of laparoscopic liver resection (LLR) due to fears of uncontrolled bleeding, margin involvement resulting from a lack of palpation of laparoscopy, and a steep learning curve, LLR has progressively developed over the past two decades. Through a review of the literature, we compare perioperative and oncologic outcomes of laparoscopic and open liver resection (OLR) for hepatocellular patients, and assess current indications and limitations of laparoscopic liver surgery. Although randomized control trials have not been reported, other data indicate the safety and better short-term outcomes of LLR compared to OLR for hepatocellular carcinoma (HCC) without compromising oncologic outcomes including resection margin status and long-term survival. Moreover, LLR is associated with reduced postoperative ascites and a lower incidence of liver failure for HCC patients with liver cirrhosis (LC) and facilitates subsequent repeat surgery by reducing operation time due to minimal adhesion formation. Major hepatectomies and resections of unfavorable locations in classic indication are expected to benefit from this approach, overcoming the current limitations.