Laparoscopic resection for the treatment of hepatocellular carcinoma as a bridge for transplantation: a systematic review

Quirino Lai, Samuele Iesari, Gianluca Mennini, Massimo Rossi, Fabio Melandro, Jan Lerut


Background: Laparoscopic liver resection (LLR) represents a fascinating approach for the treatment of patients with hepatocellular cancer (HCC) waiting for liver transplantation (LT). LLR can in fact minimize the possible disadvantages of open resection (less adhesions, minor risk of decompensation). The aim of the present study was then to perform a systematic review with the intent to investigate the role of LLR in the setting of LT.
Methods: A total of 200 studies were obtained from MEDLINE-PubMed, EMBASE, and the Cochrane Library, searching for the terms “(liver transplantation) AND (hepatocellular carcinoma) AND (laparoscopic resection OR laparoscopic hepatectomy)”. Search strategy was performed in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines.
Results: Among the screened references in the databases, only three eligible studies were identified. However, the statistical quality of the studies was generally low, with only one of them having a control group composed by patients undergoing open resection. A total of 46 cases were analyzed: 54% of LLR involving the left lobe was reported, with a 60% of minor hepatectomies performed. In 76% of cases LT was performed as a salvage therapy after post-resection recurrence. In only 15% of cases adhesions were detected at the moment of LT. Eleven percent of cases had a severe complication, with only 2% of mortality reported within 3 months from LT. Only 6% of recurrence rate was observed after LT.
Conclusions: Scarce evidence exists on the role of LLR before LT. In the few reported cases, laparoscopy appears to be safe, showing good results in terms of survival and post-LT recurrence. Not enough information exists on the comparative role between LLR and open resection. Further studies are surely needed with the intent to confirm the role of LLR in this specific setting.