Opinion Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2022; 28(43): 6090-6098
Published online Nov 21, 2022. doi: 10.3748/wjg.v28.i43.6090
Current status of minimally invasive liver surgery for cancers
Zenichi Morise
Zenichi Morise, Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki 444-0827, Aichi, Japan
Author contributions: Morise Z designed the overall concept and contributed to the writing of the manuscript and the review of literature.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zenichi Morise, FACS, MD, PhD, Chairman, Professor, Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki 444-0827, Aichi, Japan. zmorise@fujita-hu.ac.jp
Received: August 25, 2022
Peer-review started: August 25, 2022
First decision: October 20, 2022
Revised: October 23, 2022
Accepted: November 6, 2022
Article in press: November 6, 2022
Published online: November 21, 2022
Processing time: 78 Days and 8.2 Hours
Abstract

Hepatocellular carcinoma (HCC) patients have chronic liver disease with functional deterioration and multicentric oncogenicity. Liver surgeries for the patients should be planned on both oncological effects and sparing liver function. In colorectal patients with post-chemotherapy liver injury and multiple bilateral tumors, handling multiple tumors in a fragile/easy-to-bleed liver is an important issue. Liver surgery for biliary tract cancers is often performed as a resection of large-volume functioning liver with extensive lymphadenectomy and bile duct resection/reconstruction. Minimally invasive liver surgery (MILS) for HCC is applied with the advantages of laparoscopic for cases of cirrhosis or repeat resections. Small anatomical resections using the Glissonian, indocyanine green-guided, and hepatic vein-guided approaches are under discussion. In many cases of colorectal liver metastases, MILS is applied combined with chemotherapy owing to its advantage of better hemostasis. Two-stage hepatectomy and indocyanine green-guided tumor identification for multiple bilateral tumors are under discussion. In the case of biliary tract cancers, MILS with extensive lymphadenectomy and bile duct resection/reconstruction are developing. A robot-assisted procedure for dissection of major vessels and handling fragile livers may have advantages, and well-simulated robot-assisted procedure may decrease the difficulty for biliary tract cancers.

Keywords: Minimally invasive liver surgery, Laparoscopic liver resection, Robot-assisted liver resection, Hepatocellular carcinoma, Colorectal liver metastases, Biliary tract carcinoma

Core Tip: Minimally invasive liver surgery (MILS) for hepatocellular carcinoma is applied with the advantages of laparoscopic “caudal approach” for cases of cirrhosis or repeat resections. Small anatomical resections using newly developing approaches are under discussion. In many cases of colorectal liver metastases, MILS is applied combined with chemotherapy, owing to its advantage of better hemostasis. Two-stage hepatectomy and indocyanine green-guided tumor identification for multiple bilateral tumors are under discussion. In the case of biliary tract cancers, MILS with extensive lymphadenectomy and bile duct resection/reconstruction are developing. A robot-assisted procedure may have advantages.