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World J Hepatol. Sep 27, 2013; 5(9): 487-495
Published online Sep 27, 2013. doi: 10.4254/wjh.v5.i9.487
Pure laparoscopic hepatectomy for hepatocellular carcinoma with chronic liver disease
Zenichi Morise, Norihiko Kawabe, Jin Kawase, Hirokazu Tomishige, Hidetoshi Nagata, Hisanori Ohshima, Satoshi Arakawa, Rie Yoshida, Masashi Isetani
Zenichi Morise, Norihiko Kawabe, Jin Kawase, Hirokazu Tomishige, Hidetoshi Nagata, Hisanori Ohshima, Satoshi Arakawa, Rie Yoshida, Masashi Isetani, Department of Surgery, Fujita Health University School of Medicine, Banbuntane Houtokukai Hospital, Aichi 454-8509, Japan
Author contributions: Kawabe N, Kawase J, Tomishige H, Nagata H, Ohshima H, Arakawa S, Yoshida R and Isetani M collected the data and assisted in writing of the manuscript; Morise Z wrote the manuscript.
Correspondence to: Zenichi Morise, MD, PhD, Department of Surgery, Fujita Health University School of Medicine, Banbuntane Houtokukai Hospital, 3-6-10, Otobashi Nakagawa-ku, Nagoya, Aichi 454-8509, Japan. zmorise@aol.com
Telephone: +81-52-3218171 Fax: +81-52-3234502
Received: May 11, 2013
Revised: July 26, 2013
Accepted: August 17, 2013
Published online: September 27, 2013
Processing time: 143 Days and 5.4 Hours
Abstract

Pure laparoscopic hepatectomy is a less invasive procedure than conventional open hepatectomy for the resection of hepatic lesions. Increases in experiences with the technique, in combination with advances in technology, have promoted the popularity of pure laparoscopic hepatectomy. However, indications for usage and potential contraindications of the procedure remain unresolved. The characteristics and specific advantages of the procedure, especially for hepatocellular carcinoma (HCC) patients with chronic liver diseases, are reviewed and discussed in this paper. For cirrhotic patients with liver tumors, pure laparoscopic hepatectomy minimizes destruction of the collateral blood and lymphatic flow from laparotomy and mobilization, and mesenchymal injury from compression. Therefore, pure laparoscopic hepatectomy has the specific advantage of minimal postoperative ascites production that leads to lowering the risk of disturbance in water or electrolyte balance and hypoproteinemia. It minimizes complications that routinely trigger postoperative serious liver failure. Under adequate patient positioning and port arrangement, the partial resection of the liver in the area of subphrenic space, peri-inferior vena cava area or next to the attachment of retro-peritoneum is facilitated in pure laparoscopic surgery by providing good vision and manipulation in the small operative field. Furthermore, the features of reduced post-operative adhesion, good vision, and manipulation within the small area between the adhesions make this procedure safer in the context of repeat hepatectomy procedures. These improved features are especially advantageous for patients with liver cirrhosis and multicentric and/or metachronous HCCs.

Keywords: Laparoscopic hepatectomy; Hepatocellular carcinoma; Liver cirrhosis; Chronic liver disease; Liver Tumor; Liver resection; Repeat hepatectomy; Bridging therapy to transplantation; Ascites; Postoperative liver failure

Core tip: For cirrhotic patients with liver tumor, pure laparoscopic hepatectomy minimizes destruction of the collateral blood/lymphatic flow from laparotomy and mobilization, and has advantage of minimal postoperative ascites. It restrains the complications, which trigger the postoperative liver failure. The partial resection in the area of subphrenic space, peri-inferior vena cava area or next to the attachment of retro-peritoneum is facilitated with good vision and manipulation in the small operative field. Furthermore, repeat pure laparoscopic hepatectomy for patients with multicentric/metachronous hepatocellular carcinomas was feasible and safe with the advantages of less post-operative adhesion and good vision and manipulation between the adhesions.