Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 28, 2015; 7(27): 2765-2773
Published online Nov 28, 2015. doi: 10.4254/wjh.v7.i27.2765
Comparative study and systematic review of laparoscopic liver resection for hepatocellular carcinoma
Wei Qi Leong, Iyer Shridhar Ganpathi, Alfred Wei Chieh Kow, Krishnakumar Madhavan, Stephen Kin Yong Chang
Wei Qi Leong, Iyer Shridhar Ganpathi, Alfred Wei Chieh Kow, Krishnakumar Madhavan, Stephen Kin Yong Chang, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Health System, Singapore 119228, Singapore
Author contributions: Chang SKY conceptualized and designed the review together with Leong WQ; Leong WQ carried out the analysis; Leong WQ drafted the initial manuscript; Ganpathi IS, Kow AWC, Madhavan K and Chang SKY provided the data for analysis; all authors reviewed and approved the final manuscript as submitted.
Conflict-of-interest statement: The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Data sharing statement: Technical appendix, statistical code, and the dataset are available from the corresponding author at As this study comprises a review in literature and a retrospective study on patient’s data in our own hospital, informed consent from patients was not taken. The presented data are anonymized and risk of identification is low. All data generated during the project will be made available via the National University Hospital (Singapore)’s research data repository. There is no security, licensing or ethical issues related to the data, and all data used in the project was generated directly as a result of the project, without any pre-existing data being used.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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:
Correspondence to: Stephen Kin Yong Chang, Associate Professor, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 8, Singapore 119228, Singapore.
Telephone: +65-67725300 Fax: +65-67778427
Received: March 23, 2015
Peer-review started: March 26, 2015
First decision: May 13, 2015
Revised: September 22, 2015
Accepted: October 20, 2015
Article in press: October 27, 2015
Published online: November 28, 2015

AIM: To compare the surgical outcomes between laparoscopic liver resection (LLR) and open liver resection (OLR) as a curative treatment in patients with hepatocellular carcinoma (HCC).

METHODS: A PubMed database search was performed systematically to identify comparative studies of LLR vs OLR for HCC from 2000 to 2014. An extensive text word search was conducted, using combinations of search headings such as “laparoscopy”, “hepatectomy”, and “hepatocellular carcinoma”. A comparative study was also performed in our institution where we analysed surgical outcomes of 152 patients who underwent liver resection between January 2005 to December 2012, of which 42 underwent laparoscopic or hand-assisted laparoscopic resection and 110 underwent open resection.

RESULTS: Analysis of our own series and a review of 17 high-quality studies showed that LLR was superior to OLR in terms of short-term outcomes, as patients in the laparoscopic arm were found to have less intraoperative blood loss, less blood transfusions, and a shorter length of hospital stay. In our own series, both LLR and OLR groups were found to have similar overall survival (OS) rates, but disease-free survival (DFS) rates were higher in the laparoscopic arm.

CONCLUSION: LLR is associated with better short-term outcomes compared to OLR as a curative treatment for HCC. Long-term oncologic outcomes with regards to OS and DFS rates were found to be comparable in both groups. LLR is hence a safe and viable option for curative resection of HCC.

Keywords: Hepatocellular carcinoma, Laparoscopy, Open liver resection, Hepatectomy, Surgery

Core tip: Surgical resection is the standard treatment for hepatocellular carcinoma (HCC), and provides the best outcomes for patients eligible for resection. Laparoscopic liver resection (LLR) is a relatively new advancement in treatment of HCC and has raised concerns on its feasibility and safety. We reviewed 17 studies and performed our own comparative study on surgical outcomes of LLR vs open liver resection for the curative treatment of HCC. We showed that LLR resulted in more desirable short-term outcomes, whereas long-term oncologic outcomes were comparable. Hence, LLR is a safe and feasible option in the surgical treatment of HCC.