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Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2017; 9(12): 233-245
Published online Dec 27, 2017. doi: 10.4240/wjgs.v9.i12.233
Advances and challenges in laparoscopic surgery in the management of hepatocellular carcinoma
Ioannis A Ziogas, Georgios Tsoulfas
Ioannis A Ziogas, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54453, Greece
Georgios Tsoulfas, Associate Professor of Surgery, 1st Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54453, Greece
Author contributions: Ziogas IA and Tsoulfas G contributed to all aspects of this work.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Georgios Tsoulfas, MD, PhD, 1st Department of Surgery, Aristotle University of Thessaloniki, 66 Tsimiski Street, Thessaloniki 54453, Greece. tsoulfasg@auth.gr
Telephone: +30-69-71895190 Fax: +30-23-10332022
Received: September 19, 2017
Peer-review started: September 21, 2017
First decision: October 31, 2017
Revised: November 4, 2017
Accepted: December 5, 2017
Article in press: December 5, 2017
Published online: December 27, 2017
Processing time: 98 Days and 7.3 Hours
Abstract

Hepatocellular carcinoma is the fifth most common malignancy and the third most common cause of cancer-related mortality worldwide. From the wide variety of treatment options, surgical resection and liver transplantation are the only therapeutic ones. However, due to shortage of liver grafts, surgical resection is the most common therapeutic modality implemented. Owing to rapid technological development, minimally invasive approaches have been incorporated in liver surgery. Liver laparoscopic resection has been evaluated in comparison to the open technique and has been shown to be superior because of the reported decrease in surgical incision length and trauma, blood loss, operating theatre time, postsurgical pain and complications, R0 resection, length of stay, time to recovery and oral intake. It has been reported that laparoscopic excision is a safe and feasible approach with near zero mortality and oncologic outcomes similar to open resection. Nevertheless, current indications include solid tumors in the periphery < 5 cm, especially in segments II through VI, while according to the consensus laparoscopic major hepatectomy should only be performed by surgeons with high expertise in laparoscopic and hepatobiliary surgery in tertiary centers. It is necessary for a surgeon to surpass the 60-cases learning curve observed in order to accomplish the desirable outcomes and preserve patient safety. In this review, our aim is to thoroughly describe the general principles and current status of laparoscopic liver resection for hepatocellular carcinoma, as well as future prospects.

Keywords: Hepatocellular carcinoma; Laparoscopic liver resection; Minimally invasive surgery; Laparoscopic hepatectomy; Liver malignant disease; Surgical excision

Core tip: Hepatocellular carcinoma is the most common primary malignant tumor of the liver and fifth most common malignancy worldwide. Surgical resection is the therapeutic treatment of choice and its laparoscopic version has come into play since 1992. Several matched comparative studies reported its superiority over open resection regarding operating theatre time and hospital stay, blood loss, need for transfusion and postsurgical opioid analgesics, postoperative pain, morbidity, R0 resection, time to recuperation, time to oral intake and stress response. The high costs of the procedure are offset by the decrease in the length of the operation and hospital stay, while in experienced hands conversion rates and morbidity are even more diminished. Laparoscopic and robotic liver resection is a continuously evolving field of minimally invasive liver surgery with a very promising future.