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World J Clin Cases. Apr 16, 2021; 9(11): 2419-2432
Published online Apr 16, 2021. doi: 10.12998/wjcc.v9.i11.2419
Current status of radical laparoscopy for treating hepatocellular carcinoma with portal hypertension
Ze-Feng Shen, Xiao Liang
Ze-Feng Shen, Xiao Liang, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Author contributions: Shen ZF and Liang X designed the study and performed the literature search; all authors contributed to the preparation of the manuscript; All authors read and approved the final manuscript.
Conflict-of-interest statement: Xiao Liang and Ze-Feng Shen declare that they have no conflicts of interest.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao Liang, MD, PhD, Professor, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. srrshlx@zju.edu.cn
Received: November 19, 2020
Peer-review started: November 19, 2020
First decision: December 17, 2020
Revised: December 31, 2020
Accepted: February 1, 2021
Article in press: February 1, 2021
Published online: April 16, 2021
Abstract

The laparoscopic technique is clinically effective in treating hepatocellular carcinoma (HCC) with portal hypertension (PHT). However, existing studies lack systematic arrangement and induction. Here, we review the latest research advancement in laparoscopic technique for treatment of HCC with PHT, based on published literature and our single-institution experience. Our single-center experience reveals no statistical difference in both short- and long-term prognosis of HCC patients after laparoscopic liver resection (LLR), regardless of whether they suffer from PHT, which is consistent with previous studies on the use of LLR for HCC with PHT. Retrieval outcomes indicate existence of short- and long-term prognostic superiority, following laparoscopic treatment, relative to non-laparoscopic treatment. Besides that, LLR offers long-term prognostic advantage compared to laparoscopic radiofrequency ablation. In addition, we review the previous literature and propose corresponding perspectives on the therapy of hypersplenism, the utilization of Pringle maneuver, and the adoption of anatomical hepatectomy during radical laparoscopic treatment. HCC with PHT is not the "forbidden zone" of radical laparoscopic treatment. However, patients’ preoperative liver function should be adequately estimated.

Keywords: Hepatocellular carcinoma, Portal hypertension, Radical laparoscopic treatment

Core Tip: The manuscript presents the latest research advancement of laparoscopic technique for hepatocellular carcinoma (HCC) with portal hypertension (PHT) based on a combination of published literature and our single-institution experience. Consistent with previous studies of laparoscopic liver resection (LLR) for HCC with PHT, our single-institution experience showed that there exists no statistical difference in both short-term and long-term prognosis of HCC patients after LLR, regardless of whether they suffer from PHT. Retrieval outcomes indicated the possession of short-term and long-term prognostic superiority after laparoscopic treatment compared with non-laparoscopic treatment, and long-term prognostic advantage after LLR compared with laparoscopic radiofrequency ablation, respectively. In addition, this manuscript reviews previous studies and proposes corresponding perspectives on the therapy of hypersplenism, the utilization of Pringle maneuver, and the adoption of anatomical hepatectomy during radical laparoscopic treatment.