Published online Oct 27, 2021. doi: 10.4240/wjgs.v13.i10.1110
Peer-review started: March 11, 2021
First decision: June 14, 2021
Revised: June 14, 2021
Accepted: September 7, 2021
Article in press: September 7, 2021
Published online: October 27, 2021
Long-term survival is the most important outcome measurement of a curative oncological treatment. For hepatocellular carcinoma (HCC), the long-term disease-free and overall survival of laparoscopic liver resection (LLR) is shown to be non-inferior to the current standard of open liver resection (OLR). Some studies have reported a superior long-term oncological outcome in LLR when compared to OLR. It has been argued that improvement of visualization and instrumentation and reduced operative blood loss and perioperative blood transfusion may contribute to reduced risk of postoperative tumor recurrence. On the other hand, since most of the comparative studies of the oncological outcomes of LLR and OLR for HCC are non-randomized, it remained inconclusive as to whether LLR confers additional survival benefit compared to OLR. Despite the paucity of level 1 evidence, the practice of LLR for HCC has gained wide-spread acceptance due to the reproducible improvements in the perioperative outcomes and non-inferior oncological outcomes demonstrated by large-scaled, matched comparative studies. Meta-analyses of the outcomes of these studies by multiple systematic reviews have also returned noncontradictory conclusions. On the basis of a theoretical advantage of LLR over OLR in preventing tumor recurrence, the current review aims to dissect from the current meta-analyses and comparative studies any evidence of such superiority.
Core Tip: Laparoscopic liver resection (LLR) resulted in better perioperative outcomes when compared with open liver resection. However, for long-term outcomes, the reported ranges of disease-free survival rate and overall survival rate at 5 years after LLR of hepatocellular carcinoma (HCC) can be as wide as 20%-64% and 47%-95%, respectively. This reflects the heterogeneity of clinical practice and outcome reporting. The purpose of this review is to elucidate the true picture of the oncological efficacy of LLR in the treatment of HCC by critical appraisal of current evidence including meta-analyses and comparative studies.