Laparoscopic liver resection for the treatment of hepatocellular carcinoma

Table 1 Recent reports of laparoscopic and open liver resction comparative studies for hepatocellular carcinoma

Ref.	% of LC patients		Ascites		Liver failure		Hospital stay (d, mean ± SD)		Mortality		Overall survival (5-yr, %)
	LLR	OLR	LLR	OLR	LLR	OLR	LLR	OLR	LLR	OLR	LLR	OLR
Lai et al[34]	92	93.94	NA	NA	NA	NA	NA	NA	0/25	1/33	60 (3-yr)	NA
Aldrighetti et al[35]	56.25	56.25	0/16	1/6	NA	NA	6.3 ± 1.7	9 ± 3.8	0/16	0/16	(No significant difference )
Tranchart et al[36]	73.81	80.95	3/42	11/42	0/36	4/53	6.7 ± 5.9	9.6 ± 3.4	1/42	1/42	59.5	47.4
Kim et al[37]	92.31	86.21	0/26	1/29	NA	NA	11.08 ± 4.96	16.1 ± 10.7	0/26	0/29	84.6 (2-yr RFS)	82.8 (2-yr RFS)
Lee et al[38]	84.85	64	0/33	2/50	NA	NA	NA	NA	0/33	0/50	76	76.1
Truant et al[39]	100	100	5/36	12/53	NA	NA	6.5 ± 2.7	9.5 ± 4.8	0/36	4/53	70	46
Ker et al[29]	NA	NA	2/116	26/208	NA	NA	6.2 ± 3	12.4 ± 6.8	0/116	6/208	62.2	71.8
Kanazawa et al[40]	100	100	3/28	18/28	0/28	0/28	10 (6-25)1	19 (8-49)1	0/28	0/28	NA	NA
Cheung et al[41]	87.5	71.9	0/32	1/64	NA	NA	4 (2-16)1	7 (4-42)1	2/32	12/64	76.6	57

¹Median (range). LC: Liver cirrhosis; NA: Not available; RFS: Recurrence free survival; LLR: Laparoscopic liver resection; OLR: Open liver resection.

Table 2 Advantages and disadvantages of laparoscopic liver resection in technical aspects

Advantages

Good view and manipulation in a small operative field-minimum damages on the environment around the liver

Meticulous manipulation under magnified view

Less adhesion after surgery

Good view in the dorsal area of the liver around inferior vena cava

Dissection and handling organs/tumors using postural change and the gravity with the maintenance of similar view by the laparoscopic adjustments[43,44]

Less venous bleeding under the pneumo-peritoneal pressure

Disadvantages

Restrictions on the movements of forceps

Difficulties of handling large-sized/volume organs and tumors

These should be conquered with port arrangements and dissection and handling organs/tumors using postural change and the gravity

Lack of tactile sensation

Lack of overview of whole operative field

These easily lead to disorientation during surgery and should be conquered with preoperative (MDCT) simulation plus intraoperative US navigation

MDCT: Multidetector computed tomography; US: Ultrasonography.