Laparoscopic Management of Hepatocellular Carcinoma: A Critical Reappraisal

Following the introduction of the first laparoscopic liver resection, after ∼25 years, a critical reappraisal seems to be warranted. Liver resection represents the first choice for curing early hepatocellular carcinoma (HCC) allowing a curative chance also in selected patients with intermediate stage tumors. The criteria for liver resectability by laparoscopy remains the same for open surgery, which is oncological criteria (absence of extrahepatic tumor location; completely resectable R0 resection), anatomic (resectability of involved segment with its own blood surely and biliary drainage; absence of vascular invasion of portal or hepatic veins) and technical (possibility to leave in place a residual volume ≥40%). Anatomic resections being more challenging than wedged resections, were initially performed mainly for lesions located in the left liver (segments 2, 3, and 4) and segments 5 and 6 of the right liver (anterior and lateral hepatic segments). Left lateral segmentectomy seemed most suited for laparoscopic resection because of the thinness of the liver, the possibility of resection without hilar dissection, ease of stapling the left hepatic vein and portal pedicles of segment II and III by mechanical stapling. Conversely, right hepatectomy seemed most difficult and technically challenging to perform. The analysis of literature confirms that minor liver resections for HCC can be safely conducted also in cirrhotic patients and that laparoscopy, when feasible, should b...
Source: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques - Category: Surgery Tags: Review Articles Source Type: research