LAPAROSCOPIC LIVER RESECTION FOR HEPATOCELLULAR CARCINOMA PATIENTS: INDICATIONS AND BENEFITS

The treatment options for hepatocellular carcinoma (HCC) include liver resection (LR), liver transplantation (LT), transarterial chemoembolization, and local ablation therapy. LR and LT, and local ablation therapy (for small tumors only) provide the best hope for cure. However, most patients with HCC have underlying chronic liver disease (CLD) and are thus at high risk for development of postoperative complications - sometimes fatal- and metachronous multicentric recurrent lesions occurring from the preneoplastic CLD background. Although appropriate treatment is selected for HCC patients with CLD depending on the tumor condition and liver function, a large number of patients are not able to undergo any treatment because of poor liver function and/or complicated tumor condition. This is especially true after repeated treatments for the disease. In our experience of laparoscopic LR (LLR), LLR could expand the indication of LR to severe CLD patients due to its lower damages to the liver and surrounding tissue, especially to collateral circulation around the cirrhotic liver. Child-Pugh score, not class, is one of the promising candidates as a selection indicator which correlates well to our indication criteria of surface small LLR to severe CLD patients, patient’s performance status, and prognosis. Portal hypertension should also be counted in the selection criteria. For repeat LLR, there are only small number of reports with small number of patients to date. These studies generally reported that repeat LLR has better short-term outcomes than open (reduced bleedings, less or similar morbidity and shorter hospital stay) without compromising the long-term outcomes. The fact that complete adhesiolysis can be avoided in repeat LLR is also reported. In the comparison of previous procedures, it is reported that the operation time for repeat LLR was shorter for the patients previously treated with LLR than open. Furthermore, it is speculated that LLR for minor repeat LR of cirrhotic liver can be minimized the deterioration of liver function by LR. However, further experience and evaluation of anatomical resection or resections exposing major vessels as repeat LLR, especially after previous anatomical resection, are needed. It is thought that the features of LLR could lead to expanding the indications for LR to those patients in the settings of severe CLD, repeat LR, and bridging to LT. There should be a chance to prolong the overall survival of the patients by using LLR as a powerful local therapy which can be applied repeatedly with minimal deterioration of liver function.