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Cassese et al. Hepatoma Res 2022;8:24 Hepatoma Research
DOI: 10.20517/2394-5079.2022.15

Editorial Open Access

Minimally invasive surgery for HCC

1,2
Gianluca Cassese , Ho-Seong Han 1
1
Department of Surgery, College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do 13620,
South Korea.
2
Department of Clinical Medicine and Surgery, Minimally invasive and robotic HPB Surgery Unit, Federico II University, Naples
80131, Italy.
Correspondence to: Prof. Ho-Seong Han, Department of Surgery, College of Medicine, Seoul National University Bundang
Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, South Korea. E-mail: hanhs@snubh.org

How to cite this article: Cassese G, Han HS. Minimally invasive surgery for HCC. Hepatoma Res 2022;8:24.
https://dx.doi.org/10.20517/2394-5079.2022.15

Received: 27 Mar 2022 Accepted: 21 Apr 2022 Published: 13 May 2022

Academic Editors: Gianluca Cassese, Tao Peng Copy Editor: Haixia Wang Production Editor: Haixia Wang

After an initial phase of skepticism and technical difficulties, minimally invasive liver surgery (MILS) has
become a widespread practice in most high-volume hepatobiliary centers. Since the first laparoscopic liver
resection (LLR) was carried out in France in 1991 for a benign lesion, the indications have substantially
changed, including malignant diseases such as hepatocellular carcinoma (HCC) . Thanks to the
[1]
improvements in both technical aspects and perioperative management, the extent of resection has also
expanded during the last years, including patients with more advanced disease . With this redefinition of
[2]
the boundaries of MILS, liver surgeons must be aware of the specific issues concerning HCC treatment, as
well as the current evidence and strategies to overcome old limits.

The first and major concern about MILS is that up to 80%-90% of HCCs develop in chronic liver disease or
[3]
cirrhotic patient . Therefore, we must consider not only oncological outcomes but also the surgical stress
carried out on the liver itself. LLR has been considered too risky for cirrhotic patients for years. Recently,
Kabir et al. published a wide metanalysis on 11 studies including 1618 patients that showed up to 16%-26%
lower hazard ratio of death for patients with HCC on cirrhosis undergoing LLR compared to OLR, as well
[4]
as shorter length of hospital stay, reduced blood loss, and reduced major complications . Similarly, lower
incidences of post-hepatectomy liver failure and postoperative ascites after MILS have been reported in the
literature, probably related to a reduced interruption of portosystemic shunts, together with a lower
electrolyte imbalances thanks to the minimal exposure of the abdominal content to the air . Furthermore,
[5,6]

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
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