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Otsuka et al.                                                                                                                                   Indications and technique for LLR in HCC with liver cirrhosis

           may be indicated, with or without prior local ablation   Conflicts of interest
           therapy, if abdominal  adhesion  is limited  and  tumor   There are no conflicts of interest.
           location  and characteristics  are suitable  for a
           laparoscopic approach. [57]                        Patient consent
                                                              Not involved.
           Long-term outcomes
           With respect to oncological considerations, evidence from   Ethics approval
           meta-analyses suggests that surgical tumor margins are   Not involved.
           adequately maintained during LLR. [46,47,50-54]  In addition, an
           analysis of long-term outcomes showed no oncological   REFERENCES
           disadvantage as compared with open liver resection
           in relation to disease-free or overall survival in meta-  1.   Ferlay  J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM.
           analyses of LLR for HCC, especially in well compensated   Estimates of worldwide burden of cancer in 2008: GLOBOCAN
           (Child-Pugh class A) liver cirrhosis. [49,51,53]      2008. Int J Cancer 2010;127:2893-917.
                                                              2.   Forner  A, Llovet JM,  Bruix J. Hepatocellular  carcinoma.  Lancet
                                                                 2012;379:1245-55.
           The  rate  of  HCC recurrence  is  positively associated   3.   Kudo M, Izumi N, Kokudo N, Matsui O, Sakamoto M, Nakashima
           with  cirrhosis  progression;  therefore,  long-term   O, Kojiro M, Makuuchi M. Management of hepatocellular carcinoma
           outcomes of HCC patients with substantial  liver      in Japan: Consensus-Based Clinical Practice Guidelines proposed by
           cirrhosis (Child-Pugh class B or C) remain poor. Liver   the Japan Society of Hepatology (JSH) 2010 updated version. Dig Dis
                                                                 2011;29:339-64.
           transplantation is the  most  effective  treatment  for   4.   European  Association For  The Study Of  The Liver, European
           end-stage  liver  disease  and  localized  malignancy.    Organisation  For Research  Treatment  Of Cancer. EASL-EORTC
                                                         [58]
           Current evidence indicates that  liver transplantation   clinical practice guidelines: management of hepatocellular carcinoma.
           is the only suitable treatment for HCC in patients with   J Hepatol 2012;56:908-43.
           Child-Pugh  class C disease.  Unfortunately, this   5.   Sastre J, Díaz-Beveridge R, García-Foncillas J, Guardeño R, López
                                       [59]
                                                                 C, Pazo R, Rodriguez-Salas N, Salgado M, Salud A, Feliu J. Clinical
           optimal procedure is rarely performed because of the   guideline  SEOM: hepatocellular  carcinoma.  Clin Transl Oncol
           severe shortage of donor organs. A study comparing    2015;17:988-95.
           liver resection and liver transplantation for HCC with   6.   Korean Liver Cancer Study Group (KLCSG); National Cancer Center,
           liver cirrhosis found that  liver resection resulted in   Korea (NCC). 2014 Korean Liver Cancer Study Group-National
           comparable  overall survival in patients with solitary   Cancer  Center  Korea  practice  guideline  for the  management  of
                                                                 hepatocellular carcinoma. Korean J Radiol 2015;16:465-522.
           HCC less than 3 cm and cirrhosis.  Interestingly, LLR   7.   Capussotti  L,  Ferrero  A,  Viganò  L,  Polastri  R,  Tabone  M. Liver
                                         [58]
           may be better than open liver resection as a bridge   resection for HCC with cirrhosis: surgical perspectives out of EASL/
           to liver transplantation in patients with superficial HCC   AASLD guidelines. Eur J Surg Oncol 2009;35:11-5.
           accompanied by liver cirrhosis, because of the ability   8.   Hwang S, Lee SG, Belghiti  J. Liver transplantation  for HCC: its
                                                                 role: Eastern and Western perspectives. J Hepatobiliary Pancreat Sci
           of LLR to control disease while limiting postoperative   2010;17:443-8.
           abdominal  adhesion.  Because of the necessity  of   9.   Lau  WY, Leung  TW,  Yu SC, Ho SK.  Percutaneous local ablative
                              [60]
           careful maintenance of liver function and oncological   therapy  for hepatocellular  carcinoma:  a review  and look into  the
           control, LLR could  play an important role in treating   future. Ann Surg 2003;237:171-9.
           small  peripherally  located  HCC  in  patients  with   10.  Li D, Kang J, Golas BJ, Yeung VW, Madoff DC. Minimally invasive
                                                                 local therapies for liver cancer. Cancer Biol Med 2014;11:217-36.
           advanced  liver  cirrhosis. [51-53]  However, the effects of   11.  Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS,
           liver  resection  for HCC  on subsequent  suitability  for   Asbun H, OʼRourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O,
           liver transplantation are not well clarified.         Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton
                                                                 O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti
           CONCLUSION                                            LA, Cai X, Cleary S, Chen KH, Schön MR, Sugioka A, Tang CN,
                                                                 Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M,
                                                                 Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J,
           Existing evidence suggests that LLR is an important   Strasberg SM. Recommendations for laparoscopic liver resection: a
           alternative  treatment option  for HCC  in  patients  with   report from the second international  consensus  conference held in
           substantial liver cirrhosis, although this hypothesis will   Morioka. Ann Surg 2015;261:619-29.
           require further evaluation in future studies. Candidates   12.  Reich H, McGlynn F, DeCaprio J, Budin R. Laparoscopic excision of
                                                                 benign liver lesions. Obstet Gynecol 1991;78:956-8.
           for this procedure should be carefully evaluated. Use of   13.  Kaneko H, Takagi S, Shiba T. Laparoscopic partial hepatectomy and
           proper technique would maximize the benefits of LLR   left lateral segmentectomy: technique and results of a clinical series.
           and make it an ideal treatment option for this patient   Surgery 1996;120:468-75.
           subgroup.                                          14.  Kaneko H, Takagi S, Otsuka Y, Tsuchiya M, Tamura A, Katagiri T,
                                                                 Maeda  T, Shiba  T. Laparoscopic liver resection of hepatocellular
                                                                 carcinoma. Am J Surg 2005;189:190-4.
           Financial support and sponsorship                  15.  Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I,
           None.                                                 Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G,
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