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Table 3. Studies comparing long-term outcomes of laparoscopic and open liver resection for HCC
3-year 5-year Overall and
Study Type 1-year survival 1-year DFS 3-year DFS 5-year DFS
survival survival DFS
Parks et al. [36] Meta-analysis L - 92% L - 77.7% L - 61.9% NA NA NA NA
(2014) O - 91.3% O - 76.5% O - 56.5%
Kim et al. [37] Case matched L - 100% L - 100% L - 92.2% L - 81.7% L - 61.7% L - 54% NSD
(2014) with PSM O - 96.5% O - 92.2% O - 87.7% O - 78.6% O - 60.9% O - 40.1%
Han et al. [38] Case matched L - 91.6% L - 87.5% L - 76.4% L - 69.7% L - 52% L - 44.2% NSD
(2015) with PSM O - 93.1% O - 87.8% O - 73.2% O - 74.7% O - 49.5% O - 41.2%
Takahara et al. [39] Case matched L - 95.8% L - 86.2% L - 76.8% L - 83.7% L - 58.3% L - 40.7% NSD
(2015) with PSM O - 95.8% O - 84% O - 70.9% O - 79.6% O - 50.4% O - 39.3%
HCC: hepatocellular carcinoma; DFS: disease free survival; PSM: propensity score matching; L: laparoscopic liver resection; O: open liver
resection; NSD: no significant difference; NA: not available

considered standard approaches. Major laparoscopic hepatectomy has been shown to be feasible and
safe at few select experienced centers. Few meta-analyses have shown that LLR is better than OLR with
better short-term and cosmetic outcomes. Long-term oncologic and survival outcomes have been found
to be similar to open liver resection in case-matched studies. Although LLR has a steep learning curve,
indications for it are expanding fast with advances in laparoscopic techniques and skills.

CONCLUSION
LLR is a safe and effective approach to liver surgery for well selected patients in the hands of well trained
surgeons with experience in hepatobilliary and laparoscopic surgery. The current scientific support in its
favour is limited to case series, expert consensus recommendations, guidelines, meta-analyses with very
few matched controlled studies and a single randomised controlled trial.

The learning curve is still a problem.

Randomized trials and structured training will help benefit more patients with the advancement in this
technique.

DECLARATIONS
Authors’ contributions
Wrote part of the article: Golhar A, Rao P
Wrote part of the article and reviewed: Nikam V
Conceptualized the article, researched and wrote the outline and part of the article: Mohanka R

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.