Leaping the Boundaries in Laparoscopic Liver Surgery for Hepatocellular Carcinoma

Abstract

Simple Summary Recent advances in surgical techniques and perioperative management lead to a redefinition of the actual frontiers of Laparoscopic Liver Resection (LLR) by including patients with more advanced disease. Nonetheless, because of both underlying liver conditions and technical difficulty, LLR for Hepatocellular Carcinoma (HCC) is still considered as a challenging procedure. Specific concerns exist about LLR in cirrhotic patients, posterosuperior segments, giant and multiple tumors, as well as repeat resections. This review focuses on the specific limits of this approach in HCC patients in order to put into practice all the pre- and intra-operative precautions to overcome their boundaries, making this technique the standard of care within high-volume hepatobiliary centers. The minimally invasive approach for hepatocellular carcinoma (HCC) had a slower diffusion compared to other surgical fields, mainly due to inherent peculiarities regarding the risks of uncontrollable bleeding, oncological inadequacy, and the need for both laparoscopic and liver major skills. Recently, laparoscopic liver resection (LLR) has been associated with an improved postoperative course, including reduced postoperative decompensation, intraoperative blood losses, length of hospitalization, and unaltered oncological outcomes, leading to its adoption within international guidelines. However, LLR for HCC still faces several limitations, mainly linked to the impaired function of underlying parenchyma, tumor size and numbers, and difficult tumor position. The aim of this review is to highlight the state of the art and future perspectives of LLR for HCC, focusing on key points for overcoming currents limitations and pushing the boundaries in minimally invasive liver surgery (MILS).