Is Laparoscopic Liver Resection Safe and Comparable to Open Liver Resection for Hepatocellular Carcinoma?

Excerpt

The field of surgery has evolved to increasingly incorporate minimally invasive approaches. Although the use of laparoscopy gained rapid and widespread acceptance for the treatment of benign diseases such as biliary and gastroesophageal reflux diseases, its utility in the treatment of cancer has been more cautious due to initial concerns of compromising oncologic principles and fears of port-site recurrence. For colon cancer, a 10-year randomized clinical trial was conducted to compare laparoscopically assisted versus open colectomy, showing that the rates of recurrence were similar between the two groups and suggesting that the laparoscopic approach was an acceptable alternative to open resection for colon cancer.1 Liver surgery itself has evolved significantly with a better understanding of liver anatomical segments, enhanced imaging, improvements in anesthesia techniques including maintenance of low central pressures during liver mobilization and resection to prevent bleeding, and improved postoperative care and nursing. Minimally invasive liver resection is the next challenge; however, it has been slower to gain widespread acceptance, especially for cancer, due to concerns of compromising oncologic principles, uncontrollable hemorrhage, bile leakage, and air embolism.2 In addition, there has been lack of adequate training of liver surgeons in both open liver surgery and minimally invasive techniques. …