A narrative review of minimally invasive liver resections for hepatocellular carcinoma

: Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver and the third leading cause of cancer-related deaths worldwide. Liver resection has been widely accepted as the mainstay of HCC treatment, leading to long-term survival in well-selected patients. Over the last two decades, laparoscopic liver resection (LLR) has developed worldwide parallel to technological advancements and increased experience of liver surgeons. Several meta-analyses revealed that LLR for HCC has yielded better short-term outcomes without compromising long-term outcomes, compared to open liver resection (OLR). During treatment of HCC patients with chronic liver disease or liver cirrhosis, LLR decreases blood loss and postoperative complications including refractory ascites, leading to a shorter hospital stay. In the treatment of recurrent HCC, LLR makes subsequent procedures easier by minimizing adhesion formation. The procedure of laparoscopic major liver resection (major LLR) is yet to be standardized and is still in exploration stage according to the Morioka international conference, 2014. Laparoscopic parenchyma-sparing anatomical liver resection (Lap-PSAR) is a novel surgical strategy to resect all malignant tissues while preserving enough liver parenchyma to prevent postoperative liver failure. In conclusion, LLR has many advantages for the treatment of HCC patients and generally results in better short-term outcomes. Further investigations are needed to standardize the procedures of major LLR and Lap-PSAR.