Laparoscopic Liver Surgery for the Management of Hepatocellular Carcinoma: The American Perspective

  • Kadiyala V. Ravindra
  • Joseph F. Buell


Despite better understanding and advances in oncology, the best available therapeutic option for the management of hepatocellular carcinoma (HCC) is surgical – either liver transplantation or resection. Liver transplantation appears most attractive since it treats the primary tumor and the field defect associated with the underlying liver disease. However, this option is feasible only when there are an adequate number of organs available and when the disease and patient meet certain stringent criteria. Most centers abide by the Milan criteria [1] to determine candidacy for liver transplantation. These are a single tumor ≦5 cm, two or three tumors all <3 cm, absence of major vascular invasion, and no extrahepatic disease. Unfortunately, only a minority of hepatoma patients fit these morphological parameters. Many other cirrhotic patients do not fulfill the requirements for transplantation due to comorbidity or psychosocial reasons.


Laparoscopic liver surgery Laparoscopic liver resection HCC Hepatic resection Patient selection 


  1. 1.
    Mazzaferro V, Regalia E, Doci R, et al (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334:693–699CrossRefPubMedGoogle Scholar
  2. 2.
    Yao FY, Ferrell L, Bass NM, et al (2001) Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 33:1394–1403CrossRefPubMedGoogle Scholar
  3. 3.
    Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Solbiati L, Gazelle GS, et al (1999) Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Radiology 210:655–661PubMedGoogle Scholar
  4. 4.
    Zhou XD, Tang ZY (1998) Cryotherapy for primary liver cancer. Semin Surg Oncol 14:171–174CrossRefPubMedGoogle Scholar
  5. 5.
    Shiina S, Tagawa K, Niwa Y, et al (1993) Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients. AJR Am J Roentgenol 160(5):1023–1028PubMedGoogle Scholar
  6. 6.
    Matsukawa T, Yamashita Y, Arakawa A, et al (1997) Percutaneous microwave coagulation therapy in liver tumors. A 3-year experience. Acta Radiol 38:410–415PubMedGoogle Scholar
  7. 7.
    Pacella CM, Bizzarri G, Guglielmi R, et al (2001) Laser thermal ablation in the treatment of small hepatocellular carcinoma: results in 74 patients. Radiology 221:712–720CrossRefPubMedGoogle Scholar
  8. 8.
    Llovet JM, Bruix J (2003) Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology 37:429–442CrossRefPubMedGoogle Scholar
  9. 9.
    Salem R, Lewandowski RJ, Atassi B, et al (2005) Treatment of unresectable hepatocellular carcinoma with use of 90Y microspheres (TheraSphere): safety, tumor response, and survival. J Vasc Interv Radiol 16:1627–1639PubMedGoogle Scholar
  10. 10.
    Lau H, Man K, Fan ST, Yu WC, Lo CM, Wong J (1997) Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy. Br J Surg 84:1255–1259CrossRefPubMedGoogle Scholar
  11. 11.
    Bryant R, Laurent A, Tayar C, et al (2008) Liver resection for hepatocellular carcinoma. Surg Oncol Clin N Am 17:607–633, ixCrossRefPubMedGoogle Scholar
  12. 12.
    Lau WY (1997) The history of liver surgery. J R Coll Surg Edinb 42:303–309PubMedGoogle Scholar
  13. 13.
    Buell JF, Thomas MT, Rudich S, et al (2008) Experience with more than 500 minimally invasive hepatic procedures. Ann Surg 248:475–486PubMedGoogle Scholar
  14. 14.
    Koffron AJ, Auffenberg G, Kung R, Abecassis M (2007) Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg 246:385–392CrossRefPubMedGoogle Scholar
  15. 15.
    Nguyen KT, Gamblin TC, Geller DA (2008) Laparoscopic liver resection for cancer. Future Oncol 4:661–670CrossRefPubMedGoogle Scholar
  16. 16.
    Vauthey JN, Chaoui A, Do KA, et al (2000) Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery 127:512–519CrossRefPubMedGoogle Scholar
  17. 17.
    Makuuchi M, Sano K (2004) The surgical approach to HCC: our progress and results in Japan. Liver Transpl 10(2 Suppl 1):S46–S52Google Scholar
  18. 18.
    Gigot JF, Glineur D, Santiago Azagra J, et al (2002) Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg 236:90–97CrossRefPubMedGoogle Scholar
  19. 19.
    Cherqui D, Laurent A, Tayar C, et al (2006) Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg 243:499–506CrossRefPubMedGoogle Scholar
  20. 20.
    Belli G, Fantini C, D’Agostino A, et al (2007) Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results. Surg Endosc 21:2004–2011CrossRefPubMedGoogle Scholar
  21. 21.
    Chen HY, Juan CC, Ker CG (2008) Laparoscopic liver surgery for patients with hepatocellular carcinoma. Ann Surg Oncol 15:800–806CrossRefPubMedGoogle Scholar
  22. 22.
    Poon RT (2007) Current role of laparoscopic surgery for liver malignancies. Surg Technol Int 16:73–81PubMedGoogle Scholar
  23. 23.
    Buell JF, Koffron AJ, Thomas MJ, et al (2005) Laparoscopic liver resection. J Am Coll Surg 200:472–480CrossRefPubMedGoogle Scholar
  24. 24.
    Santambrogio R, Aldrighetti L, Barabino M, et al (2009) Laparoscopic liver resections for hepatocellular carcinoma. Is it a feasible option for patients with liver cirrhosis? Langenbecks Arch Surg 394:255–264CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Kadiyala V. Ravindra
    • 1
  • Joseph F. Buell
    • 2
  1. 1.Department of SurgeryDuke University Medical CenterDurhamUSA
  2. 2.Surgery and PediatricsAbdominal Transplant Institute, Hepatobiliary Surgery and Oncology, Tulane UniversityNew OrleansUSA

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