Cassese Gianluca, Han Ho-Seong, Lee Boram, Lee Hae Won, Cho Jai Young, Troisi Roberto
Department of HPB Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
Minimally Invasive and Robotic HPB Surgery Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
Cancers (Basel). 2022 Apr 15;14(8):2012. doi: 10.3390/cancers14082012.
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).
与其他外科领域相比，肝细胞癌（HCC）的微创治疗方法传播较慢，主要是由于其在不可控出血风险、肿瘤学疗效欠佳以及需要腹腔镜和肝脏手术专业技能等方面存在固有特性。近年来，腹腔镜肝切除术（LLR）与术后恢复改善相关，包括术后失代偿减少、术中失血减少、住院时间缩短以及肿瘤学疗效不变，这使得它被纳入国际指南。然而，HCC的LLR仍面临一些限制，主要与肝实质功能受损、肿瘤大小和数量以及肿瘤位置困难有关。本综述的目的是强调HCC的LLR的现状和未来前景，重点关注克服当前限制以及推动微创肝脏手术（MILS）边界的关键点。
