Current status of radical laparoscopy for treating hepatocellular carcinoma with portal hypertension

Abstract

The laparoscopic technique is clinically effective in treating hepatocellular carcinoma (HCC) with portal hypertension (PHT). However, existing studies lack systematic arrangement and induction. Here, we review the latest research advancement in laparoscopic technique for treatment of HCC with PHT, based on published literature and our single-institution experience. Our single-center experience reveals no statistical difference in both short- and long-term prognosis of HCC patients after laparoscopic liver resection (LLR), regardless of whether they suffer from PHT, which is consistent with previous studies on the use of LLR for HCC with PHT. Retrieval outcomes indicate existence of short- and long-term prognostic superiority, following laparoscopic treatment, relative to non-laparoscopic treatment. Besides that, LLR offers long-term prognostic advantage compared to laparoscopic radiofrequency ablation. In addition, we review the previous literature and propose corresponding perspectives on the therapy of hypersplenism, the utilization of Pringle maneuver, and the adoption of anatomical hepatectomy during radical laparoscopic treatment. HCC with PHT is not the "forbidden zone" of radical laparoscopic treatment. However, patients’ preoperative liver function should be adequately estimated.

Laparoscopic versus open repeat hepatectomy for recurrent hepatocellular carcinoma: a systematic review and meta-analysis of propensity score-matched cohort studies

“…In the surgical outcomes, LRH had less estimated blood loss and shorter operation time than ORH. The first likely reason for this difference is that high-definition magnification of the field of view of the laparoscope helps the operator identify the bile ducts and blood vessels, which reduces intraoperative injury of these structures 25 , 26 . The second likely reason is that the pneumoperitoneum of laparoscopy tightens the adhesive zone and facilitates the exposure of the surgical field; moreover, the relatively high pressure may reduce bleeding from the hepatic vein 27 .…”

Efficacy of radiofrequency ablation combined with sorafenib for treating liver cancer complicated with portal hypertension and prognostic factors

“…The condition of patients suffering from liver cancer complicated with portal hypertension is relatively complex, and since there are no obvious symptoms in the initial stages, most patients visit the hospital when they are typically already in the middle or late stages and have missed the best time for surgical treatment. Moreover, patients suffering from liver cancer complicated with portal hypertension are in poor physical condition and cannot tolerate surgical operation[ 3 , 4 ]. The treatment principle of radiofrequency ablation (RFA) is to increase the temperature of liver tissue to > 60°C and maintain it at that temperature for a certain time to cause degeneration and irreversible necrosis of cellular proteins.…”

Laparoscopic hepatectomy for hepatocellular carcinoma in patients with clinically significant portal hypertension: a systematic review and meta-analysis

“…Cirrhosis is currently considered the main precancerous lesion of primary HCC, and cirrhotic patients with clinically significant portal hypertension (CSPH) are more likely to develop HCC [ 3 ]. Due to the dearth of efficient radical treatments, the long-term prognosis of HCC patients with CSPH is poor, with a 5-year overall survival (OS) being less than 50% [ 4 ]. Up to now, there has been no uniform guideline for the treatment of HCC with CSPH due to the complex conditions of the patients and the great difficulty of the surgery.…”