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Cancers
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Advances in Minimally Invasive Liver Resection for Cancer Therapies
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Advances in Minimally Invasive Liver Resection for Cancer Therapies

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (1 May 2023) | Viewed by 23629

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editor

Prof. Dr. Zenichi Morise

E-Mail Website
Guest Editor
Department of Surgery, School of Medicine, Fujita Health University Okazaki Medical Center , 1 Gotanda Harisakicho, Okazaki, Aichi 444-0827, Japan
Interests: liver resection; laparoscopic liver resection; hepatocellular carcinoma; liver metastasis; chemotherapy (neoadjuvant, induction); liver venoocclusive disease; anus neoplasms; intensity modulated radiation therapy; chemoradiotherapy

Special Issue Information

Dear Colleagues, 

For the initial 30 years after the first report of laparoscopic liver resection (LLR) in 1991, minimally invasive liver resection has been developing rapidly with less invasiveness (especially for patients with deteriorated liver function). Resections in anterolateral segments (segments 2, 3, 4a, 5, 6) and left lateral sectionectomy are now common procedures. Left and right hemi-hepatectomies are often performed, and sectionectomies of left median, right anterior and posterior are also now common procedures in many centers. Partial resection and segmentectomies in posterosuperior segments (segments 1, 4b, 7, 8), repeat LLR and combinations of small anatomical resection and hepatic vein-guided resection are now being established as common generalized approaches that many centers can adapt to common practice.

Preoperative simulation and intraoperative navigation with/without anatomical resections (CT-based simulation, US-guided navigation, ICG/florescence-guided navigation for anatomical boundary and tumor localization, etc.) are now under investigation. Though liver cancers of metastasis (mainly colorectal origin), hepatocellular carcinoma, and intrahepatic cholangiocellular carcinoma are the main indications for LLR besides benign diseases, its use in biliary tract cancers, including gallbladder carcinoma and perihilar carcinoma with bile duct/vascular resection/reconstruction, are now under discussion. The advantages/disadvantages and indications of robot-assisted liver resection compared to usual LLR should be investigated. Furthermore, re-evaluations and discussions of the results from currently performing LLR should be done.

This Special Issue of Cancers is dedicated to clarifying the above-listed points with the aim of stimulating further discussion and taking further steps in implementing minimally invasive liver resection as a cancer therapy.

Prof. Dr. Zenichi Morise
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • laparoscopic liver resection
  • minimally invasive liver resection
  • deteriorated liver function
  • anatomical resection
  • preoperative simulation
  • intraoperative navigation
  • liver metastasis
  • hepatocellular carcinoma biliary tract cancers
  • robot-assisted liver resection

Published Papers (14 papers)

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Editorial

Jump to: Research, Review, Other

4 pages, 476 KiB  
Editorial
Editorial (Preface) for the Special Issue on Advances in Minimally Invasive Liver Resection for Cancer Therapies
by Zenichi Morise
Cancers 2023, 15(13), 3520; https://doi.org/10.3390/cancers15133520 - 6 Jul 2023
Viewed by 758
Abstract
After the initial reports of laparoscopic liver resection (LLR) in the early 1990s, minimally invasive liver resection has been rapidly developing based on technical and instrumental improvements [...] Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Liver Resection for Cancer Therapies)
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Research

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12 pages, 900 KiB  
Article
Laparoscopic Right Hemihepatectomy after Future Liver Remnant Modulation: A Single Surgeon’s Experience
by Tijs J. Hoogteijling, Jasper P. Sijberden, John N. Primrose, Victoria Morrison-Jones, Sachin Modi, Giuseppe Zimmitti, Marco Garatti, Claudio Sallemi, Mario Morone and Mohammad Abu Hilal
Cancers 2023, 15(10), 2851; https://doi.org/10.3390/cancers15102851 - 21 May 2023
Viewed by 1572
Abstract
Background: Laparoscopic right hemihepatectomy (L-RHH) is still considered a technically complex procedure, which should only be performed by experienced surgeons in specialized centers. Future liver remnant modulation (FLRM) strategies, including portal vein embolization (PVE), and associating liver partition and portal vein ligation for [...] Read more.
Background: Laparoscopic right hemihepatectomy (L-RHH) is still considered a technically complex procedure, which should only be performed by experienced surgeons in specialized centers. Future liver remnant modulation (FLRM) strategies, including portal vein embolization (PVE), and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), might increase the surgical difficulty of L-RHH, due to the distortion of hepatic anatomy, periportal inflammation, and fibrosis. Therefore, this study aims to evaluate the safety and feasibility of L-RHH after FLRM, when compared with ex novo L-RHH. Methods: All consecutive right hemihepatectomies performed by a single surgeon in the period between October 2007 and March 2023 were retrospectively analyzed. The patient characteristics and perioperative outcomes of L-RHH after FLRM and ex novo L-RHH were compared. Results: A total of 59 patients were included in the analysis, of whom 33 underwent FLRM. Patients undergoing FLRM prior to L-RHH were most often male (93.9% vs. 42.3%, p < 0.001), had an ASA-score >2 (45.5% vs. 9.5%, p = 0.006), and underwent a two-stage hepatectomy (45.5% vs. 3.8% p < 0.001). L-RHH after FLRM was associated with longer operative time (median 360 vs. 300 min, p = 0.008) and Pringle duration (31 vs. 24 min, p = 0.011). Intraoperative blood loss, unfavorable intraoperative incidents, and conversion rates were similar in both groups. There were no significant differences in length of hospital stay and 30-day overall and severe morbidity rates. Radical resection margin (R0) and textbook outcome rates were equal. One patient who underwent an extended RHH in the FLRM group deceased within 90 days of surgery, due to post-hepatectomy liver failure. Conclusion: L-RHH after FLRM is more technically complex than L-RHH ex novo, as objectified by longer operative time and Pringle duration. Nevertheless, this procedure appears safe and feasible in experienced hands. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Liver Resection for Cancer Therapies)
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14 pages, 827 KiB  
Article
Surgical and Oncological Outcomes of Salvage Hepatectomy for Locally Recurrent Hepatocellular Carcinoma after Locoregional Therapy: A Single-Institution Experience
by Takuya Minagawa, Osamu Itano, Minoru Kitago, Yuta Abe, Hiroshi Yagi, Taizo Hibi, Masahiro Shinoda, Hidenori Ojima, Michiie Sakamoto and Yuko Kitagawa
Cancers 2023, 15(8), 2320; https://doi.org/10.3390/cancers15082320 - 16 Apr 2023
Viewed by 1301
Abstract
Surgical and oncological outcomes of hepatectomy for recurrent hepatocellular carcinoma (HCC) after locoregional therapy, including locally recurrent HCC (LR-HCC), were examined. Among 273 consecutive patients who underwent hepatectomy for HCC, 102 with recurrent HCC were included and retrospectively reviewed. There were 35 patients [...] Read more.
Surgical and oncological outcomes of hepatectomy for recurrent hepatocellular carcinoma (HCC) after locoregional therapy, including locally recurrent HCC (LR-HCC), were examined. Among 273 consecutive patients who underwent hepatectomy for HCC, 102 with recurrent HCC were included and retrospectively reviewed. There were 35 patients with recurrent HCC after primary hepatectomy and 67 with recurrent HCC after locoregional therapies. Pathologic review revealed 30 patients with LR-HCC. Background liver function was significantly worse in patients with recurrent HCC after locoregional therapy (p = 0.002). AFP (p = 0.031) and AFP-L3 (p = 0.033) serum levels were significantly higher in patients with LR-HCC. Perioperative morbidities were significantly more frequently observed with recurrent HCC after locoregional therapies (p = 0.048). Long-term outcomes of recurrent HCC after locoregional therapies were worse than those after hepatectomy, though there was no prognostic difference according to the recurrence patterns after locoregional therapies. Multivariate analyses showed that prognostic factors for resected recurrent HCC were previous locoregional therapy (hazard ratio [HR] 2.0; p = 0.005), multiple HCCs (HR 2.8; p < 0.001), and portal venous invasion (HR 2.3; p = 0.001). LR-HCC was not a prognostic factor. In conclusion, salvage hepatectomy for LR-HCC showed worse surgical outcomes but a favorable prognosis. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Liver Resection for Cancer Therapies)
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20 pages, 1918 KiB  
Article
Minimally Invasive Anatomic Liver Resection for Hepatocellular Carcinoma Using the Extrahepatic Glissonian Approach: Surgical Techniques and Comparison of Outcomes with the Open Approach and between the Laparoscopic and Robotic Approaches
by Yutaro Kato, Atsushi Sugioka, Masayuki Kojima, Satoshi Mii, Yuichiro Uchida, Hideaki Iwama, Takuya Mizumoto, Takeshi Takahara and Ichiro Uyama
Cancers 2023, 15(8), 2219; https://doi.org/10.3390/cancers15082219 - 9 Apr 2023
Cited by 4 | Viewed by 1754
Abstract
Surgical techniques and outcomes of minimally invasive anatomic liver resection (AR) using the extrahepatic Glissonian approach for hepatocellular carcinoma (HCC) are undefined. In 327 HCC cases undergoing 185 open (OAR) and 142 minimally invasive (MIAR; 102 laparoscopic and 40 robotic) ARs, perioperative and [...] Read more.
Surgical techniques and outcomes of minimally invasive anatomic liver resection (AR) using the extrahepatic Glissonian approach for hepatocellular carcinoma (HCC) are undefined. In 327 HCC cases undergoing 185 open (OAR) and 142 minimally invasive (MIAR; 102 laparoscopic and 40 robotic) ARs, perioperative and long-term outcomes were compared between the approaches, using propensity score matching. After matching (91:91), compared to OAR, MIAR was significantly associated with longer operative time (643 vs. 579 min, p = 0.028); less blood loss (274 vs. 955 g, p < 0.0001); a lower transfusion rate (17.6% vs. 47.3%, p < 0.0001); lower rates of major 90-day morbidity (4.4% vs. 20.9%, p = 0.0008), bile leak or collection (1.1% vs. 11.0%, p = 0.005), and 90-day mortality (0% vs. 4.4%, p = 0.043); and shorter hospital stay (15 vs. 29 days, p < 0.0001). On the other hand, laparoscopic and robotic AR cohorts after matching (31:31) had comparable perioperative outcomes. Overall and recurrence-free survivals after AR for newly developed HCC were comparable between OAR and MIAR, with potentially improved survivals in MIAR. The survivals were comparable between laparoscopic and robotic AR. MIAR was technically standardized using the extrahepatic Glissonian approach. MIAR was safe, feasible, and oncologically acceptable and would be the first choice of AR in selected HCC patients. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Liver Resection for Cancer Therapies)
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9 pages, 4948 KiB  
Communication
Latest Findings on Minimally Invasive Anatomical Liver Resection
by Yoshiki Fujiyama, Taiga Wakabayashi, Kohei Mishima, Malek A. Al-Omari, Marco Colella and Go Wakabayashi
Cancers 2023, 15(8), 2218; https://doi.org/10.3390/cancers15082218 - 9 Apr 2023
Cited by 3 | Viewed by 1454
Abstract
Minimally invasive liver resection (MILR) is being widely utilized owing to recent advancements in laparoscopic and robot-assisted surgery. There are two main types of liver resection: anatomical (minimally invasive anatomical liver resection (MIALR)) and nonanatomical. MIALR is defined as a minimally invasive liver [...] Read more.
Minimally invasive liver resection (MILR) is being widely utilized owing to recent advancements in laparoscopic and robot-assisted surgery. There are two main types of liver resection: anatomical (minimally invasive anatomical liver resection (MIALR)) and nonanatomical. MIALR is defined as a minimally invasive liver resection along the respective portal territory. Optimization of the safety and precision of MIALR is the next challenge for hepatobiliary surgeons, and intraoperative indocyanine green (ICG) staining is considered to be of considerable importance in this field. In this article, we present the latest findings on MIALR and laparoscopic anatomical liver resection using ICG at our hospital. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Liver Resection for Cancer Therapies)
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15 pages, 2638 KiB  
Article
Safety and Feasibility of Laparoscopic Parenchymal-Sparing Hepatectomy for Lesions with Proximity to Major Vessels in Posterosuperior Liver Segments 7 and 8
by Hirokatsu Katagiri, Hiroyuki Nitta, Syoji Kanno, Akira Umemura, Daiki Takeda, Taro Ando, Satoshi Amano and Akira Sasaki
Cancers 2023, 15(7), 2078; https://doi.org/10.3390/cancers15072078 - 30 Mar 2023
Cited by 1 | Viewed by 1132
Abstract
Laparoscopic parenchymal-sparing hepatectomy (PSH) for lesions with proximity to major vessels (PMV) in posterosuperior segments (PSS) has not yet been sufficiently examined. The aim of this study is to examine the safety and feasibility of laparoscopic PSH for lesions with PMV in PSS [...] Read more.
Laparoscopic parenchymal-sparing hepatectomy (PSH) for lesions with proximity to major vessels (PMV) in posterosuperior segments (PSS) has not yet been sufficiently examined. The aim of this study is to examine the safety and feasibility of laparoscopic PSH for lesions with PMV in PSS 7 and 8. We retrospectively reviewed the outcomes of laparoscopic liver resection (LLR) and open liver resection (OLR) for PSS lesions and focused on patients who underwent laparoscopic PSH for lesions with PMV in PSS. Blood loss was lower in the LLR group (n = 110) than the OLR group (n = 16) (p = 0.009), and no other short-term outcomes were significantly different. Compared to the pure LLR group (n = 93), there were no positive surgical margins or complications in hand-assisted laparoscopic surgery (HALS) (n = 17), despite more tumors with PMV (p = 0.009). Regarding pure LLR for one tumor lesion, any short-term outcomes in addition to the operative time were not significantly different between the PMV (n = 23) and no-PMV (n = 48) groups. The present findings indicate that laparoscopic PSH for lesions with PMV in PSS is safe and feasible in a matured team, and the HALS technique still plays an important role. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Liver Resection for Cancer Therapies)
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15 pages, 474 KiB  
Article
Conversion of Minimally Invasive Liver Resection for HCC in Advanced Cirrhosis: Clinical Impact and Role of Difficulty Scoring Systems
by Federica Cipriani, Francesca Ratti, Gianluca Fornoni, Rebecca Marino, Antonella Tudisco, Marco Catena and Luca Aldrighetti
Cancers 2023, 15(5), 1432; https://doi.org/10.3390/cancers15051432 - 23 Feb 2023
Cited by 4 | Viewed by 1209
Abstract
Background: Minimally invasive liver resections (MILRs) in cirrhosis are at risk of conversion since cirrhosis and complexity, which can be estimated by scoring systems, are both independent factors for. We aimed to investigate the consequence of conversion of MILR for hepatocellular carcinoma in [...] Read more.
Background: Minimally invasive liver resections (MILRs) in cirrhosis are at risk of conversion since cirrhosis and complexity, which can be estimated by scoring systems, are both independent factors for. We aimed to investigate the consequence of conversion of MILR for hepatocellular carcinoma in advanced cirrhosis. Methods: After retrospective review, MILRs for HCC were divided into preserved liver function (Cohort-A) and advanced cirrhosis cohorts (Cohort-B). Completed and converted MILRs were compared (Compl-A vs. Conv-A and Compl-B vs. Conv-B); then, converted patients were compared (Conv-A vs. Conv-B) as whole cohorts and after stratification for MILR difficulty using Iwate criteria. Results: 637 MILRs were studied (474 Cohort-A, 163 Cohort-B). Conv-A MILRs had worse outcomes than Compl-A: more blood loss; higher incidence of transfusions, morbidity, grade 2 complications, ascites, liver failure and longer hospitalization. Conv-B MILRs exhibited the same worse perioperative outcomes than Compl-B and also higher incidence of grade 1 complications. Conv-A and Conv-B outcomes of low difficulty MILRs resulted in similar perioperative outcomes, whereas the comparison of more difficult converted MILRs (intermediate/advanced/expert) resulted in several worse perioperative outcomes for patients with advanced cirrhosis. However, Conv-A and Conv-B outcomes were not significantly different in the whole cohort where “advanced/expert” MILRs were 33.1% and 5.5% in Cohort A and B. Conclusions: Conversion in the setting of advanced cirrhosis can be associated with non-inferior outcomes compared to compensated cirrhosis, provided careful patient selection is applied (patients elected to low difficulty MILRs). Difficulty scoring systems may help in identifying the most appropriate candidates. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Liver Resection for Cancer Therapies)
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10 pages, 541 KiB  
Article
An International Retrospective Observational Study of Liver Functional Deterioration after Repeat Liver Resection for Patients with Hepatocellular Carcinoma
by Zenichi Morise, Luca Aldrighetti, Giulio Belli, Francesca Ratti, Tan To Cheung, Chung Mau Lo, Shogo Tanaka, Shoji Kubo, Yukiyasu Okamura, Katsuhiko Uesaka, Kazuteru Monden, Hiroshi Sadamori, Kazuki Hashida, Kazuyuki Kawamoto, Naoto Gotohda, KuoHsin Chen, Akishige Kanazawa, Yutaka Takeda, Yoshiaki Ohmura, Masaki Ueno, Toshiro Ogura, Kyung Suk Suh, Yutaro Kato, Atsushi Sugioka, Andrea Belli, Hiroyuki Nitta, Masafumi Yasunaga, Daniel Cherqui, Nasser Abdul Halim, Alexis Laurent, Hironori Kaneko, Yuichiro Otsuka, Ki Hun Kim, Hwui-Dong Cho, Charles Chung-Wei Lin, Yusuke Ome, Yasuji Seyama, Roberto I. Troisi, Giammauro Berardi, Fernando Rotellar, Gregory C. Wilson, David A. Geller, Olivier Soubrane, Tomoaki Yoh, Takashi Kaizu, Yusuke Kumamoto, Ho-Seong Han, Ela Ekmekcigil, Ibrahim Dagher, David Fuks, Brice Gayet, Joseph F. Buell, Ruben Ciria, Javier Briceno, Nicholas O’Rourke, Joel Lewin, Bjorn Edwin, Masahiro Shinoda, Yuta Abe, Mohammed Abu Hilal, Mohammad Alzoubi, Minoru Tanabe and Go Wakabayashiadd Show full author list remove Hide full author list
Cancers 2022, 14(11), 2598; https://doi.org/10.3390/cancers14112598 - 24 May 2022
Cited by 4 | Viewed by 2476
Abstract
Whether albumin and bilirubin levels, platelet counts, ALBI, and ALPlat scores could be useful for the assessment of permanent liver functional deterioration after repeat liver resection was examined, and the deterioration after laparoscopic procedure was evaluated. For 657 patients with liver resection of [...] Read more.
Whether albumin and bilirubin levels, platelet counts, ALBI, and ALPlat scores could be useful for the assessment of permanent liver functional deterioration after repeat liver resection was examined, and the deterioration after laparoscopic procedure was evaluated. For 657 patients with liver resection of segment or less in whom results of plasma albumin and bilirubin levels and platelet counts before and 3 months after surgery could be retrieved, liver functional indicators were compared before and after surgery. There were 268 patients who underwent open repeat after previous open liver resection, and 224 patients who underwent laparoscopic repeat after laparoscopic liver resection. The background factors, liver functional indicators before and after surgery and their changes were compared between both groups. Plasma levels of albumin (p = 0.006) and total bilirubin (p = 0.01) were decreased, and ALBI score (p = 0.001) indicated worse liver function after surgery. Laparoscopic group had poorer preoperative performance status and liver function. Changes of liver functional values before and after surgery and overall survivals were similar between laparoscopic and open groups. Plasma levels of albumin and bilirubin and ALBI score could be the indicators for permanent liver functional deterioration after liver resection. Laparoscopic group with poorer conditions showed the similar deterioration of liver function and overall survivals to open group. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Liver Resection for Cancer Therapies)
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Review

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11 pages, 1750 KiB  
Review
Minimally Invasive ALPPS Procedure: A Review of Feasibility and Short-Term Outcomes
by Luigi Cioffi, Giulio Belli, Francesco Izzo, Corrado Fantini, Alberto D’Agostino, Gianluca Russo, Renato Patrone, Vincenza Granata and Andrea Belli
Cancers 2023, 15(6), 1700; https://doi.org/10.3390/cancers15061700 - 10 Mar 2023
Cited by 1 | Viewed by 1474
Abstract
Background: Associated liver partition with portal vein ligation for staged hepatectomy (ALPPS) represents a recent strategy to improve resectability of extensive hepatic malignancies. Recent surgical advances, such as the application of technical variants and use of a mini-invasive approach (MI-ALPPS), have been proposed [...] Read more.
Background: Associated liver partition with portal vein ligation for staged hepatectomy (ALPPS) represents a recent strategy to improve resectability of extensive hepatic malignancies. Recent surgical advances, such as the application of technical variants and use of a mini-invasive approach (MI-ALPPS), have been proposed to improve clinical outcomes in terms of morbidity and mortality. Methods: A total of 119 MI-ALPPS cases from 6 series were identified and discussed to evaluate the feasibility of the procedure and short-term clinical outcomes. Results: Hepatocellular carcinoma were widely the most common indication for MI-ALPPS. The median estimated blood loss was 260 mL during Stage 1 and 1625 mL in Stage 2. The median length of the procedures was 230 min in Stage 1 and 184 in Stage 2. The median increase ratio of future liver remnant volume was 87.8%. The median major morbidity was 8.14% in Stage 1 and 23.39 in Stage 2. The mortality rate was 0.6%. Conclusions: MI-ALPPS appears to be a feasible and safe procedure, with potentially better short-term outcomes in terms of blood loss, morbidity, and mortality rate if compared with those of open series. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Liver Resection for Cancer Therapies)
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12 pages, 1186 KiB  
Review
Multiple Laparoscopic Liver Resection for Colorectal Liver Metastases
by Alexandra Nassar, Stylianos Tzedakis, Alix Dhote, Marie Strigalev, Romain Coriat, Mehdi Karoui, Anthony Dohan, Martin Gaillard, Ugo Marchese and David Fuks
Cancers 2023, 15(2), 435; https://doi.org/10.3390/cancers15020435 - 10 Jan 2023
Viewed by 1885
Abstract
Over the past decades, liver cancer’s minimally invasive approach has primarily become as a new standard of oncological care. Colorectal liver metastases (CRLM) are one of the most developed indications of laparoscopic liver resection (LLR). CRLM resection is still the best treatment known [...] Read more.
Over the past decades, liver cancer’s minimally invasive approach has primarily become as a new standard of oncological care. Colorectal liver metastases (CRLM) are one of the most developed indications of laparoscopic liver resection (LLR). CRLM resection is still the best treatment known in terms of survival. As multiple CRLM are found in up to 80% of cases at diagnosis (Manfredi S. and al, Annals of Surgery 2006), a lot of possible technical management approaches are described. With the development of the parenchymal-sparing strategy, multiple concomitant laparoscopic liver resections (LLR) are gaining acceptance. However, no recommendation is available regarding its indications and feasibility. Also, laparoscopic two-stage hepatectomy is developing for bilobar CRLM, and this also does not have established recommendation. The purpose of this paper was to highlight novelty and updates in the field of multiple minimally invasive liver resections. A review of the international literature was performed. The feasibility of laparoscopic concomitant multiple LLR and two-stage hepatectomy for CRLM as well as their outcomes were discussed. These clarifications could further guide the implementation of minimal resection in multiple colorectal liver metastases therapies. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Liver Resection for Cancer Therapies)
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15 pages, 415 KiB  
Review
Recent Advances in Minimally Invasive Liver Resection for Colorectal Cancer Liver Metastases—A Review
by Winifred M. Lo, Samer T. Tohme and David A. Geller
Cancers 2023, 15(1), 142; https://doi.org/10.3390/cancers15010142 - 26 Dec 2022
Cited by 3 | Viewed by 1755
Abstract
Minimally invasive surgical (MIS) approaches to liver resection have been increasingly adopted into use for surgery on colorectal cancer liver metastases. The purpose of this review is to evaluate the outcomes when comparing laparoscopic liver resection (LLR), robotic liver resection (RLR), and open [...] Read more.
Minimally invasive surgical (MIS) approaches to liver resection have been increasingly adopted into use for surgery on colorectal cancer liver metastases. The purpose of this review is to evaluate the outcomes when comparing laparoscopic liver resection (LLR), robotic liver resection (RLR), and open liver resection (OLR) for colorectal cancer liver metastases (CRLM) in 39 studies (2009–2022) that include a case-matched series, propensity score analyses, and three randomized clinical trials. LLR is associated with less intraoperative blood loss and shorter hospital stay compared with OLR. LLR can be performed with comparable operative time. LLR has similar rates of perioperative complications and mortality as OLR. There were no significant differences in 5-year overall or disease-free survival between approaches. Robotic liver resection (RLR) has comparable perioperative safety to LLR and may improve rates of R0 resection in certain patients. Finally, MIS approaches to the hepatic resection of CRLM reduce the time from liver resection to initiation of adjuvant chemotherapy. Thus, MIS liver surgery should be considered in the array of options for patients with CRLM, though thoughtful patient selection and surgeon experience should be part of that decision. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Liver Resection for Cancer Therapies)
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14 pages, 2443 KiB  
Review
Leaping the Boundaries in Laparoscopic Liver Surgery for Hepatocellular Carcinoma
by Gianluca Cassese, Ho-Seong Han, Boram Lee, Hae Won Lee, Jai Young Cho and Roberto Troisi
Cancers 2022, 14(8), 2012; https://doi.org/10.3390/cancers14082012 - 15 Apr 2022
Cited by 11 | Viewed by 2491
Abstract
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 [...] Read more.
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). Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Liver Resection for Cancer Therapies)
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Other

17 pages, 675 KiB  
Systematic Review
Challenging Scenarios and Debated Indications for Laparoscopic Liver Resections for Hepatocellular Carcinoma
by Giammauro Berardi, Edoardo Maria Muttillo, Marco Colasanti, Germano Mariano, Roberto Luca Meniconi, Stefano Ferretti, Nicola Guglielmo, Marco Angrisani, Alessio Lucarini, Eleonora Garofalo, Davide Chiappori, Ludovica Di Cesare, Damiano Vallati, Paolo Mercantini and Giuseppe Maria Ettorre
Cancers 2023, 15(5), 1493; https://doi.org/10.3390/cancers15051493 - 27 Feb 2023
Cited by 9 | Viewed by 1580
Abstract
Laparoscopic liver resections (LLRs) have been increasingly adopted for the treatment of hepatocellular carcinoma (HCC), with safe short- and long-term outcomes reported worldwide. Despite this, lesions in the posterosuperior segments, large and recurrent tumors, portal hypertension, and advanced cirrhosis currently represent challenging scenarios [...] Read more.
Laparoscopic liver resections (LLRs) have been increasingly adopted for the treatment of hepatocellular carcinoma (HCC), with safe short- and long-term outcomes reported worldwide. Despite this, lesions in the posterosuperior segments, large and recurrent tumors, portal hypertension, and advanced cirrhosis currently represent challenging scenarios in which the safety and efficacy of the laparoscopic approach are still controversial. In this systematic review, we pooled the available evidence on the short-term outcomes of LLRs for HCC in challenging clinical scenarios. All randomized and non-randomized studies reporting LLRs for HCC in the above-mentioned settings were included. The literature search was run in the Scopus, WoS, and Pubmed databases. Case reports, reviews, meta-analyses, studies including fewer than 10 patients, non-English language studies, and studies analyzing histology other than HCC were excluded. From 566 articles, 36 studies dated between 2006 and 2022 fulfilled the selection criteria and were included in the analysis. A total of 1859 patients were included, of whom 156 had advanced cirrhosis, 194 had portal hypertension, 436 had large HCCs, 477 had lesions located in the posterosuperior segments, and 596 had recurrent HCCs. Overall, the conversion rate ranged between 4.6% and 15.5%. Mortality and morbidity ranged between 0.0% and 5.1%, and 18.6% and 34.6%, respectively. Full results according to subgroups are described in the study. Advanced cirrhosis and portal hypertension, large and recurrent tumors, and lesions located in the posterosuperior segments are challenging clinical scenarios that should be carefully approached by laparoscopy. Safe short-term outcomes can be achieved provided experienced surgeons and high-volume centers. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Liver Resection for Cancer Therapies)
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13 pages, 1436 KiB  
Perspective
Positioning of Minimally Invasive Liver Surgery for Hepatocellular Carcinoma: From Laparoscopic to Robot-Assisted Liver Resection
by Shogo Tanaka, Shoji Kubo and Takeaki Ishizawa
Cancers 2023, 15(2), 488; https://doi.org/10.3390/cancers15020488 - 12 Jan 2023
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Abstract
Laparoscopic liver resection (LLR) is widely accepted in the surgical treatment of hepatocellular carcinoma (HCC) through international consensus conferences and the development of difficulty classifications. LLR has been reported to result in earlier postoperative recovery and fewer postoperative complications than open liver resection [...] Read more.
Laparoscopic liver resection (LLR) is widely accepted in the surgical treatment of hepatocellular carcinoma (HCC) through international consensus conferences and the development of difficulty classifications. LLR has been reported to result in earlier postoperative recovery and fewer postoperative complications than open liver resection (OLR) for HCC. However, the prevalence of liver cirrhosis, obesity, the elderly, HCC recurrence (repeat liver resection), and major resection must be considered for LLR for HCC. Some systematic reviews, meta-analysis studies, and large cohort studies indicated that LLR is technically feasible for selected patients with HCC with these factors that led to less intraoperative blood loss, fewer transfusions and postoperative complication incidences, and shorter hospital stays than OLR. Furthermore, some reported LLR prevents postoperative loss of independence. No difference was reported in long-term outcomes among patients with HCC who underwent LLR and OLR; however, some recent reports indicated better long-term outcomes with LLR. In recent years, robot-assisted liver resection (RALR) has gradually become popular, and its short- and long-term results for HCC are not different from those of LLR. Additionally, RALR is expected to become the mainstay of minimally invasive surgery in the future. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Liver Resection for Cancer Therapies)
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