Laparoscopic hepatic resection for completely exophytic hepatocellular carcinoma on cirrhosis

Laparoscopic surgery is a relatively new option for the treatment of hepatocellular carcinoma (HCC) on cirrhosis. To date, there have been only a few reports of this option for this pathology in the literature, probably because of the intra operative difficulties related to the treatment of this pathology (even at laparotomy) and because of the problems related to the minimally invasive approach (technical difficulties, complicated management of the bleeding, lack of dedicate tools, and fear of gas embolism). In this article we report four patients from our whole series (23 laparoscopic liver resections for HCC) who underwent a laparoscopic resection for completely exophytic HCC on cirrhosis, located in segment IV in two patients, and in segment III and segment V respectively, in the other two. The mean operative time was 116 min (range, 90-150 min). The Pringle maneuver was never performed. No blood transfusions were needed. No postoperative complications occurred, neither ascites, nor jaundice, nor encephalopathy. Postoperative liver function returned to the preoperative level within 3 days. Food intake started on postoperative day 2. The patients were discharged on postoperative days 5 (one patient), 6 (two patients), and 7 (one patient) after uncomplicated courses. In our opinion, limited laparoscopic liver resections could be considered, at present, to be the best option for the treatment of extremely rare protruding HCC on cirrhosis. We believe that a minimally invasive approach can minimize the postoperative morbidity rate, which is still too high in this group of patients. Our experience confirmed that nonanatomical limited resections or anatomical left lateral segmentectomies for HCC on cirrhosis are feasible and safe in the hands of surgeons trained in both open liver surgery and advanced laparoscopic surgery.