Protective Benefit of Minimally Invasive Liver Surgery for Hepatocellular Carcinoma Before Transplant

Abstract

Introduction: The clinical entity of hepatocellular carcinoma (HCC) is responsible for 80-90% of primary liver cancers, and it is the third leading cause of cancer-related death worldwide. The challenge in management arises from being able to deliver a curative treatment without precipitating further liver decompensation. The surgical options for curative treatment are defined as liver resection (LR), liver transplantation (LT), and ablation modalities. Methods: Data on liver resections were gathered from the Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT) from 2003-2021. A retrospective analysis on 1408 consecutive adult patients who had a liver resection was performed with categorization based on the underlying disease process. A sub-analysis studied the 291 patients who had an LLR with an intention to transplant approach after laparoscopic LR (LLR). Results: LLR has benefits before LT for HCC with significantly reduced de-listing and death after LT when prior liver resection was performed laparoscopically. Compared with open surgery, minimally invasive liver surgery is protective for the risk of delisting, post-transplant patient death, and tumor recurrence. Conclusion: Laparoscopic surgery has important protective advantages over laparotomy surgery for the surgical treatment of HCC, particularly since treatment is not always curative. LLR can be considered a bridge therapy for transplantation, ensuring less crowding of waiting lists, a desirable condition in areas of donor storage.