Are large hepatocellular carcinomas still a contraindication for laparoscopic liver resection?
Although laparoscopic liver resection has been gradually adopted as an attractive option, it is still not indicated for large hepatocellular carcinoma (HCC). The aim of this study is to assess the feasibility of laparoscopic liver resection for large HCCs. A retrospective comparative study between 20 patients with HCC ≥ 5 cm and 103 patients with HCC <5 cm who underwent laparoscopic liver resection for hepatocellular carcinoma from September 2003 until December 2011 at Seoul National University Bundang Hospital was performed. In total, 95 men and 28 women with a mean age of 56.92 ± 11.28 years were enrolled in this study. There were no significant differences in preoperative patient demographics and tumor characteristics between the two groups. A major operation was performed more frequently in the large tumor group than in the small tumor group. On the other hand, intraoperative and postoperative outcomes, the rate of conversion, mean operative time, mean blood loss, and mean postoperative hospital stay showed no significant difference between the two groups. Also, there was no significant difference in rate of morbidity and mortality between the two groups. During a median follow-up of 37 months (range, 3-99 months), there was no significant difference in disease-free survival and overall survival. Laparoscopic liver resection for an HCC that is larger than 5 cm can be an optional treatment in selective cases.