Laparoscopic hepatectomy is superior to open procedures for hepatic hemangioma

Background:Laparoscopic hepatectomy(LH)has become increasingly popular for liver neoplasms,but its safety and effectiveness remain controversial.Hepatic hemangiomas are the most common benign liver neoplasm;the main approaches to hepatic hemangiomas include open hepatectomy(OH)and LH.In this study,we compared early outcomes between patients undergoing OH and those with LH.Methods:Patients underwent OH or LH in our hospital for hepatic hemangiomas between December 2013 and December 2017 were enrolled.All patients underwent comprehensive preoperative evaluations.The clinicopathological index and risk factors of hemangioma resection were assessed.Results:In total,41 patients underwent OH while 53 underwent LH.There was no significant difference in any preoperative clinical variables,including liver function,prothrombin time,or platelet count.Hepatic portal occlusion time and operative time were 39.74 vs.38.35 minutes(P=0.717)and 197.20 vs.203.68 minutes(P=0.652)in the OH and LH groups,respectively.No mortality nor significant perioperative complications were observed between the two groups.In LH group,two cases were converted to OH,one for an oversized tumor and the other for hemorrhage.Compared with OH patients,those with LH had less blood loss(361.69 vs.437.81 m L,P=0.024),shorter postoperative hospital stay(7.98 vs.11.07 days,P=0.001),and lower postoperative C-reactive protein(43.63 vs.58.21 mg/L,P=0.026).Conclusions:LH is superior to OH in terms of postoperative recovery and blood loss for selected patients with hepatic hemangioma.

Expert Consensus on Laparoscopic Hepatectomy(2013 Version)

Background： Laparoscopic hepatectomy has many advantages over open surgery, including minimiza- tion of local injury, reduced systemic reactions, and faster postoperative recovery. The aim of this ＂Consensus＂ is to provide guidance and reference to surgeons who perform, or are interested in per- forming laparoscopic liver surgeries. Methods： The National Hepatic Surgery Group of the Society of Surgery, a professional society of the Chinese Medical Association, gathered 60 expert hepatic surgeons in Wuhan, China in December 2012, and an ＂Expert Consensus on Laparoseopic Hepatectomy＂ was developed. Results： The types of hepatectomy, indications and contraindications, preoperative preparation, anes- thesia, patient position, insuffiation pressure, port position, control of hepatic inflow and outflow, indi- cations for conversion to open surgery, and surgical devices and equipment are reviewed. Techniques and procedures of various laparoscopic hepatectomies are also discussed.

Is laparoscopic hepatectomy superior to open hepatectomy for hepatocellular carcinoma?

The low perioperative morbidity and shorter hospital stay associated with laparoscopic hepatectomy have made it an often-used option at many liver centers, despite the fact that many patients with hepatocellular carcinoma have cirrhosis, which makes the procedure more difficult and dangerous. Type of surgical procedure proves not to be a primary risk factor for poor outcomes after hepatic resection for hepatocellular carcinoma, the available evidence clearly shows that laparoscopic hepatectomy is an effective alternative to the open procedure for patients with early-stage hepatocellular carcinoma, even in the presence of cirrhosis. Whether the same is true for patients with intermediate or advanced disease is less clear, since laparoscopic major hepatectomy remains a technically demanding procedure.

Laparoscopic hepatectomy reduces postoperative complications and hospital stay in overweight and obese patients

BACKGROUND Laparoscopic liver surgery is currently considered the standard of care for various liver malignancies.However,studies focusing on perioperative outcome after laparoscopic hepatectomy(LH)in overweight patients are still sparse and its benefit compared to open hepatectomy(OH)is a matter of debate.AIM To analyze postoperative outcomes in overweight[body mass index(BMI)over 25 kg/m²]and obese(BMI over 30 kg/m²)patients undergoing LH and compare postoperative outcome with patients undergoing OH.METHODS Perioperative data of 68 overweight(BMI over 25 kg/m²)including a subcohort of obese(BMI over 30 kg/m²)patients(n=27)who underwent LH at our institution between 2015 and 2019 were retrospectively analyzed regarding surgical outcome and compared to an equal number of patients undergoing OH.RESULTS The mean BMI was 29.8±4.9 kg/m2 in the LH group and 29.7±3.6 kg/m2 in the OH group with major resections performed in 20.6%(LH)and 26.5%(OH)of cases,respectively.Operative time(194±88 min vs 275±131 min;P<0.001)as well as intensive care(0.8±0.7 d vs 1.1±0.8 d;P=0.031)and hospital stay(7.3±3.6 d vs 15.7±13.5 d;P<0.001)were significant shorter in the LH group.Also,overall complications(20.6%vs 45.6%;P=0.005)and major complications(1.5%vs 14.7%,P=0.002)were observed less frequently after LH.An additional investigation analyzing the subgroup of obese patients who underwent LH(n=27)and OH(n=29)showed a shorter operative time(194±81 min vs 260±137 min;P=0.009)and a reduced length of hospitalization(7.7±4.3 d vs 17.2±17 d;P<0.001)but no difference in postoperative complications or overall cost.CONCLUSION LH is safe and cost-effective in overweight and obese patients.Furthermore,LH is significantly associated with fewer postoperative complications and reduced hospital stay compared to OH in these patients.

Expanding the selection criteria of laparoscopic hepatectomy for hepatocellular carcinoma

The introduction of laparoscopic procedures is one of the milestones of surgical innovation over the past few decades. The advantages of minimally invasive approach have been gradually accepted owing to its less postoperative pain, reduced morbidity and faster recovery. Also, since the introduction of laparoscopic approach of liver surgery in 1955 （1）, the benefit of the procedure had long been questioned but expected.

Successful outcome of massive carbon dioxide embolism during laparoscopic hepatectomy

Carbon dioxide embolism is a rare but severe complication of laparoscopic hepatectomy.We reported a case of massive carbon dioxide embolism that developed into a rare paradoxical gas embolism during laparoscopic hepatectomy and resulted in reduced muscular power of the left upper extremity,severe pleural effusion and hypoalbuminemia after surgery.Fortunately,the patient fully recovered with positive prevention and postoperative treatment.This case report highlights that the surgeon and anaesthesiologist must be aware of the risks and the importance for prompt treatment when massive carbon dioxide embolism occurs.

Laparoscopic left hemihepatectomy guided by indocyanine green fluorescence: A cranial-dorsal approach

BACKGROUND Advancements in laparoscopic technology and a deeper understanding of intra-hepatic anatomy have led to the establishment of more precise laparoscopic hepatectomy(LH)techniques.The indocyanine green(ICG)fluorescence navi-gation technique has emerged as the most effective method for identifying hepatic regions,potentially overcoming the limitations of LH.While laparoscopic left hemihepatectomy(LLH)is a standardized procedure,there is a need for innova-tive strategies to enhance its outcomes.important anatomical markers,surgical skills,and ICG staining methods.METHODS Thirty-seven patients who underwent ICG fluorescence-guided LLH at Qujing Second People's Hospital between January 2019 and February 2022 were retrospectively analyzed.The cranial-dorsal approach was performed which involves dissecting the left hepatic vein cephalad,isolating the Arantius ligament,exposing the middle hepatic vein,and dissecting the parenchyma from the dorsal to the foot in order to complete the anatomical LLH.The surgical methods,as well as intra-and post-surgical data,were recorded and analyzed.Our hospital’s Medical Ethics Committee approved this study(Ethical review:2022-019-01).RESULTS Intraoperative blood loss during LLH was 335.68±99.869 mL and the rates of transfusion and conversion to laparotomy were 13.5%and 0%,respectively.The overall incidence of complications throughout the follow-up(median of 18 months;range 1-36 months)was 21.6%.No mortality or severe complications(level IV)were reported.CONCLUSION LLH has the potential to become a novel,standardized approach that can effectively,safely,and simply expose the middle hepatic vein and meet the requirements of precision surgery.

Clinical feasibility of laparoscopic left lateral segment liver resection with magnetic anchor technique:The first clinical study from China

BACKGROUND Magnetic anchor technique(MAT)has been applied in laparoscopic cholecystectomy and laparoscopic appendectomy,but has not been reported in laparoscopic partial hepatectomy.AIM To evaluate the feasibility of the MAT in laparoscopic left lateral segment liver resection.METHODS Retrospective analysis was conducted on the clinical data of eight patients who underwent laparoscopic left lateral segment liver resection assisted by MAT in our department from July 2020 to November 2021.The Y-Z magnetic anchor devices(Y-Z MADs)was independently designed and developed by the author of this paper,which consists of the anchor magnet and magnetic grasping apparatus.Surgical time,intraoperative blood loss,intraoperative accidents,operator experience,postoperative incision pain score,postoperative complications,and other indicators were evaluated and analyzed.RESULTS All eight patients underwent a MAT-assisted laparoscopic left lateral segment liver resection,including three patients undertaking conventional 5-port and five patients having a transumbilical single-port operation.The mean operation time was 138±34.32 min(range 95-185 min)and the mean intraoperative blood loss was 123±88.60 mL(range 20-300 mL).No adverse events occurred during the operation.The Y-Z MADs showed good workability and maneuverability in both tissue and organ exposure.In particular,the operators did not experience either a“chopstick”or“sword-fight”effect in the single-port laparoscopic operation.CONCLUSION The results show that the MAT is safe and feasible for laparoscopic left lateral segment liver resection,especially,exhibits its unique abettance for transumbilical single-port laparoscopic left lateral segment liver resection.

Laparoscopic VS open hepatectomy for hepatolithiasis: An updated systematic review and meta-analysis

AIM To perform a meta-analysis on laparoscopic hepatectomy VS conventional liver resection for treating hepatolithiasis.METHODS We conducted a systematic literature search on Pub Med,Embase,Web of Science and Cochrane Library,and undertook a meta-analysis to compare the efficacy and safety of laparoscopic hepatectomy V S conventional open liver resection for local hepatolithiasis in the left or right lobe. Intraoperative and postoperative outcomes(time,estimated blood loss,blood transfusion rate,postoperative intestinal function recovery time,length of hospital stay,postoperative complication rate,initial residual stone,final residual stone and stone recurrence) were analyzed systematically.RESULTS A comprehensive literature search retrieved 16 publications with a total of 1329 cases. Meta-analysis of these studies showed that the laparoscopic approach for hepatolithiasis was associated with significantly less intraoperative estimated blood loss [weighted mean difference(WMD): 61.56,95% confidence interval(CI): 14.91-108.20,P = 0.01],lower blood transfusion rate [odds ratio(OR): 0.41,95%CI: 0.22-0.79,P = 0.008],shorter intestinal function recovery time(WMD: 0.98,95%CI: 0.47-1.48,P = 0.01),lower total postoperative complication rate(OR: 0.52,95%CI: 0.39-0.70,P < 0.0001) and shorter stay in hospital(WMD: 3.32,95%CI: 2.32-4.32,P < 0.00001). In addition,our results showed no significant differences between the two groups in operative time(WMD: 21.49,95%CI: 0.27-43.24,P = 0.05),residual stones(OR: 0.79,95%CI: 0.50-1.25,P = 0.31) and stone recurrence(OR: 0.34,95%CI: 0.11-1.08,P = 0.07). Furthermore,with subgroups analysis,our results proved that the laparoscopic approach for hepatolithiasis in the left lateral lobe and left side could achieve satisfactory therapeutic effects. CONCLUSION The laparoscopic approach is safe and effective,with less intraoperative estimated blood loss,fewer postoperative complications,reduced length of hospital stay and shorter intestinal function recovery time than with conventional approaches.

Transumbilical single-incision laparoscopic hepatectomy： an initial report

Transumbilical single-incision laparoscopic surgeries have attracted the attention of surgeon. Here we report a patient with multiple hepatic hemagiomas and symptomatic cholelithiasis who underwent laparoscopic left lateral hepatecomy and left hepatic hemangioma enucleation with single incision followed by cholecystectomy. The duration of the operation was 155 minutes and the blood loss was 100 ml. There were no complications during or after the treatment. This surgical treatment yields a good cosmetic effect and rapid recovery.

A nomogram predicting the recurrence of hepatocellular carcinoma in patients after laparoscopic hepatectomy

Background:Patients with hepatocellular carcinoma(HCC)undergoing surgical resection still have a high 5-year recurrence rate(~60%).With the development of laparoscopic hepatectomy(LH),few studies have compared the efficacy between LH and traditional surgical approach on HCC.The objective of this study was to establish a nomo-gram to evaluate the risk of recurrence in HCC patients who underwent LH.Methods:The clinical data of 432 patients,pathologically diagnosed with HCC,underwent LH as initial treatment and had surgical margin>1 cm were collected.The significance of their clinicopathological features to recurrence-free survival(RFS)was assessed,based on which a nomogram was constructed using a training cohort(n=324)and was internally validated using a temporal validation cohort(n=108).Results:Hepatitis B surface antigen(hazard ratio[HR],1.838;P=0.044),tumor number(HR,1.774;P=0.003),tumor thrombus(HR,2.356;P=0.003),cancer cell differentiation(HR,0.745;P=0.080),and microvascular tumor invasion(HR,1.673;P=0.007)were found to be independent risk factors for RFS in the training cohort,and were used for con-structing the nomogram.The C-index for RFS prediction in the training cohort using the nomogram was 0.786,which was higher than that of the 8th edition of the American Joint Committee on Cancer TNM classification(C-index,0.698)and the Barcelona Clinic Liver Cancer staging system(C-index,0.632).A high consistency between the nomogram prediction and actual observation was also demonstrated by a calibration curve.An improved predictive benefit in RFS and higher threshold probability of the nomogram were determined by receiver operating characteristic curve analysis,which was also confirmed in the validation cohort compared to other systems.Conclusions:We constructed and validated a nomogram able to quantify the risk of recurrence after initial LH for HCC patients,which can be clinically implemented in assisting the planification of individual postoperative surveil-lance protocols.

Laparoscopic vs open liver re-resection for cirrhotic patients with post-hepatectomy hepatocellular carcinoma recurrence:A comparative study

BACKGROUND Repeated liver resection is an effective treatment for recurrent hepatocellular carcinoma(HCC).However,few studies have compared the outcome of laparoscopic repeat hepatectomy(LRH)and open repeat hepatectomy(ORH)for recurrent HCC,and few of those have included cirrhotic patients.AIM To compare short-term and long-term outcomes of cirrhotic patients with LRH and ORH for recurrent HCC.METHODS We retrospectively analysed the clinical records retrieved from a prospectively collected database of all patients who underwent hepatectomy for posthepatectomy recurrent HCC at our institute between May 2006 and June 2021.Cases of recurrent HCCs larger than 7 cm were excluded.Patient demographics,operative details,perioperative outcomes,pathologic details,disease-free survival(DFS),and overall survival(OS)data of LRH and ORH were compared.RESULTS Data from 29 patients with LRH and 22 with ORH were compared.The LRH group showed significantly better outcomes for blood loss(median 300 mL vs 750 mL,P=0.013)and length of hospital stay(median 5 d vs 7 d,P=0.003).The 1-,3-and 5-year OS rates in the LRH group were 100.0%,60.0%and 30.0%,respectively;the corresponding rates in the ORH group were 81.8%,36.4%and 18.2%(P=0.336).The 1-,3-and 5-year DFS rates in the LRH group were 68.2%,27.3%and 4.5%,respectively;the corresponding rates in the ORH group were 31.3%,6.3%and 6.3%(P=0.055).There were no significant differences in overall and DFS between the two groups.CONCLUSION Laparoscopic re-resection should be considered for patients presenting with recurrent HCC less than or equal to 7 cm after previous hepatectomy.

Global dissemination of minimally invasive living donor hepatectomy: What are the barriers?

Minimally invasive donor hepatectomy(MIDH)is a relatively novel procedure that can potentially increase donor safety and contribute to faster rehabilitation of donors.After an initial period in which donor safety was not effectively validated,MIDH currently seems to provide improved results,provided that it is conducted by experienced surgeons.Appropriate selection criteria are crucial to achieve better outcomes in terms of complications,blood loss,operative time,and hospital stay.Beyond a pure laparoscopic technique,various approaches have been recommended such as hand-assisted,laparoscopic-assisted,and robotic donation.The latter has shown equal outcomes compared to open and laparoscopic approaches.A steep learning curve seems to exist in MIDH,mainly due to the fragility of the liver parenchyma and the experience needed for adequate control of bleeding.This review investigated the challenges and the opportunities of MIDH and the barriers to its global dissemination.Surgeons need expertise in liver transplantation,hepatobiliary surgery,and minimally invasive techniques to perform MIDH.Barriers can be categorized into surgeon-related,institutionalrelated,and accessibility.More robust data and the creation of international registries are needed for further evaluation of the technique and the acceptance from more centers worldwide.

The application of the extraglissonian approach for selective hepatic inflow occlusion during laparoscopic anatomical segmentectomy

Objective:Laparoscopic anatomical hepatectomy has been proven to be achievable for segmentectomy,subsegmentectomy and multi-segmentectomy.The extraglissonian approach in the context of selective hepatic inflow ocdlusion has been skilled under laparoscopy.This study aims to examine the suitability of the technique stated above for laparoscopic anatomical hepatectomy.Methods:This retrospective study analyzed the dinical data of 114 patients diagnosed with hepatocel-lular carcinoma who underwent laparoscopic anatomical hepatectomy using the extraglissonian hepatic inflow occlusion technique at the Faculty of Hepato-Pancreato-Biliary Surgery,Chinese PLA General Hospital between September 2020 and December 2022.Results:The success rate of achieving the ischemic area using the described methods was determined to be 74.6%.Out of the 85 cases that underwent laparoscopic anatomical hepatectomy,34 cases involved segmentectomy,5 cases involved subsegmentectomy,and 46 cases involved multi-segmentectomy.The average duration of the operation,blood loss volume,and postoperative hospi-tal stay were 229.0±85.0 min,133.0±112.0 mL,and 5.4±1.7 d,res pectively.Notably,no intraoperative blood transfusions were necessary,and no postoperative complications were observed.Conclusion:The extraglissonian hepatic inflow occlusion technique exhibits a notable advantage in terms of a high success rate,effectively guiding the selection process during laparoscopic parenchymal tran-section.Moreover,this technique has demonstrated safety,reproducibility,and significant potential for broader clinical adoption.

International consensus statement on robotic hepatectomy surgery in 2018

The robotic surgical system has been applied in liver surgery. However,controversies concerns exist regarding a variety of factors including the safety,feasibility, efficacy, and cost-effectiveness of robotic surgery. To promote the development of robotic hepatectomy, this study aimed to evaluate the current status of robotic hepatectomy and provide sixty experts' consensus and recommendations to promote its development. Based on the World Health Organization Handbook for Guideline Development, a Consensus Steering Group and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 22 topics were prepared analyzed and widely discussed during the 4 meetings. Based on the published articles and expert panel opinion, 7 recommendations were generated by the GRADE method using an evidence-based method, which focused on the safety, feasibility, indication,techniques and cost-effectiveness of hepatectomy. Given that the current evidences were low to very low as evaluated by the GRADE method, further randomized-controlled trials are needed in the future to validate these recommendations.

Advances and challenges in laparoscopic surgery in the management of hepatocellular carcinoma

Hepatocellular carcinoma is the fifth most common malignancy and the third most common cause of cancer-related mortality worldwide. From the wide variety of treatment options, surgical resection and liver transplantation are the only therapeutic ones. However, due to shortage of liver grafts, surgical resection is the most common therapeutic modality implemented. Owing to rapid technological development, minimally invasive approaches have been incorporated in liver surgery. Liver laparoscopic resection has been evaluated in comparison to the open technique and has been shown to be superior because of the reported decrease in surgical incision length and trauma, blood loss, operating theatre time, postsurgical pain and complications, R0 resection, length of stay, time to recovery and oral intake. It has been reported that laparoscopic excision is a safe and feasible approach with near zero mortality and oncologic outcomes similar to open resection. Nevertheless, current indications include solid tumors in the periphery < 5 cm, especially in segments Ⅱ through Ⅵ, while according to the consensus laparoscopic major hepatectomy should only be performed by surgeons with high expertise in laparoscopic and hepatobiliary surgery in tertiary centers. It is necessary for a surgeon to surpass the 60-cases learning curve observed in order to accomplish the desirable outcomes and preserve patient safety. In this review, our aim is to thoroughly describe the general principles and current status of laparoscopic liver resection for hepatocellular carcinoma, as well as future prospects.

Functional anatomical hepatectomy guided by indocyanine green fluorescence imaging in patients with localized cholestasis:Report of four cases

BACKGROUND Liver cancer is a malignant tumor with a high incidence.At present,the most effective treatment is laparoscopic hepatectomy(LH).Indocyanine green fluorescence imaging(ICG-FI)has become an important tool in LH,and the most common fluorescent types of tumors are total fluorescence,partial fluorescence,and rim fluorescence.CASE SUMMARY We presented four cases of LH guided by ICG-FI in which we also observed the fourth special fluorescent type.When the tumor or intrahepatic stone compresses the adjacent bile duct to cause local cholestasis,the liver segment or subsegment with obstructed bile drainage will show strong fluorescence.Complete removal of the lesion together with the fluorescent liver parenchyma may help reduce the risk of tumor or stone recurrence.CONCLUSION This type of partial fluorescence can indicate local biliary compression,and the resection method is related to bile drainage,which may be called functional anatomical hepatectomy and ensures radical resection of the lesion.

Laparoscopic versus Traditional Open Splenectomy for Hepatocellular Carcinoma with Hypersplenism

This study aimed to examine the efficacy of the laparoscopic vs. traditional open splenectomy for hepatocellular carcinoma（HCC） with hypersplenism. Between 2002 and 2013, 51 Chinese HCC patients with hypersplenism underwent either simultaneous laparoscopic splenectomy plus anticancer therapies（Lap-S＆A）（n=25） or traditional open splenectomy plus anti-cancer therapies（TOS＆A）（n=26）. The outcomes were reviewed during and after the operation. Anti-cancer therapies for HCC included laparoscopic hepatectomy（LH） and laparoscopic microwave ablation（LMA）. The results showed that there was no significant difference in the operating time between the two groups, but the blood loss and blood transfusion were less, pain intensity after surgery was weaker, the time to first bowel movement, time to the first flatus and postoperative hospital stay were shorter, and the postoperative complication rate and the readmission rate were lower in the Lap-S＆A group than in the TO-S＆A group. Two patients in the Lap-S＆A group and one patient in the TO-S＆A group died 30 days after surgery. However, no significant difference in the mortality rate was noted between the two groups. It was concluded that simultaneous Lap-S＆A holds the advantages of more extensive indications, lower complication incidence and less operative expenditure than conventional open approach and it is a feasible and safe approach for HCC with hypersplenism.

Short-term and middle-term evaluation of laparoscopic hepatectomies compared with open hepatectomies: A propensity score matching analysis

AIM To compare short-term results between laparoscopic hepatectomy and open hepatectomy using a propensity score matching. METHODS A patient in the laparoscopic liver resection(LLR) groupwas randomly matched with another patient in the open liver resection(OLR) group using a 1:1 allocated ratio with the nearest estimated propensity score. Patients of the LLR group without matches were excluded. Matching criteria included age, gender, body mass index, American Society of Anesthesiologists score, potential co-morbidities, hepatopathies, size and number of nodules, preoperative chemotherapy, minor or major liver re-sections. Intraoperative and postoperative data were compared in both groups.RESULTS From January 2012 to January 2015, a total of 241 hepa-tectomies were consecutively performed, of which 169 in the OLR group(70.1%) and 72 in the LLR group(29.9%). The conversion rate was 9.7%(n = 7). The mortality rate was 4.2% in the OLR group and 0% in the LLR group. Prior to and after propensity score matching, there was a statistically significant difference favorable to the LLR group regarding shorter operative times(185 min vs 247.5 min; P = 0.002), less blood loss(100 m L vs 300 m L; P = 0.002), a shorter hospital stay(7 d vs 9 d; P = 0.004), and a significantly lower rate of medical complications(4.3% vs 26.4%; P < 0.001). CONCLUSION Laparoscopic liver resections seem to yield better short-term and mid-term results as compared to open hepatectomies and could well be considered a privileged approach and become the gold standard in carefully selected patients.

Long-term survival outcome of laparoscopic liver resection for hepatocellular carcinoma

Long-term survival is the most important outcome measurement of a curative oncological treatment.For hepatocellular carcinoma(HCC),the long-term disease-free and overall survival of laparoscopic liver resection(LLR)is shown to be non-inferior to the current standard of open liver resection(OLR).Some studies have reported a superior long-term oncological outcome in LLR when compared to OLR.It has been argued that improvement of visualization and instrumentation and reduced operative blood loss and perioperative blood transfusion may contribute to reduced risk of postoperative tumor recurrence.On the other hand,since most of the comparative studies of the oncological outcomes of LLR and OLR for HCC are non-randomized,it remained inconclusive as to whether LLR confers additional survival benefit compared to OLR.Despite the paucity of level 1 evidence,the practice of LLR for HCC has gained wide-spread acceptance due to the reproducible improvements in the perioperative outcomes and non-inferior oncological outcomes demonstrated by large-scaled,matched comparative studies.Meta-analyses of the outcomes of these studies by multiple systematic reviews have also returned noncontradictory conclusions.On the basis of a theoretical advantage of LLR over OLR in preventing tumor recurrence,the current review aims to dissect from the current meta-analyses and comparative studies any evidence of such superiority.