Laparoscopic hepatectomy is feasible for patients diagnosed with hepatocellular carcinoma and cirrhotic liver

doi:10.4240/wjgs.v18.i1.114262

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 18, Issue 1

This Article

Peer-Review Report of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (300)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-3) series, Tables (1-4) series.

Item

Count

PDF

HTML

Figures (1-3)

Tables (1-4)

Sum=136

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

Download

101

Sum=129

Jan 27, 2026 (publication date) through Feb 19, 2026

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Gastrointestinal Surgery

ISSN

1948-9366

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Gastrointest Surg. Jan 27, 2026; 18(1): 114262
Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.114262

Laparoscopic hepatectomy is feasible for patients diagnosed with hepatocellular carcinoma and cirrhotic liver

Krerkrit Kijpongpans, Shunichi Ariizumi, Yusuke Ome, Yusuke Kawamoto, Yutaro Matsunaga, Goro Honda

Krerkrit Kijpongpans, Department of Surgery, Naresuan University Hospital, Phitsanulok 65000, Thailand

Shunichi Ariizumi, Yusuke Ome, Yusuke Kawamoto, Yutaro Matsunaga, Goro Honda, Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Shinjuku 162-8666, Tokyo, Japan

Author contributions: Kijpongpans K conceptualized and designed the study, collected and analyzed the clinical data, and drafted the manuscript; Ariizumi S, Ome Y, Kawamoto Y, Matsunaga Y, and Honda G contributed to patient recruitment and data interpretation and critically revised the manuscript for intellectual content; All authors reviewed and approved the final version of the manuscript.

Institutional review board statement: The study protocol adhered to the principles of the Declaration of Helsinki and this study was approved by the Ethics Committee of Tokyo Women’s Medical University (Approval No. 2024-0133).

Informed consent statement: Informed consent was waived due to the retrospective nature of the study.

Conflict-of-interest statement: There is no conflict of interest associated with the senior author or other coauthors who contributed their efforts in this manuscript.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Data sharing statement: Available on request.

Corresponding author: Goro Honda, MD, Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku 162-8666, Tokyo, Japan. ghon67@outlook.jp

Received: September 22, 2025
Revised: October 24, 2025
Accepted: November 21, 2025
Published online: January 27, 2026
Processing time: 123 Days and 3.8 Hours

Abstract

BACKGROUND

Hepatocellular carcinoma (HCC) commonly arises in cirrhotic livers. Laparoscopic hepatectomy (LH) has shown promising outcomes, but its safety in moderate liver dysfunction remains unclear. Despite comparable surgical indications for LH and open hepatectomy (OH), data on impaired liver function are scarce. The Japanese Liver Damage Grading System (LDGS), incorporating indocyanine green retention at 15 min, provides a precise functional assessment.

AIM

To compare short-term and long-term outcomes of LH and OH in patients with HCC LDGS grade B or C.

METHODS

The 97 patients with HCC and LDGS grade B or C who underwent hepatectomy (26 LH; 71 OH) between 2010 and 2022 at Tokyo Women’s Medical University Hospital were retrospectively analyzed. Propensity score matching (1:1) was applied. Baseline biochemical and tumor characteristics were compared. Short-term and long-term outcomes were assessed.

RESULTS

Before matching patients who underwent LH had smaller tumors (2.7 cm vs 4.5 cm, P = 0.004) and lower surgical difficulty scores (P < 0.001). After matching LH was associated with lower intraoperative blood loss (242 mL vs 941 mL; P = 0.049), reduced postoperative ascites (0% vs 21.2%; P = 0.035), and shorter hospital stay with no conversion to OH. The 5-year overall survival rate was significantly higher in the LH group (91% vs 36%; P = 0.021) while recurrence-free survival was comparable.

CONCLUSION

LDGS provides a comprehensive assessment of surgical candidates with moderate cirrhosis. In patients with HCC and grade B or C liver damage, LH appears to have better long-term outcomes than OH due to reduced morbidity and preservation of liver function.

Keywords: Laparoscopic hepatectomy; Open hepatectomy; Hepatocellular carcinoma; Cirrhotic liver; Liver damage score; Propensity score matching

Core Tip: Laparoscopic hepatectomy (LH) is a feasible and safe procedure for patients with hepatocellular carcinoma and moderate cirrhosis, particularly Liver Damage Grading System grade B or C. In this single-center retrospective study with propensity score matching, LH significantly reduced intraoperative blood loss and postoperative ascites, shortened hospital stay, and improved 5-year overall survival compared with open hepatectomy. The Liver Damage Grading System provides a practical tool for selecting surgical candidates. These findings support LH as a preferred approach in patients with hepatocellular carcinoma and grade B liver damage, optimizing long-term outcomes while preserving liver function.