Kijpongpans K, Ariizumi S, Ome Y, Kawamoto Y, Matsunaga Y, Honda G. Laparoscopic hepatectomy is feasible for patients diagnosed with hepatocellular carcinoma and cirrhotic liver. World J Gastrointest Surg 2026; 18(1): 114262 [DOI: 10.4240/wjgs.v18.i1.114262]
Corresponding Author of This Article
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
Research Domain of This Article
Surgery
Article-Type of This Article
Observational Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 27, 2026 (publication date) through Jan 28, 2026
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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
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Kijpongpans K, Ariizumi S, Ome Y, Kawamoto Y, Matsunaga Y, Honda G. Laparoscopic hepatectomy is feasible for patients diagnosed with hepatocellular carcinoma and cirrhotic liver. World J Gastrointest Surg 2026; 18(1): 114262 [DOI: 10.4240/wjgs.v18.i1.114262]
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.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
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.
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.
