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. 2025 Jan;39(1):545-553.
doi: 10.1007/s00464-024-11300-0. Epub 2024 Oct 18.

Laparoscopic central hepatectomy: Feasibility and safety

Tiing-Foong Siow #  1   2 , Chiung-Hui Hsieh #  2 , U-Chon Chio  2 , Fu-Shan Jaw  1 , Jiann-Ming Wu  2 , Kuo-Hsin Chen  3   4
Affiliations

Laparoscopic central hepatectomy: Feasibility and safety

Tiing-Foong Siow et al. Surg Endosc. 2025 Jan.

Abstract

Background: Anatomical liver resection is the gold standard for hepatocellular carcinoma (HCC), enhancing survival and disease-free outcomes. For centrally located tumors, major resections are necessary but risky, especially for patients with liver disease. Central hepatectomy (CH) offers a parenchymal-sparing alternative to extended or hemihepatectomy (HH), reducing postoperative liver failure risk. However, its complexity and the large transection area make it challenging, especially with laparoscopic techniques. This study evaluates the feasibility and safety of laparoscopic CH for centrally located HCC, comparing surgical outcomes with those of the HH group.

Methods: A total of 1592 laparoscopic hepatectomy cases from January 2011 to April 2023 were reviewed in a single institution. Patients undergoing laparoscopic CH were compared to those receiving HH during the same period. Exclusion criteria included non-HCC diagnosis, non-central tumors, and cases involving combined procedures.

Results: 70 cases of laparoscopic CH and 32 cases of laparoscopic HH were included. The CH and HH groups showed similar estimated blood loss (median 400 ml vs. 290 ml, p = 0.187) and intraoperative blood transfusion rates (10% vs. 15%, p = 0.413). Operation time did not significantly differ (median 330 min vs. 360 min, p = 0.862). Postoperative hospital stay was shorter in CH (median 6 days vs. 9 days, p = 0.018), with fewer ICU transfers (19% vs. 44%, p = 0.014) and lower 90-day mortality (1% vs. 9%, p = 0.055) compared to HH. Complication rates were similar overall (26% vs. 41%, p = 0.069), but HH had more Clavien-Dindo class I and II complications (13% vs. 19%, p = 0.040). Long-term survival did not significantly differ, but tended to favor the CH group.

Conclusion: Despite the complexity, laparoscopic CH offers comparable perioperative outcomes and favorable long-term survival compared to HH. It can be considered a viable option for centrally located HCC, preserving liver function.

Keywords: Anatomical liver resection; Central bisectionectomy; Central hepatectomy; Hemihepatectomy; Laparoscopic hepatectomy; Mesohepatectomy.

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Conflict of interest statement

Declarations. Disclosures: Dr. Chiung-Hui Hsieh, Dr. Tiing-Foong Siow, Dr. U-Chon Chio, Prof. Fu-Shan Jaw, Dr. Jiann-Ming Wu and Dr. Kuo-Hsin Chen have no conflicts of interest or financial ties to disclose.

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