title: Liver resection for hepatocellular carcinoma in patients with portal hypertension: the role of laparoscopy.
abstract: Liver resection (LR) for hepatocellular carcinoma (HCC) in patients with chronic liver disease (CLD) is a major issue since patients are at risk of serious intraoperative and postoperative complications. The current EASL/AASLD guidelines recommend LR only in case of patients with stage A HCC with well-preserved liver function and consider the presence of portal hypertension (PHT) as a contraindication to surgery. Nevertheless, the literature on this topic is conflicting. Recently several studies reported that favorable outcomes can be achieved with a careful patients' selection in high volume centers. Laparoscopic LR, when performed by well-trained surgeons and with appropriate indications, proved to be a valid option for the surgical treatment of HCC on cirrhosis offering similar oncologic outcomes but a reduction in surgical related morbidities. Laparoscopic LR thanks to a reduction in the incidence of post-operative liver failure and ascites development in comparison to standard open LR could, in selected cases challenge alternative treatments in the treatment of HCC patients with preserved liver function and clinical signs of mild PHT.
authors.affiliation: 1 Division of Surgical Oncology, Department of Abdominal Oncology, "Istituto Nazionale Tumori Fondazione G. Pascale"-IRCCS, Naples 80131, Italy ; 2 Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo Hospital, Naples 80142, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Belli
authors.affiliation: 1 Division of Surgical Oncology, Department of Abdominal Oncology, "Istituto Nazionale Tumori Fondazione G. Pascale"-IRCCS, Naples 80131, Italy ; 2 Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo Hospital, Naples 80142, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cioffi
authors.affiliation: 1 Division of Surgical Oncology, Department of Abdominal Oncology, "Istituto Nazionale Tumori Fondazione G. Pascale"-IRCCS, Naples 80131, Italy ; 2 Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo Hospital, Naples 80142, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Russo
authors.affiliation: 1 Division of Surgical Oncology, Department of Abdominal Oncology, "Istituto Nazionale Tumori Fondazione G. Pascale"-IRCCS, Naples 80131, Italy ; 2 Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo Hospital, Naples 80142, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Belli
keywords: Laparoscopic; cirrhosis; hepatocellular carcinoma (HCC); liver resection (LR); portal hypertension (PHT)