Liver resection for hepatocellular carcinoma, are we going to dismiss the traditional approach?

Background: Minimally invasive surgery has recently demonstrated results comparable to traditional surgery for recurrence-free or overall survival, even in cirrhotic patients. Laparoscopic liver resection (LLR) is gaining a central role for the treatment of hepatocellular carcinoma (HCC). The aim of our study is to analyze the evolution of traditional and minimally invasive liver resection for HCC in our Center since 2001.Methods: We divided the cohort into two groups: group 1, patients between 2001 and 2007 and group 2, patients between 2008 and 2015. Since 2001, 429 patients were resected in our department.Results: In group 1, we performed 42 major hepatectomies (25.3%) and 124 minor hepatectomies (74.7%). In group 2, we respectively performed 49 (18.6%) major hepatectomies and 214 (81.4%) minor hepatectomies. In group 1, 3% of patients and 44.5% in group 2 were treated by LLR. We observed an improvement of morbidity between the two groups (P<0.001), and of mortality with 3.6% in group 1 versus no mortality in group 2.Conclusions: The number of LLR has increased since 2001. However, the complexity of HCC resection on patients with cirrhosis seems to leave a place to the traditional approach. In our experience, the traditional surgical approach has still a place for the major resection in patients with HCC.