To evaluate the safety and feasibility of laparoscopic resection of difficult segments for hepatocellular carcinoma (HCC).

Clinical data of 14 patients with HCC who underwent resection of difficult liver segments in the First People's Hospital of Foshan from January 2016 to January 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 12 patients were male and 2 female, aged (49±9) years on average. The tumors were located in segment Ⅰ in 2 cases, segment Ⅶ in 3 cases, segment Ⅷ in 8 cases and junction of segments Ⅷ and Ⅵa in 1 case. The median tumor diameter was 2.4(2.0-2.5) cm. The diagnoses of all patients were confirmed by postoperative pathological examination. Operative conditions and postoperative complications were observed.

All 14 patients completed laparoscopic hepatectomy, and none of them was converted to open surgery. The operation time was 345(330-390) min and intraoperative blood loss was 200(100-200) ml. Postoperative pleural effusion occurred in 1 case, peritoneal encapsulated effusion complicated with infection in 1 case and pulmonary infection in 1 case, which were cured after conservative treatments. No perioperative death was noted. The length of postoperative hospital stay was 8(7-10) d. The follow-up time was 23(14-42) months. No patient was lost to follow-up. 6 patients recurred during postoperative follow-up. Among them, 3 cases underwent surgical resection, 2 cases received radiofrequency ablation, and1 case gave up treatments.

Laparoscopic resection of difficult segments for HCC is a safe and feasible treatment. Reasonable selection of surgical approach, full exposure of surgical field, accurate positioning by intraoperative ultrasound, appropriate control of liver blood inflow and liver resection plane are the key factors for the safe performance of laparoscopic resection of difficult segments for HCC.