With the continuous development in laparoscopic devices and approaches, laparoscopic minor liver resections have even become standard surgical procedures for treating solitary lesion located in liver segments 2-6 [2-4]. Due to the long learning curve for laparoscopic liver resection, it is necessity to consider the expertise of the surgeon for safe laparoscopic minor resection [15,16]. Recently, in some highly specialized centers, LMH can be performed as effectively and safely as OMH . LMH even was not inferior to OMH in terms of resection margin, postoperative complications, operative mortality and long-term outcomes stated by the Second International Consensus Conference held in Morioka; in addition, LLR was superior in terms of shorter hospital stay .
As showed in table 3, we have summarized all comparative studies of major LLR vs. major OLR [4-8,17-23]. The negative margins and oncologic integrity of the procedure should be obtained, when major laparoscopic liver resection is performed for cancer. No difference in the resection margin was found in the comparative studies of major LLR vs. major OLR, although tumor size of major LLR was large than major OLR in the studies of Goumard , Guro , Komatsu  and Tarantino . In the present case-matched study, the negative margin of major LLR was similar to major OLR. In addition, the R0 resection rate of LMH group was 96.2%. Recently, some meta-analyses of retrospective studies also observed that no significant difference was found between major LLR and major OLR in the resection margin for HCC patients [24,25]. In order to better learn major LLR for HCC patients, long-term survival rate should also be obtained. As showed in table 3, there were three studies provided data of five-year over survival (OS) and disease-free survival (DFS) including the data of our study. Although laparoscopic group has a longer OS comparing with open group, no significant difference was found between both groups in regarding with OS and DFS. Therefore, we can conclude that major LLR may be as oncological safety as major OLR. Due to the above data come from observational clinical studies (OCS), however, additional randomized controlled trials (RCTs) studies are required to provide convincing evidence in the future.
With regard to the data on perioperative outcomes, major LLR was associated with favorable intraoperative blood loss, total postoperative complications and postoperative hospital stay in the summarized comparative studies. However, the operation time of major LLR was significantly longer than major OLR in most of the retrospective studies [4-8,17-19,21,22]. Recently, the Japanese National Clinical Database showed that major LLR was associated with less blood loss, a lower complication rate and shorter hospital stay comparing with major OLR . Regarding short-term outcomes in the present study, the average operation time of major LLR group was longer than OLR group. However, major LLR group has a significantly lower intraoperative blood loss and postoperative complication rate and shorter postoperative hospital stay. This indicates that although major LLR is technically more difficult than OLR, major LLR is similar to major OLR in short-term outcomes. Furthermore, owing to its minimal invasiveness, major LLR facilitates earlier patient recovery. Interesting, our results showed that although no significant difference was found in surgical cost between both groups, the overall cost of LMH group was significantly lower than OMH group which might be related with fast recovering.
To the best of our knowledge, the present report was the first study summarized the long-term survival rate of major LLR in patients with HCC. However, several limitations should be care in our study. First, this was a retrospective study, which may introduce bias. Second, although there was no difference in the resection margin between the two groups, we preferred major OLR in patients with HCC close to the major Glisson pedicle or the inferior vena cava. In conclusion, major LLR of HCC is feasible and safe with favorable short- and long-term outcomes, when performed in experienced centers.