Abstract: Hepatectomy is one of the most effective therapeutic measures for the hepatocellular carcinoma (HCC) with high morbidity and mortality. Due to the biological characteristics of HCC metastasis through portal vein, removing both the tumor and the hepatic segment of the tumor-bearing portal territory by anatomical liver resection (AR) can effectively reduce the postoperative local recurrence and improve the long-term survival of HCC patients. In recent years, laparoscopic AR, which is widely used in the treatment of HCC, has formed a standardized operation process and achieved a double improvement in technology and concept. From the perspective of surgery and oncology, it has been proved that laparoscopic AR can bring patients both minimally invasive and survival benefits. The application of navigation techniques such as 3D visualization, laparoscopic ultrasound and indocyanine green (ICG) fusion fluorescence is more conducive to the implementation of laparoscopic AR. For HCC patients, laparoscopic AR should be the first choice if conditions permit. However, AR is not necessary for HCC patients with conditions such as severe cirrhosis, insufficient residual liver volume, large tumor and tumor located in the central region or adjacent major vessels. Both laparoscopic AR and non-anatomical liver resection (NAR) should adhere to the principle of tumor centered and margin oriented. Skillful surgical technique is the prerequisite for laparoscopic AR, while early diagnosis and comprehensive treatment remain important to improve the overall survive of patients with HCC. Laparoscopic limited AR emphasizes taking the tumor as the center and the tumor-bearing portal territory as the reference plane. It will not only maximally remove the liver tissue in the tumor-bearing portal territory, but also maximally retain the structure and volume of functional liver tissue, and it will become one of the most important methods for minimally invasive and precise treatment of HCC. Owing to the complexity of liver anatomy and the special and changeable bio-oncology behaviors of HCC, there are still some controversies and problems worthy of consideration in the treatment of HCC by laparoscopic AR.

Key words: Hepatocellular carcinoma, Laparoscope, Anatomical liver resection