title: Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results.
abstract: BACKGROUND
  Liver surgery, especially for cirrhotic patients, is one of the last areas of resistance to progress in laparoscopic surgery. This study compares the postoperative results and the 2-year patient outcomes between laparoscopic and open resection for hepatocellular carcinoma in patients with histologically proven cirrhosis.
  
  
  METHODS
  From May 2000 to October 2004, 23 consecutive cirrhotic patients who underwent laparoscopic hepatectomy (LH) for HCC were compared in a retrospective analysis with a historic group of 23 patients who underwent open hepatectomy (OH). The two groups were well matched for age, gender, American Society of Anesthesiology (ASA) class, tumor location and size, type of liver resection, and severity of cirrhosis. The selection criteria for both groups specified a small (size < 5 cm), exophytic, or subcapsular tumor located in the left or peripheral right segments of the liver (II-VI segments, Couinaud); a well-compensated cirrhosis (Child-Pugh A); and an ASA score lower than 3. In the LH group, 15 subsegmentectomies, 3 segmentectomies, and 5 left lateral sectionectomies were performed, as compared with 12 subsegmentectomies, 5 segmentectomies, and 6 left lateral sectionectomies in the OH group.
  
  
  RESULTS
  One patient in the LH group (4.3%) underwent conversion to laparotomy for inadequate exposition. The mean operative time was statistically longer for the LH group (LH, 148 min; OH, 125 min; p = 0.016), whereas blood transfusions (LH, 0%; OH, 17.3%; p = 0.036), Pringle maneuver (LH, 0%; OH, 21.73%; p = 0.017), mean hospital stay (LH, 8.3 days; OH, 12 days; p = 0.047), and postoperative complications (LH, 13%; OH, 47.8%; p = 0.010) were significantly greater in OH group. There was no statistically significant difference in mortality and 2-year survival rates between the two groups.
  
  
  CONCLUSIONS
  This study shows that LH for HCC in properly selected cirrhotic patients results in fewer early postoperative complications and a shorter hospital stay than the traditional OH. The 2-year survival rate was the same for LH and OH.
authors: Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo Hospital, Via A. Vespucci, 80142, Via Cimarosa 2/A, 80127, Naples, Italy. chirurgia.loretonuovo@tin.it
authors: G
authors: G
authors: Belli
authors: C
authors: C
authors: Fantini
authors: A
authors: A
authors: D'Agostino
authors: L
authors: L
authors: Cioffi
authors: S
authors: S
authors: Langella
authors: N
authors: N
authors: Russolillo
authors: A
authors: A
authors: Belli
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008113:Liver Neoplasms / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
references: Surg Endosc. 1996 Jul;10(7):758-61
references: 8662435
references: Ann Surg. 2002 Jan;235(1):27-30
references: 11753039
references: Am J Surg. 2005 Feb;189(2):190-4
references: 15720988
references: Ann Surg. 2000 Apr;231(4):544-51
references: 10749616
references: J Hepatobiliary Pancreat Surg. 2005;12(6):438-43
references: 16365815
references: Ann Surg. 2004 Aug;240(2):205-13
references: 15273542
references: Ann Surg. 1998 Apr;227(4):527-32
references: 9563541
references: Ann Surg. 2000 Dec;232(6):753-62
references: 11088070
references: J Am Coll Surg. 2003 Feb;196(2):236-42
references: 12595052
references: J Hepatobiliary Pancreat Surg. 2005;12(6):488-93
references: 16365825
references: Surg Endosc. 2005 Jul;19(7):886-91
references: 15920694
references: Ann Surg. 2001 Jul;234(1):71-8
references: 11420485
references: Br J Surg. 2006 Jan;93(1):67-72
references: 16273531
references: Hepatogastroenterology. 1998 Nov-Dec;45(24):2333-8
references: 9951918
references: Arch Surg. 2003 Jul;138(7):763-9; discussion 769
references: 12860758
references: Surg Endosc. 2003 Jan;17(1):23-30
references: 12364994
references: Ann Surg. 2006 Apr;243(4):499-506
references: 16552201
references: Ann Surg. 2002 Jul;236(1):90-7
references: 12131090
references: Surg Endosc. 2003 Dec;17(12):1914-8
references: 14574547
references: Hepatogastroenterology. 1998 Jan-Feb;45(19):29-33
references: 9496482
references: J Hepatobiliary Pancreat Surg. 2006;13(2):149-54
references: 16547677
references: Surg Endosc. 2001 Jun;15(6):541-4
references: 11591936
references: Surgery. 2002 Mar;131(3):311-7
references: 11894036
references: Chir Ital. 2005 Jan-Feb;57(1):15-25
references: 15832734
references: Surg Endosc. 1998 Apr;12(4):331-4
references: 9543523
references: Ann Surg. 2002 Mar;235(3):373-82
references: 11882759
references: Br J Surg. 2007 Jan;94(1):58-63
references: 17054316
references: Surg Endosc. 2007 Feb;21(2):181-8
references: 17122984