title: Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver.
abstract: BACKGROUND
  Laparoscopic liver resection (LLR) is still not a well-established treatment modality for hepatocellular carcinoma (HCC). Moreover, most reported cases have been limited to tumors in the anterolateral (AL) segments (segments 2, 3, 4b, 5, and 6). We evaluated clinical and oncologic outcomes after LLR for HCC located in all segments, including lesions located in the posterosuperior (PS) segments (segments 1, 4a, 7, and 8).
  
  
  METHODS
  This retrospective study included 69 patients who had undergone LLR for HCC between September 2003 and November 2008. The patients were divided into two groups (group AL and group PS) according to tumor location. The clinical data of the two groups were retrospectively analyzed.
  
  
  RESULTS
  There was no postoperative mortality. Fifteen patients (21.7%) experienced 19 postoperative complications. During a median follow-up period of 21.3 months, recurrence was detected in 21 (30.4%) patients. The 3-year overall survival rate and disease-free survival rate were 90.4 and 60.4%, respectively. There was no difference in clinicopathologic characteristics between the two groups except for a male predominance in group PS (p = 0.021) and that there were more patients with thrombocytopenia in group AL (p = 0.001). Although group PS patients had longer operative time (p = 0.001) and longer postoperative hospital stay (p = 0.039), along with a tendency toward a higher rate of open conversion (p = 0.054) and greater blood loss (p = 0.068), there was no significant difference in rates of postoperative complications (p = 0.375), recurrence (p = 0.740), 3-year overall survival (p = 0.237) or disease-free survival (p = 0.411) between the two groups.
  
  
  CONCLUSIONS
  Our experience shows that LLR can be safely performed in selected patients with HCC located in all segments of the liver, including the posterosuperior segments, with acceptable postoperative morbidity and oncologic results.
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi, 463-707, Korea.
authors.forename: Yoo-Seok
authors.initials: YS
authors.lastname: Yoon
authors.forename: Ho-Seong
authors.initials: HS
authors.lastname: Han
authors.forename: Jai Young
authors.initials: JY
authors.lastname: Cho
authors.forename: Keun Soo
authors.initials: KS
authors.lastname: Ahn
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008099:Liver / Q000473:pathology* / Q000601:surgery; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis