title: Laparoscopic liver resection for hepatocellular carcinoma in cirrhosis: long-term outcomes.
abstract: BACKGROUND
  Few data regarding survival or pattern of recurrence after laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) on cirrhosis have been reported so far.
  
  
  METHODS
  A retrospective analysis of a prospectively maintained database of 109 laparoscopic interventional procedures performed for HCC in cirrhotic liver between 2000 and 2008 was conducted.
  
  
  RESULTS
  Sixty-five patients underwent an LLR. Morbidity rates were 20% (13/65), whereas there was only 1 death (1.5%). Reoperation was required in 2 patients. The overall mean postoperative hospital stay was 8.2 (2.6; 3-15) days. The actuarial overall 1-, 3-, and 5-year survival rates were 95, 70, and 55%, respectively, with a median overall survival of 75 months. Excluding the one hospital death, the actuarial 1-, 3-, and 5-year disease-free survival rates were 81, 62, and 32%, respectively, with a median overall disease-free survival of 42 months (95% confidence interval, CI: 18-65). On multivariate analysis, tumor grade (OR: 3.5, 95% CI: 1.1-10.7, p = 0.026) and microvascular invasion (OR: 4.9, 95% CI: 1.2-18.8, p = 0.020) resulted as independent predictors of overall survival. On multivariate analysis, gender (OR: 3.4, 95% CI: 1.1-10.2, p = 0.023), satellite tumor (OR: 4.3, 95% CI: 1.5-12.3, p = 0.006), microvascular invasion (OR: 3.3, 95% CI: 1.0-10.1, p = 0.036) and surgical margin (OR: 3.7, 95% CI: 1.0-10.1, p = 0.036) were identified as independent prognostic predictors of better disease-free survival. After a median follow-up of 29 (range 3-81) months, 31 (48%) out of 64 patients had recurrence. The cumulative recurrence rates at 1, 3, and 5 years were 19, 39, and 68%, respectively.
  
  
  CONCLUSIONS
  This prospective observational study has confirmed the feasibility and safety of LLR in selected patients with HCC in cirrhotic liver, and proved that it can warrant long-term outcome similar to those reported with the traditional open approach.
authors.affiliation: Department of General and Hepato-Pancreato-Biliary Surgery, S.M. Loreto Nuovo Hospital, Naples, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Belli
authors.forename: Corrado
authors.initials: C
authors.lastname: Fantini
authors.forename: Andrea
authors.initials: A
authors.lastname: Belli
authors.forename: Paolo
authors.initials: P
authors.lastname: Limongelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome