title: Laparoscopic resection vs. open liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: a case-matched study.
abstract: BACKGROUND
  Studies that compare laparoscopic to open liver resection for hepatocellular carcinoma (HCC) in cirrhotic patients are rare and may have suffered from low patient numbers. This work was designed to determine the impact of laparoscopic resection on postoperative and long-term outcomes in a large series of cirrhotic patients with hepatocellular carcinoma (HCC) compared with open resection.
  
  
  METHODS
  From 2002 to 2009, 36 patients with chronic liver disease with complicating HCC were selected for laparoscopic resection (laparoscopic group, LG). The outcomes were compared with those of 53 patients who underwent open hepatectomy (open group, OG) during the same period in a matched-pair analysis. The two groups were similar in terms of tumor number and size and number of resected segments.
  
  
  RESULTS
  Morbidity and mortality rates were similar in the two groups (respectively 25 and 0% in LG vs. 35.8 and 7.5% in OG; p = 0.3). Severe complications were more frequent in OG (13.2%) than in LG (2.8%; p = 0.09). Despite similar portal hypertension levels, complications related to ascites (namely evisceration or variceal bleeding) were fatal in 4 of 12 affected patients in OG but 0 of 5 cases in LG (p = 0.2). The mean hospitalization durations were 6.5 ± 2.7 days and 9.5 ± 4.8 days in LG and OG, respectively (p = 0.003). The surgical margins were similar in the two groups. Although there was a trend toward better 5-year overall survival in LG (70 vs. 46% in OG; p = 0.073), 5-year disease-free survival was similar (35.5 vs. 33.6%).
  
  
  CONCLUSIONS
  Laparoscopic resection of HCC in patients with chronic liver disease has similar results to open resection in terms of postoperative outcomes, surgical margins, and long-term survival.
authors.affiliation: Department of Digestive Surgery and Transplantation, Hôpital HURIEZ, Rue M. Polonovski, CHU, Univ Nord de France, 59000 Lille, France. stephanie.truant@chru-lille.fr
authors.forename: S
authors.initials: S
authors.lastname: Truant
authors.forename: A F
authors.initials: AF
authors.lastname: Bouras
authors.forename: M
authors.initials: M
authors.lastname: Hebbar
authors.forename: E
authors.initials: E
authors.lastname: Boleslawski
authors.forename: G
authors.initials: G
authors.lastname: Fromont
authors.forename: S
authors.initials: S
authors.lastname: Dharancy
authors.forename: E
authors.initials: E
authors.lastname: Leteurtre
authors.forename: P
authors.initials: P
authors.lastname: Zerbib
authors.forename: F R
authors.initials: FR
authors.lastname: Pruvot
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D016022:Case-Control Studies; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D010535:Laparoscopy; D008107:Liver Diseases / Q000150:complications* / Q000601:surgery; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications