title: Impact of laparoscopic liver resection for hepatocellular carcinoma with F4-liver cirrhosis.
abstract: BACKGROUND
  Although the utility of laparoscopic liver resection for hepatocellular carcinoma (HCC) has been recognized in recent years, the impact of the laparoscopic liver resection for HCC with complete liver cirrhosis (F4) is still unknown.
  
  
  METHODS
  Retrospective analysis of 56 patients who underwent partial hepatectomy for HCC (3 cm or smaller in a diameter) and had complete liver cirrhosis (F4) diagnosed histologically was performed. Of the 56 patients, partial hepatectomy was performed under laparotomy in 28 patients (laparotomy group) or under laparoscopy in 28 patients (laparoscopy group). Perioperative outcome was analyzed in the two groups.
  
  
  RESULTS
  There were no significant differences in the results of the preoperative liver function tests and the operation time between the two groups. The intraoperative blood loss was lower in the laparoscopy group than the laparotomy group (p = 0.0003). The incidence of the postoperative complications was significantly higher in the laparotomy group (20/36 patients) than in the laparoscopy group (3/28 patients, p < 0.0001). The incidences of surgical site infection, especially incisional infection, and intractable ascites were significantly higher in the laparotomy group than in the laparoscopy group (p = 0.0095, p < 0.0001, respectively). The proportions of patients who were classified into Clavien's grade I and IIIa were higher in the laparotomy group than in the laparoscopy group (p = 0.0043, p = 0.051, respectively). The duration of the postoperative hospital stay was significantly shorter in the laparoscopy group than in the laparotomy group (p < 0.0001).
  
  
  CONCLUSIONS
  The postoperative morbidity, such as surgical site infection and intractable ascites, decreased by the induction of laparoscopic liver resection in patients with liver cirrhosis. As the results, the necessity of invasive treatment for postoperative complications decreased and the duration of the postoperative stay was shortened.
authors: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-Hondori, Miyakojima-ku, Osaka 534-0021, Japan. kanazawa@msic.med.osaka-cu.ac.jp
authors: Akishige
authors: A
authors: Kanazawa
authors: Tadashi
authors: T
authors: Tsukamoto
authors: Sadatoshi
authors: S
authors: Shimizu
authors: Shintaro
authors: S
authors: Kodai
authors: Sadaaki
authors: S
authors: Yamazoe
authors: Satoshi
authors: S
authors: Yamamoto
authors: Shoji
authors: S
authors: Kubo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000209:etiology; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects; D006470:Hemorrhage / Q000453:epidemiology; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000145:classification / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology
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