title: Evaluation of a laparoscopic liver resection in the setting of cirrhosis.
abstract: BACKGROUND
  Patients presenting with cirrhosis and hepatic tumours represent a fragile group that have typically been avoided in early series of laparoscopic liver resection. This study was undertaken to evaluate the results of a laparoscopic hepatectomy in the setting of cirrhosis.
  
  
  METHODS
  Subgroup analysis of patients with cirrhosis within a series of 327 patients undergoing a laparoscopic resection was performed. Comparisons were made with patients without cirrhosis where appropriate to highlight differences in patient selection and outcomes. Specific variables assessed included operative details and short-term outcomes including length of stay (LOS), morbidity and mortality. Outcomes specific to hepatocellular carcinoma (HCC) were also assessed.
  
  
  RESULTS
  There were 52 patients with cirrhosis undergoing a laparoscopic hepatic resection. Ninety per cent of patients were Childs class A, with a median model for end-stage liver disease (MELD) score of 8. Hepatitis C was the most common cause of cirrhosis (88.5%), whereas the most common indication for an operation was HCC (71.2%). Resections were generally limited, with the median number of segments resected being 2 (range: 1-4). Complications occurred in 13 (25%) patients, with a 90-day mortality of 5.8%. The median LOS was 3 days.
  
  
  CONCLUSIONS
  A laparoscopic hepatectomy is safe in the setting of cirrhosis, provided the application of appropriate selection criteria and sufficient experience with the procedure.
authors.affiliation: Deparment of Surgery, University of Louisville, Louisville, KY, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Cannon
authors.forename: Bob
authors.initials: B
authors.lastname: Saggi
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Buell
mesh_terms: D000328:Adult; D000368:Aged; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000401:mortality; D008103:Liver Cirrhosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome