title: Laparoscopic vs. open liver resection for hepatocellular carcinoma of cirrhotic liver: a case-control study.
abstract: BACKGROUND
  Laparoscopic liver resection is considered a safe and feasible alternative to open surgery for malignant liver lesions. However, laparoscopic surgery in cirrhotic patients remains challenging. The aim of this retrospective case-control study was to compare morbidity, mortality, and long-term patient survival between laparoscopic liver resections (LLR) and open liver resections (OLR) for hepatocellular carcinoma (HCC) in patients with histologically proven cirrhosis.
  
  
  METHODS
  A total of 45 patients treated with LLR were matched by cause of cirrhosis, Child-Pugh score, type of surgical resection (subsegmentectomy, segmentectomy, and bisegmentectomy), tumor number, tumor size, and alpha-fetoprotein value with 45 patients treated with OLR. Pre-, intra-, and post-operative variables were compared between groups.
  
  
  RESULTS
  Compared with OLR, the LLR group displayed a significantly shorter operative time (140 vs. 180 min; p = 0.02), shorter hospital stay (7 vs. 12 days; p < 0.0001), and lower morbidity rate (20 vs. 45 % of patients; p = 0.01). A higher rate of R0 resection was observed in the LLR group than in the OLR group (95 vs. 85 %; p = 0.03). Postoperative ascites was more frequently observed in the OLR group (18 vs. 2 %; p = 0.01). Mortality, patient, and disease-free survival rates were similar between groups. The 1-, 5-, and 10-year survival rates were 88, 59, and 12 %, respectively, in the LLR group and 63, 44, and 22 % in the OLR group (p = 0.27).
  
  
  CONCLUSIONS
  Significantly shorter operative times, better resection margins, lower postoperative complications, and shorter hospital stay were observed in the LLR group compared with the OLR group. LLR and OLR have similar overall and disease-free survival rates in cirrhotic HCC patients.
authors.affiliation: Digestive, HPB and Transplant Liver Surgery Unit, Henri-Mondor Hospital, Université Paris Est-Créteil, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France, drmemeo@yahoo.it.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Memeo
authors.forename: Nicola
authors.initials: N
authors.lastname: de'Angelis
authors.forename: Philippe
authors.initials: P
authors.lastname: Compagnon
authors.forename: Chady
authors.initials: C
authors.lastname: Salloum
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
authors.forename: Alexis
authors.initials: A
authors.lastname: Laurent
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate