title: Laparoscopic versus open liver resection for hepatocellular carcinoma at a North-American Centre: a 2-to-1 matched pair analysis.
abstract: BACKGROUND
  Oncological implications of laparoscopic resection in primary hepatic malignancy are not well defined. Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) in comparison to an open liver resection (OLR) in peri-operative and long-term oncological outcomes are described from a single North American institution.
  
  
  METHODS
  From 2006 to 2013, all forty-three LLR patients for HCC were evaluated. Each patient was matched to two OLR patients for age at operation, maximal tumour size and tumour number.
  
  
  RESULTS
  When compared with OLR, LLR had a lower severity of complication (0% versus 27%, P = 0.050) and lower 30-day readmission rate (2.3% versus 18.6%, P = 0.010). The length of stay (LOS) was shorter in LLR patients (5 versus 7 days, P < 0.001) and the estimated blood loss was also lower in LLR (300 versus 700 ml, P = 0.004). Admission to intensive care unit (ICU), emergency room (ER) visits and complication rates were similar. Overall, recurrence-free and intra-hepatic recurrence-free survival were comparable between LLR and OLR.
  
  
  CONCLUSIONS
  LLR confers the widely-accepted benefits of laparoscopic surgery, namely severity of complication, 30-day readmission rate, LOS and blood loss. Further studies are required to examine intra- and extra-hepatic recurrence after LLR. LLR for HCC should be considered for appropriately selected patients in centres with requisite volume and expertise.
authors.affiliation: University Health Network, Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Jonghun J
authors.initials: JJ
authors.lastname: Lee
authors.forename: John B
authors.initials: JB
authors.lastname: Conneely
authors.forename: Rory L
authors.initials: RL
authors.lastname: Smoot
authors.forename: Steven
authors.initials: S
authors.lastname: Gallinger
authors.forename: Paul D
authors.initials: PD
authors.lastname: Greig
authors.forename: Carol-Anne
authors.initials: CA
authors.lastname: Moulton
authors.forename: Alice
authors.initials: A
authors.lastname: Wei
authors.forename: Ian
authors.initials: I
authors.lastname: McGilvray
authors.forename: Sean P
authors.initials: SP
authors.lastname: Cleary
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009864:Ontario; D010359:Patient Readmission; D011183:Postoperative Complications / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden