title: Laparoscopic versus open hepatic resection for hepatocellular carcinoma: improvement in outcomes and similar cost.
abstract: OBJECTIVE
  To compare outcomes of laparoscopic versus open hepatic resection (OHR) exclusively for hepatocellular carcinoma in terms of morbidity and cost.
  
  
  BACKGROUND
  Laparoscopic hepatic resection (LHR) has become more prevalent with recent improvements in instrumentation and surgeon experience.
  
  
  METHODS
  A review of multicenter, prospectively collected hepatobiliary databases from three institutions was performed from 12/1990 to 12/2009. Prospective evaluation of all patients undergoing hepatectomy for hepatocellular cancer was performed.
  
  
  RESULTS
  A total of 354 patients who had resections for Hepatocellular carcinoma (HCC) were analyzed, 100 were performed laparoscopically. The two groups were similar in terms of demographics and comorbidities. Evaluation of outcomes showed significantly higher intraoperative estimated blood loss although postoperative transfusion rates were similar. The incidence of any complication (44 vs 44%, p = 0.23) and 90-day mortality (6 vs 6%, p = 0.8) were similar between the two groups, with a similar reoperation rate (4.0 vs. 2.4%; p = 0.9). Using Cox regression analysis, the laparoscopic approach had no effect on disease-free interval (OR 1.4, CI 0.31-6.3, p = 0.66) or overall survival (HR 1.2, CI 0.59-2.5 p = 0.6). Length of stay was significantly shorter in the laparoscopic group 6.2 vs. 9.3 days (p = 0.001). Adjusted operative charges ($41 vs. $39 k, p = 0.601) and adjusted total hospital charges ($71 vs. $82 k, p = 0.368) were similar in LHR versus OHR.
  
  
  CONCLUSIONS
  Our study confirms previous literature showing comparable perioperative outcomes and recurrence. We further show comparable cost with laparoscopic versus open liver resection for HCC.
authors: Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 East Broadway, Suite 301, Louisville, KY, 40202, USA, robert.martin@lousville.edu.
authors: Robert C G
authors: RC
authors: Martin
authors: Nsehniitooh A
authors: NA
authors: Mbah
authors: Randy
authors: R
authors: St Hill
authors: David
authors: D
authors: Kooby
authors: Sharon
authors: S
authors: Weber
authors: Charles R
authors: CR
authors: Scoggins
authors: Shishir K
authors: SK
authors: Maithel
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018572:Disease-Free Survival; D005251:Fees, Medical; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D017722:Hospital Charges; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics; D007902:Length of Stay; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D015996:Survival Rate