title: Outcomes of Pure Laparoscopic versus Open Hepatic Resection for Hepatocellular Carcinoma in Cirrhotic Patients: A Case-Control Study with Propensity Score Matching.
abstract: OBJECTIVE
  Laparoscopic hepatic resection (LH) for hepatocellular carcinoma (HCC) has gradually gained ground as a safe and minimally invasive treatment, although LH for cirrhotic patients remains challenging.
  
  
  METHODS
  Between January 2007 and August 2014, 28 and 57 patients with histologically proven cirrhosis (histological activity index, fibrosis score 4) underwent pure LH and open hepatic resection (OH; less than segmentectomy), respectively, for peripheral HCC ≤5 cm. To correct the difference in clinicopathological factors, including difficulty scores, between the two groups, propensity score matching was used at a 1:1 ratio, which resulted in a comparison of 20 patients per group. We compared the short- and long-term outcomes of LH and OH to investigate the efficacy of LH.
  
  
  RESULTS
  Clinicopathological variables, including difficulty scores, were well balanced between the two groups. The incidence of complications and mean intraoperative blood loss were lower in the LH group than the OH group (0 vs. 45% and 180 vs. 440 ml, p = 0.001 and 0.04, respectively). The 3-year disease-free survival rate was 42% in the LH group and 30% in the OH group (p = 0.533), whereas the 5-year overall survival rates were 46 and 60%, respectively (p = 0.606).
  
  
  CONCLUSIONS
  LH is a safe and effective treatment option for cirrhotic patients with HCC in terms of intraoperative blood loss and morbidity.
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Takemura
authors.forename: Hiroji
authors.initials: H
authors.lastname: Shinkawa
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Nishioka
authors.forename: Genya
authors.initials: G
authors.lastname: Hamano
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kinoshita
authors.forename: Tokuji
authors.initials: T
authors.lastname: Ito
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo