title: Laparoscopic liver resection for hepatocellular carcinoma in cirrhotic patients: single center experience of 90 cases.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) with or without underlying liver disease can be treated by surgical resection. The aim of this study was to evaluate the feasibility, morbidity and mortality of a laparoscopic approach in cirrhotic patients with HCC.
  
  
  METHODS
  From 2004 to September 2014, 90 patients underwent a laparoscopic liver resection (LLR) for HCC. Data were collected in a prospectively maintained database since 2001. Preoperative patient evaluation was based on a multidisciplinary team meeting assessment.
  
  
  RESULTS
  Median age was 63 years; 67 (74.4%) patients were male. Median body mass index (BMI) was 26.7. Underlying liver disease was known in 68 patients: in 46 patients' hepatitis C virus (HCV)-related, in 15 patients to hepatitis B virus (HBV)-related, in 5 patients alcohol-related. Child-Pugh Score was of grade A in 85 patients and of grade B in 5 patients; 63 patients had a Model for End-stage Liver Disease (MELD) <10 and 27 patients MELD >10. A total of 18 left lateral sectionectomies, 1 left hepatectomy and 71 wedge resections or segmentectomies were performed. Conversion to laparotomy was necessary in 7 (7.7%) patients (five cases for bleeding and two cases for oncological reasons). In 90 patients, 98 HCC nodules were resected: 79 patients had one nodule, 8 patients had two nodules and 1 patient had three nodules. HCC nodules medium diameter was 29 mm (range, 4-100 mm) with median value of 25 mm. Tumor margins distance was 16 mm (range, 0-35 mm) with a median of 5 mm. Seventy nodules were located within the anterior sectors and 28 nodules within the posterior sectors.
  
  
  CONCLUSIONS
  LLR for HCC can be performed with acceptable morbidity in patients with underlying liver disease. The use of laparoscopic surgery in cirrhotic patients may be proposed as the first-line treatment for HCC or as bridge treatment before liver transplantation.
authors.affiliation: 1 Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy ; 2 Department of Surgical Sciences, Sapienza University, Rome, Italy ; 3 Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy ; 4 Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Ettorre
authors.affiliation: 1 Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy ; 2 Department of Surgical Sciences, Sapienza University, Rome, Italy ; 3 Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy ; 4 Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Levi Sandri
authors.affiliation: 1 Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy ; 2 Department of Surgical Sciences, Sapienza University, Rome, Italy ; 3 Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy ; 4 Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Santoro
authors.affiliation: 1 Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy ; 2 Department of Surgical Sciences, Sapienza University, Rome, Italy ; 3 Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy ; 4 Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vennarecci
authors.affiliation: 1 Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy ; 2 Department of Surgical Sciences, Sapienza University, Rome, Italy ; 3 Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy ; 4 Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Lepiane
authors.affiliation: 1 Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy ; 2 Department of Surgical Sciences, Sapienza University, Rome, Italy ; 3 Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy ; 4 Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Colasanti
authors.affiliation: 1 Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy ; 2 Department of Surgical Sciences, Sapienza University, Rome, Italy ; 3 Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy ; 4 Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Felli
authors.affiliation: 1 Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy ; 2 Department of Surgical Sciences, Sapienza University, Rome, Italy ; 3 Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy ; 4 Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: de Werra
authors.affiliation: 1 Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy ; 2 Department of Surgical Sciences, Sapienza University, Rome, Italy ; 3 Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy ; 4 Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors.forename: Lidia
authors.initials: L
authors.lastname: Colace
authors.affiliation: 1 Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy ; 2 Department of Surgical Sciences, Sapienza University, Rome, Italy ; 3 Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy ; 4 Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors.forename: Gianpiero
authors.initials: G
authors.lastname: D'Offizi
authors.affiliation: 1 Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy ; 2 Department of Surgical Sciences, Sapienza University, Rome, Italy ; 3 Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy ; 4 Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors.forename: Marzia
authors.initials: M
authors.lastname: Montalbano
authors.affiliation: 1 Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy ; 2 Department of Surgical Sciences, Sapienza University, Rome, Italy ; 3 Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy ; 4 Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors.forename: Ubaldo
authors.initials: U
authors.lastname: Visco
authors.affiliation: 1 Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy ; 2 Department of Surgical Sciences, Sapienza University, Rome, Italy ; 3 Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy ; 4 Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Maritti
authors.affiliation: 1 Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy ; 2 Department of Surgical Sciences, Sapienza University, Rome, Italy ; 3 Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy ; 4 Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Antonini
authors.affiliation: 1 Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy ; 2 Department of Surgical Sciences, Sapienza University, Rome, Italy ; 3 Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy ; 4 Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Santoro
keywords: Laparoscopic liver resection (LLR); Model for End-stage Liver Disease (MELD); cirrhosis; hepatocellular carcinoma (HCC)