title: The procedure outcome of laparoscopic resection for 'small' hepatocellular carcinoma is comparable to vlaparoscopic radiofrequency ablation.
abstract: BACKGROUND
  The aim of this study was to compare the effectiveness of laparoscopic liver resection (LLR) and laparoscopic radiofrequency ablation (LRFA) in the treatment of small nodular hepatocellular carcinoma (HCC).
  
  
  METHODS
  We enrolled 50 cirrhotic patients with similar baseline characteristics that underwent LLR (n = 26) or LRFA (n = 24), in both cases with intraoperative ultrasonography. Operative and peri-operative data were retrospectively evaluated.
  
  
  RESULTS
  LLR included anatomic resection in eight cases and non-anatomic resection in 18. In LRFA patients, a thermoablation of 62 nodules was achieved. Between LLR and LRFA groups, a significant difference was found both for median diameters of treated HCC nodules (30 vs. 17.1 mm; P < 0.001) and the number of treated nodules/patient (1.29 ± 0.62 vs. 2.65 ± 1.55; P < 0.001). A conversion to laparotomy occurred in two LLR patient (7.7%) for bleeding. No deaths occurred in both groups. Morbidity rates were 26.9% in the LLR group versus 16.6% in the LRFA group (P = 0.501). Hospital stay in the LLR and LRFA group was 8.30 ± 6.52 and 6.52 ± 2.69 days, respectively (P = 0.022). The surgical margin was free of tumour cells in all LLR patients, with a margin <5 mm in only one case. In the LRFA group, a complete response was achieved in 90.3% of thermoablated HCC nodules at the 1-month post-treatment computed tomography evaluation.
  
  
  CONCLUSIONS
  LLR for small peripheral HCC in patients with chronic liver disease represents a valid alternative to LRFA in terms of patient toleration, surgical outcome of the procedure, and short-term morbidity.
authors.affiliation: Surgical Clinic Unit 2, St. Martino Hospital, University of Genoa, Genoa, Italy ; Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Casaccia
authors.affiliation: Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Santori
authors.affiliation: Hepato-bilio-pancreatic and Liver Transplant Unit, St. Martino Hospital, Genoa, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Bottino
authors.affiliation: Hepato-bilio-pancreatic and Liver Transplant Unit, St. Martino Hospital, Genoa, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Diviacco
authors.affiliation: Hepato-bilio-pancreatic and Liver Transplant Unit, St. Martino Hospital, Genoa, Italy.
authors.forename: Antonella De
authors.initials: AD
authors.lastname: Negri
authors.affiliation: Hepato-bilio-pancreatic and Liver Transplant Unit, St. Martino Hospital, Genoa, Italy.
authors.forename: Eva
authors.initials: E
authors.lastname: Moraglia
authors.affiliation: Hepato-bilio-pancreatic and Liver Transplant Unit, St. Martino Hospital, Genoa, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Adorno
keywords: Hepatocellular carcinoma; laparoscopy; liver cirrhosis; liver resection; radiofrequency ablation