title: Comparative study and systematic review of laparoscopic liver resection for hepatocellular carcinoma.
abstract: OBJECTIVE
  To compare the surgical outcomes between laparoscopic liver resection (LLR) and open liver resection (OLR) as a curative treatment in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  A PubMed database search was performed systematically to identify comparative studies of LLR vs OLR for HCC from 2000 to 2014. An extensive text word search was conducted, using combinations of search headings such as "laparoscopy", "hepatectomy", and "hepatocellular carcinoma". A comparative study was also performed in our institution where we analysed surgical outcomes of 152 patients who underwent liver resection between January 2005 to December 2012, of which 42 underwent laparoscopic or hand-assisted laparoscopic resection and 110 underwent open resection.
  
  
  RESULTS
  Analysis of our own series and a review of 17 high-quality studies showed that LLR was superior to OLR in terms of short-term outcomes, as patients in the laparoscopic arm were found to have less intraoperative blood loss, less blood transfusions, and a shorter length of hospital stay. In our own series, both LLR and OLR groups were found to have similar overall survival (OS) rates, but disease-free survival (DFS) rates were higher in the laparoscopic arm.
  
  
  CONCLUSIONS
  LLR is associated with better short-term outcomes compared to OLR as a curative treatment for HCC. Long-term oncologic outcomes with regards to OS and DFS rates were found to be comparable in both groups. LLR is hence a safe and viable option for curative resection of HCC.
authors.affiliation: Wei Qi Leong, Iyer Shridhar Ganpathi, Alfred Wei Chieh Kow, Krishnakumar Madhavan, Stephen Kin Yong Chang, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Health System, Singapore 119228, Singapore.
authors.forename: Wei Qi
authors.initials: WQ
authors.lastname: Leong
authors.affiliation: Wei Qi Leong, Iyer Shridhar Ganpathi, Alfred Wei Chieh Kow, Krishnakumar Madhavan, Stephen Kin Yong Chang, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Health System, Singapore 119228, Singapore.
authors.forename: Iyer Shridhar
authors.initials: IS
authors.lastname: Ganpathi
authors.affiliation: Wei Qi Leong, Iyer Shridhar Ganpathi, Alfred Wei Chieh Kow, Krishnakumar Madhavan, Stephen Kin Yong Chang, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Health System, Singapore 119228, Singapore.
authors.forename: Alfred Wei Chieh
authors.initials: AW
authors.lastname: Kow
authors.affiliation: Wei Qi Leong, Iyer Shridhar Ganpathi, Alfred Wei Chieh Kow, Krishnakumar Madhavan, Stephen Kin Yong Chang, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Health System, Singapore 119228, Singapore.
authors.forename: Krishnakumar
authors.initials: K
authors.lastname: Madhavan
authors.affiliation: Wei Qi Leong, Iyer Shridhar Ganpathi, Alfred Wei Chieh Kow, Krishnakumar Madhavan, Stephen Kin Yong Chang, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Health System, Singapore 119228, Singapore.
authors.forename: Stephen Kin Yong
authors.initials: SK
authors.lastname: Chang
keywords: Hepatectomy; Hepatocellular carcinoma; Laparoscopy; Open liver resection; Surgery