title: Liver cirrhosis grading Child-Pugh class B: a Goliath to challenge in laparoscopic liver resection?-prior experience and matched comparisons.
abstract: BACKGROUND
  Laparoscopic hepatectomy (LH) is highly difficult in the background of liver cirrhosis. In this case series, we aimed to summarize our prior experience of LH in liver cirrhosis grading Child-Pugh class B.
  
  
  METHODS
  In the LH database of Sir Run Run Shaw Hospital in Zhejiang, China, patients who were pathologically diagnosed with cirrhosis and graded as Child-Pugh class B or C were reviewed.
  
  
  RESULTS
  Five patients grading Child B were included. There was no Child C case in our LH database. For included cases, median blood loss (BL) was 800 (range, 240-1,000) mL, median operative time was 135 (range, 80-170) minutes, and median length of hospital stay was 9 (range, 7-15) days. Forty percent (2/5) of patients was converted to open. The postoperative complication (PC) rate was 20.0% (1/5). When these Child B cases were compared with Child A cases undergoing LH, there was no statistical significance in BL, complication rate, operative time, open rate and hospital stay (HS) (P>0.05). This finding was confirmed by two ways of matched comparisons (a 1:2 comparison based on age and gender, and a 1:1 propensity score matching).
  
  
  CONCLUSIONS
  Although relevant literatures had suggested feasibility of LH in cirrhotic cases grading Child A, this study was the first one to discuss the value of LH in Child B cases. Our prior experience showed that in selected patients, LH in Child B patients had the potential to be as safe as in Child A cases. The efficacy of LH in Child C patients needs further exploration.
authors.affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Minimally Invasive Surgery, Zhejiang University, Hangzhou 310016, China.
authors.forename: Xiujun
authors.initials: X
authors.lastname: Cai
authors.affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Minimally Invasive Surgery, Zhejiang University, Hangzhou 310016, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Liang
authors.affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Minimally Invasive Surgery, Zhejiang University, Hangzhou 310016, China.
authors.forename: Tunan
authors.initials: T
authors.lastname: Yu
authors.affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Minimally Invasive Surgery, Zhejiang University, Hangzhou 310016, China.
authors.forename: Yuelong
authors.initials: Y
authors.lastname: Liang
authors.affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Minimally Invasive Surgery, Zhejiang University, Hangzhou 310016, China.
authors.forename: Renan
authors.initials: R
authors.lastname: Jing
authors.affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Minimally Invasive Surgery, Zhejiang University, Hangzhou 310016, China.
authors.forename: Wenbing
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Minimally Invasive Surgery, Zhejiang University, Hangzhou 310016, China.
authors.forename: Jianbo
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Minimally Invasive Surgery, Zhejiang University, Hangzhou 310016, China.
authors.forename: Hanning
authors.initials: H
authors.lastname: Ying
keywords: Laparoscopy; hepatectomy; liver cirrhosis and hemostasis