title: Laparoscopic versus open liver resection for hepatocellular carcinoma: initial experience in Greece.
abstract: BACKGROUND
  Liver resection represents the treatment of choice for a small proportion of patients with hepatocellular carcinoma (HCC), amenable to surgery. The remarkable evolution in surgical techniques during the last decades introduced laparoscopic hepatectomy in the operative management of HCC, even in the presence of liver cirrhosis. No comparative study on laparoscopic or open liver resection for HCC has been conducted in Greece yet.
  
  
  METHODS
  Patients undergoing liver resection for HCC by one senior hepatobiliary surgeon in our Institution during the period 11/2011-02/2016 were prospectively sampled and retrospectively analyzed for the purposes of this study. Statistical analysis encompassed Student's t-test, Fisher's exact test, the Kaplan-Meier method/log rank test and Cox proportional hazard regression analyses.
  
  
  RESULTS
  Eleven patients underwent laparoscopic and 21 open liver resection, respectively. Statistical differences between the 2 groups were observed for tumor size (P=0.04), major resections (P=0.01), Pringle maneuver (P=0.008), intraoperative blood transfusion (P=0.03), and duration of operation (P=0.004). Resection margins, and tumor recurrence showed no statistical differences. Three-year postoperative survival after laparoscopic and open hepatectomy was 100%, and 67%, respectively (P=0.06). Regression analysis for patient survival revealed prognostic value for BCLC staging, γ-glutamyl transferase levels, laparoscopic hepatectomy, UICC stage, Dindo-Clavien classification, and hospital stay. Laparoscopic hepatectomy remained as independent predictor of survival by multivariate analysis (P=0.0142).
  
  
  CONCLUSIONS
  Laparoscopic hepatectomy for HCC in chronic liver disease represents a safe and innovative treatment tool in the management of these patients under the presupposition of careful patient selection.
authors.affiliation: 2 Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, General Hospital Laiko, Athens, Greece.
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.affiliation: 2 Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, General Hospital Laiko, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Machairas
authors.affiliation: 2 Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, General Hospital Laiko, Athens, Greece.
authors.forename: Paraskevas
authors.initials: P
authors.lastname: Stamopoulos
authors.affiliation: 2 Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, General Hospital Laiko, Athens, Greece.
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Kostakis
authors.affiliation: 2 Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, General Hospital Laiko, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Dimitroulis
authors.affiliation: 2 Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, General Hospital Laiko, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Mantas
authors.affiliation: 2 Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, General Hospital Laiko, Athens, Greece.
authors.forename: Gregory
authors.initials: G
authors.lastname: Kouraklis
keywords: Laparoscopic hepatectomy; hepatocellular carcinoma; hospital stay; liver cirrhosis; liver resection