title: Laparoscopic Liver Resection of Right Posterior Segments for Hepatocellular Carcinoma on Cirrhosis.
abstract: BACKGROUND
  Laparoscopic liver resection (LLR) is now widely adopted for the treatment of liver malignancies. Liver resection with laparoscopic approach was first adopted for tumors located in the peripheral portion of the anterolateral segments of the liver, but recent experiences in literature modified the attitude toward that approach. We herein report our technique and outcomes of LLR for hepatocellular carcinoma (HCC) located in the right-posterior segments of the liver (VI and VII).
  
  
  METHODS
  We retrospectively reviewed our prospectively maintained database, comparing peri- and postoperative outcomes of patients who underwent laparoscopic (13 patients) or open (51 patients) resections for HCC localized in the right-posterior segments between 2000 and 2014.
  
  
  RESULTS
  The two populations were homogeneous, showing no statistically significant differences in terms of gender, age, body mass index, and cirrhosis prevalence. Alpha-fetoprotein levels were higher in the open group (P = .04) and etiology of cirrhosis varied in a statistically significant manner (P = .01). The laparoscopic group showed an improved perioperative outcome with statistically significant less postoperative morbidity (P = .01) and less in-hospital stay (P = .0001). No differences were found in terms of blood loss or operative time, but any Pringle maneuver was needed (P = .04).
  
  
  CONCLUSIONS
  Patients affected by HCC localized in the right-posterior segments of the liver can be safely treated with laparoscopic approach. However, this kind of procedure can be challenging and should be performed in tertiary referral hospitals to provide the patient the best care, with the integration of different specialties.
authors.affiliation: 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy .
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantino
authors.affiliation: 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy .|2 Department of Medical and Surgical Sciences and Translational Medicine, Sapienza-University of Rome , Rome, Italy .
authors.forename: Paolo
authors.initials: P
authors.lastname: Magistri
authors.affiliation: 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy .
authors.forename: Valentina
authors.initials: V
authors.lastname: Serra
authors.affiliation: 2 Department of Medical and Surgical Sciences and Translational Medicine, Sapienza-University of Rome , Rome, Italy .
authors.forename: Giammauro
authors.initials: G
authors.lastname: Berardi
authors.affiliation: 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy .
authors.forename: Giacomo
authors.initials: G
authors.lastname: Assirati
authors.affiliation: 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy .
authors.forename: Roberto
authors.initials: R
authors.lastname: Ballarin
authors.affiliation: 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy .
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Di Benedetto
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: HCC; laparoscopy; minimally invasive liver surgery; right-lateral segments; segmentectomy; surgical technique