Journal of Surgical Oncology 2010;102:82–86 Case-Matched Analysis of Totally Laparoscopic Versus Open Liver Resection for HCC: Short and Middle Term Results LUCA ALDRIGHETTI, MD, PhD, ELEONORA GUZZETTI, MD,* CARLO PULITANO ` , MD, FEDERICA CIPRIANI, MD, MARCO CATENA, MD, PhD, MICHELE PAGANELLI, MD, AND GIANFRANCO FERLA, MD Department of Surgery—Liver Unit, Scientific Institute H San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy Background and Objectives: Laparoscopy is gaining acceptance as a safe procedure for resection of liver neoplasms. The aim of this study is to evaluate surgical results and mid-term survival of minor hepatic resection performed for HCC. Methods: Data of 16 patients with HCC, undergoing laparoscopic hepatectomy from September 2005 to January 2009, were compared to a control group of 16 patients who underwent open resection (OR) during the same period. The two groups were matched in terms of type of resection, tumor size, and severity of cirrhosis. Results: One patient underwent conversion to an open approach. Laparoscopic approach resulted in shorter operating time (150 min, P:0.044) and lower blood loss (258 ml, P:0.008). There was no difference in perioperative morbidity and mortality rate; laparoscopic approach was associated with a shorter hospital stay (6.3 days, P:0.039). After a mean follow up of 32 months, disease free survival and overall survival were 40.2 and 23.3 months for laparoscopic group, and 47.7 and 31.4 months for OR group (P NS). Conclusion: Laparoscopic resection of HCC is feasible and safe in selected patients and can result in good surgical results, with similar outcomes in terms of overall and disease-free survival. J. Surg. Oncol. 2010;102:82–86. ß 2010 Wiley-Liss, Inc. KEY WORDS: laparoscopic; liver; resection; hepatic cell cancer; HCC INTRODUCTION Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world and in 90% of cases it occurs in patients with chronic liver disease. Therapeutic options for HCC include liver transplantation, resection and local ablative techniques, such as radiofrequency ablation and alcohol injection. Liver resection is considered an efficient treatment for patients with preserved liver function, but, in the context of chronic liver disease, surgical outcome can be affected by significant morbidity due in part to laparotomy itself [1]. Laparoscopic liver procedures were first described in 1990s, including biopsies and fenestration of cysts [2,3]. First hepatic wedge resection was performed in 1992 and, since then, the availability of new surgical instruments and modern anaesthesiological techniques, as well as the increased expertise in laparoscopic field, allowed the diffu- sion of laparoscopic approach for resection of liver lesions. Never- theless, the real benefits of laparoscopic approach for liver resection are still under investigation, as well as the potential risks of intrao- perative complications and inadequate radicality of tumor resection. The aim of this study is to compare the results of laparoscopic and open liver resection performed for HCC using a case matched analysis for tumor size, type of resection and degree of hepatic cirrhosis. MATERIALS AND METHODS On September 2005, a clinical program of laparoscopic liver resections was started at the Hepatobiliary Unit of the Department of General and Specialistic Surgery—S. Raffaele Hospital in Milan, Italy. Since then, data concerning all cases have been collected for a prospective evaluation of laparoscopic liver resections. Patients who were potential candidates for liver resection were systematically evaluated for laparoscopic approach at weekly multidisciplinary meetings. Indications included benign lesions, hepatocellular carcinomas (HCC) in cirrhotic patients, and metastases. The laparo- scopic approach was considered on the basis of the tumor size and location: it was proposed for lesion located in the left lobe or peripheral right segments of the liver (from 2 to 6 Couinaud segment), smaller than 12 cm, and if there were no doubts about adequate disease-free margins. Tumor larger than 12 cm may make the laparoscopic approach harder because of increased difficulty in mobilizing the liver and higher risk of positive surgical margin. Design of the Study We searched our prospectively collected hepatobiliary surgical database starting from the January 2004 (start up of the activities of Hepatobiliary Unit) for patients who underwent laparoscopic liver resection for HCC. Fifty-six patients from September 2005 to June 2009 underwent liver resection with a laparoscopic approach. Of the 56 resections, 16 were performed for HCC and are considered the study group. Preoperative assessment included standard liver function tests (to assess Child Pugh classification), abdominal ultrasonography, and multislice computed tomography. Magnetic resonance imaging was selectively used. Indications for resection were not modified by the choice of the laparoscopic approach. Indications to resection included Child class A patients, absence of previous upper major abdominal surgery, and cardiac or respiratory impairments. *Correspondence to: Dr. Guzzetti Eleonora, MD, H San Raffaele, Via Olgettina 60, 20132 Milan, Italy. Fax: 39-022643-7807. E-mail: guzzetti.eleonora@hsr.it Received 31 August 2009; Accepted 21 January 2010 DOI 10.1002/jso.21541 Published online 1 April 2010 in Wiley InterScience (www.interscience.wiley.com). ß 2010 Wiley-Liss, Inc.