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Year : 2018  |  Volume : 37  |  Issue : 3  |  Page : 375-383

Resection of hepatocellular carcinoma in cirrhotic patients: laparoscopic versus open resection

1 Department of Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
2 Department of General Surgery, Faculty of Medicine, Helwan University, Helwan, Egypt

Correspondence Address:
Ahmed Khalil
Department of Surgery, Faculty of Medicine, Ain Shams University, Cairo, 11471, Egypt
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ejs.ejs_37_18

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Background Liver resection is an established modality of treatment for hepatocellular carcinoma although not commonly used in liver cirrhosis due to the poor liver reserve and the risk of decompensation. Laparoscopic surgery is known for its short-term and long-term benefits. Also, laparoscopic hepatectomy has many advantages in cirrhotic patients like minimizing the destruction of collateral blood and lymphatics. Our study aims at evaluating the effectiveness and safety of laparoscopic approach in patients with cirrhotic livers and compares it with the open approach. Patients and methods This prospective study involved 65 patients with hepatic tumors (with Child A classification) managed by hepatic resection at Ain Shams University Hospitals (Ain Shams University) and Badr Hospital (Helwan University) during the period from October 2014 to August 2016. The patients were randomly divided into two groups, group A (32 patients) was managed with laparoscopic hepatic resection technique and group B (33 patients) was managed with open hepatic resection technique. The patients were followed up to 12 months from the time of operation. Results Group A showed significantly shorter hospital stay; the mean hospital stay in the open group was 5.51±1.28 days ranging from 4 to 7 days, while in the laparoscopic group it was 3.75±1.16 days ranging from 3 to 5 days with highly statistically positive correlation difference between the two groups (P<0.001). Also, postoperative complications (mainly postoperative ascites) were significantly lower in the laparoscopic group, with no statistically significant difference in 1-year survival or recurrence rate. Conclusion The laparoscopic approach has superior short-term outcome compared with the open approach. Laparoscopic approach carries less postoperative complications and should be considered when possible.

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