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Ratti et al. Hepatoma Res 2016;2:271-8                               Hepatoma Research
           DOI: 10.20517/2394-5079.2016.20
                                                                                                  www.hrjournal.net
            Topic: Advances in Minimally Invasive Cirrhotic Surgery                             Open Access


           Liver resection for hepatocellular

           carcinoma within a fast-track management:

           a propensity-score matched analysis

           between open and laparoscopic approach



           Francesca Ratti , Federica Cipriani , Raffaella Reineke , Marco Catena , Michele Paganelli , Luigi Beretta , Luca
                                                          2
                                                                                         1
                                                                        1
                         1
                                         1
                                                                                                     2
           Aldrighetti 1
           1 Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milano, Italy.
           2 Department of Anaesthesiology and Intensive Care, IRCCS San Raffaele Hospital, 20132 Milano, Italy.
           Correspondence to: Dr. Francesca Ratti, Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milano, Italy.
           E-mail: ratti.francesca@hsr.it
           How to cite this article: Ratti F, Cipriani F, Reineke R, Catena M, Paganelli M, Beretta L, Aldrighetti L. Liver resection for hepatocellular
           carcinoma within a fast-track management: a propensity-score matched analysis between open and laparoscopic approach. Hepatoma Res
           2016;2:271-8.
                                         ABSTRACT

            Article history:             Aim: The study was designed to assess the implications of enhanced recovery after surgery
            Received: 08-06-2016         (ERAS) approach in patients submitted to open liver resection for hepatocellular carcinoma
            Accepted: 20-09-2016         (HCC) comparing their short term outcome with patients treated by laparoscopic approach,
            Published: 30-09-2016        in a case-matched design. Methods: The open-group (n = 60) was matched in a ratio of 1:1
                                         with patients undergoing laparoscopic liver resection for HCC (Lap-group, n = 60), with a
                                         matching achieved on a basis of propensity scores including 6 covariates representing patients
                                         characteristics and severity of the disease. Primary outcome analysis was performed in
            Key words:                   terms of ERAS-specific items and postoperative morbidity and mortality. Results: Overall
            Hepatocellular carcinoma,    morbidity and mortality were comparable between groups. Incidence of ascites was slightly
            fast track,                  higher in the open- compared with the Lap-group (respectively 11.7% and 13.3%), without
            laparoscopy,                 statistical significance. The need for introduction or increase of chronic diuretic therapy was
            liver surgery,               significantly higher in the open-compared with the Lap-group (16.7% vs. 11.7%, P = 0.046).
            enhanced recovery after surgery,   Furthermore, ascites more frequently required percutaneous drainage in the open-compared
            liver failure                with the Lap-group (5%  vs. 1.7% respectively,  P = 0.041).  Conclusion: In patients who
                                         can’t  benefit  from  minimally-invasive  approach  because  of  disease  characteristics,  ERAS
                                         management seems to be associated with an improved postoperative functional recovery and
                                         postoperative outcomes, comparable to those of the minimally invasive approach.


           INTRODUCTION                                       a significant improvement that was widen to encompass
                                                              even patients management. [1-3]  Indeed, this innovative
           Thanks  to  the  widespread  diffusion  of  laparoscopic   trend included the application of multimodal perioperative
           surgery of the liver, surgical technique has experienced   care protocols, called fast track or enhanced recovery
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