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Kilburn et al. Hepatoma Res 2016;2:264-70                            Hepatoma Research
           DOI: 10.20517/2394-5079.2016.29
                                                                                                  www.hrjournal.net
            Topic: Advances in Minimally Invasive Cirrhotic Surgery                             Open Access


           Laparoscopic resection of hepatocellular

           carcinoma in patients with and without

           cirrhosis: the Brisbane experience



           Daniel J. Kilburn , Universe Leung , David J. Cavallucci , Cassandra Jeavons , Mehan Siriwardhane , Richard
                                                                               1
                                                                                                   1,2
                          1,3
                                          1
                                                            1,3
           Bryant , Thomas R. O’Rourke , Shinn Yeung , Nicholas A. O’Rourke 1,3
                                                 2
                                     2
                 1
           1 Hepatopancreatobiliary Unit, Department of Surgery, Royal Brisbane and Women’s Hospital, Brisbane, Queensland 4029, Australia.
           2 Hepatopancreatobiliary Unit, Department of Surgery, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia.
           3 School of Medicine, The University of Queensland, Brisbane, Queensland 4072, Australia.
           Correspondence to: Dr. Nicholas A. O’Rourke, Wesley Medical Centre Suite 47, 40 Chasely Street, Auchenflower, Brisbane, Queensland 4066,
           Australia. E-mail: orourke.nick@gmail.com
           How to cite this article: Kilburn DJ, Leung U, Cavallucci DJ, Jeavons C, Siriwardhane M, Bryant R, O’Rourke TR, Yeung S, O’Rourke NA.
           Laparoscopic resection of hepatocellular carcinoma in patients with and without cirrhosis: the Brisbane experience. Hepatoma Res 2016;2:264-70.
                                 Dr. Nicholas A. O’Rourke (Right) and Dr. Daniel J. Kilburn (Left) are co-authors of this paper. Dr. O’Rourke
                                 is the Chairman of General Surgery and the Chief of HPB at the Royal Brisbane Hospital (RBH), Brisbane,
                                 Queensland, Australia. He is an immediate past President of ANZHPBA and current Secretary-General
                                 of the International Laparoscopic Liver Society (ILLS). Dr. Kilburn is a surgical resident at the RBH with a
                                 keen interest in laparoscopic HPB surgery.



                                         ABSTRACT
            Article history:              Aim:  Laparoscopic  liver  resection  for  hepatocellular  carcinoma  (HCC)  is  increasingly
            Received: 08-07-2016          common  around  the  world.  There  may  be  significant  advantages  over  open  resections.
            Accepted: 09-08-2016          However, due to technical difficulties, they are performed in few centers with expertise
            Published: 30-09-2016         in  liver  and  advanced  laparoscopic  surgery.  In  this  study  the  authors  summarize  the
                                          experience to date. Methods: A retrospective analysis of consecutive patients undergoing
            Key words:                    laparoscopic liver resection for HCC in 2 tertiary academic hepatobiliary units in Brisbane,
            Hepatocellular carcinoma,     Australia, between 1999 and 2015 was performed. Operative characteristics, perioperative
            hepatoma,                     morbidity, and pathological data were described. Patients with and without cirrhosis were
            hepatectomy,                  analyzed  and  compared.  Results: Fifty-two patients underwent resection  of 79 HCCs.
            laparoscopic surgery,         Sixty-five percent of patients had cirrhosis. Fourteen percent of patients underwent a major
            liver cirrhosis               hepatectomy. There was a trend towards more parenchyma-sparing resections for cirrhotic
                                          patients. Blood loss was higher in cirrhotics. Conversion to an open procedure occurred
                                          in 9%. There was one 90-day mortality due to liver failure (1.9%), and 7 patients (13%)
                                          experienced a complication. R0 resection was achieved in 92%. Overall survival at 1, 3, and
                                          5 years was 88%, 81%, and 61%, respectively. Conclusion: Laparoscopic liver resection for
                                          HCC, particularly in cirrhotic patients, is technically challenging. It can be performed with
                                          acceptable morbidity and adequate surgical margins.

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