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Robichaux et al.                                                                                                                                                                                    LLR in the cirrhotic patient

            Table 1: Patient demographics
                                              Open                 Laparoscopic               P-value
            Number                             39                       75
            Age (years)                     58.1 ± 12.8              61.3 ± 9.86               0.152
            Male gender (%)                 89.7 ± 30.7              66.7 ± 47.5               0.007*
            Government insurance (%)        25.6 ± 44.2              32.0 ± 47.0               0.486
            BMI                             28.2 ± 6.0               27.8 ± 4.9                0.713
            HTN (%)                         74.4 ± 44.2              80.0 ± 40.3               0.494
            DM (%)                          33.3 ± 47.8              30.7 ± 40.2               0.664
            INR                              1.1 ± 0.2                1.1 ± 0.1                0.638
            Bilirubin                       0.83 ± 0.42             0.691 ± 0.36               0.071
            Creatinine                      1.05 ± 0.58              0.86 ± 0.24               0.013*
            PLT                            187.5 ± 87.2             173.4 ± 73.7               0.357
            Varicies (%)                    33.3 ± 47.7              17.3 ± 38.1               0.054
            Ascites (%)                     2.6 ± 47.7               10.7 ± 31.1               0.130
            ASA score                        3.3 ± 0.5                3.1 ± 0.3                0.020*
            Tumor size (cm)                 6.56 ± 4.26              3.20 ± 2.01              < 0.001*
           *Statistically significant. BMI: body mass index; HTN: hypertension; DM: diabetes mellitus; INR: international normalized ratio; PLT: platelet; ASA:
           American Society of Anesthesiologists
           significant proportion of these cirrhotic patients will present   imaging with triphasic computed tomography scan or
           for the management of hepatocellular cancer.  However,   contrasted magnetic resonance  imaging, estimation
                                                 [11]
           with the incidence of cirrhosis ever rising in the general   of  functional  liver  remnant,  confirmation  of  platelet
           population, other pathologic lesions will be presented   count,  and selective measurement of  transjugular
           for  diagnosis and surgical management including   wedge pressures. In the setting of high risk patients
           symptomatic benign  tumors, colorectal metastases   such as platelet counts less than 100 K or presence
           and  in the era of increasing  resolution  imaging   of  significant  varicies,  transhepatic  wedge  pressures
           indeterminate lesions.                             and extent  of  resection dictated the  decision to
                                                              proceed  with resection and in marginal  cases portal
           This study examines our experience with laparoscopic   vein embolization  was employed. Both open and
           liver resection in cirrhotic patients for multiple pathologies.   laparoscopic  resections were performed using a
           The aim of the current study was to elucidate the   parenchymal sparing intent with the aid of low central
           potential  benefits  of  laparoscopic  liver  resection  over   venous pressures, and parenchymal division with an
           open hepatic resection in the management of surgically   ultrasonic dissector and stapler hepatectomy.
           resectable liver lesions in cirrhotic patients.
                                                              Patient demographics, tumor characteristics, operative
           METHODS                                            and postoperative  outcome data were collected and
                                                              analyzed. Data was reported with means and standard
           This is a retrospective study analyzing the effect of a   deviations. Statistical comparisons were calculated and
           laparoscopic approach on the resection of liver tumors   analyzed using SAS software. Significant differences
           in cirrhotic patients. The current study was submitted   were  identified  at  a  P-value of < 0.05. Multivariate
           and approved by an institutional review board at our   regression analysis was then applied to  evaluate
           institution. One hundred and fourteen cirrhotic liver   the  effects  of  laparoscopic  liver resection on patient
           resections  were  identified  in  a  surgical  database   morbidity, mortality and readmission.
           performed by a single surgeon. The cohort of cirrhotic
           resections was evaluated for  patient demographics,   RESULTS
           operative outcomes, morbidity,  mortality,  and long-
           term  patient survival.  The  impact of  laparoscopic   The study cohort of cirrhotic resection patients was
           liver resection  was then compared  to the open  liver   composed of 114 cirrhotic patients. The laparoscopic
           resection group. Further examination was performed   liver resection  group was comprised of  75 patients
           using a  subset  analysis to  evaluate the extent of   (65.8%) and the open liver resection group 39 patients.
           resection.  Major  resections  were  defined  as  in  prior   Age, gender, race, and demographics were all similar
           studies as removal of three or greater segments.   between the 2 groups [Table 1]. The tumor size was
                                                              significantly larger in the open resection group while
           The  surgical evaluation and  resection techniques   the preoperative diagnosis  and etiology of cirrhosis
           used during  this study were identical  throughout   were similar.
           the series.  All resection  candidates  were evaluated
           with an  established criterion including:  preoperative   The operative outcomes were noted to have significant

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