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Surg Endosc. 2019 May;33(5):1451-1458. doi: 10.1007/s00464-018-6426-3. Epub 2018 Sep 10.

Laparoscopic liver resection of hepatocellular carcinoma located in unfavorable segments: a propensity score-matched analysis from the I Go MILS (Italian Group of Minimally Invasive Liver Surgery) Registry.

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Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy.
Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy.
Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Milan, Italy.
Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
Department of Surgery, Parma University Hospital, Parma, Italy.
Department of Hepatobiliary Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy.
HPB Surgery and Liver Transplantation, Department of Surgery, University of Milan, Milan, Italy.
Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy.
Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
Abdominal Surgery and Organ Transplant Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Mediterranean Institute for Transplantation and Specialization Therapies (IRCCS-ISMETT), Palermo, Italy.
Surgical and Transplant Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.



Laparoscopic liver resection (LLR) for Hepatocellular Carcinoma (HCC) is one of the most important indications for the minimally invasive approach. Our study aims to analyze the experience of the Italian Group of Minimally Invasive Liver Surgery with laparoscopic surgical treatment of HCC, with a focus on tumor location and how it affects morbidity and mortality.


38 centers participated in this study; 372 cases of LLR for HCC were prospectively enrolled. Patients were divided into two groups according to the HCC nodule location. Group 1 favorable location and group 2 unfavorable location. Perioperative outcomes were compared between the two groups before and after a propensity score match (PS) 1:1.


Before PS in group 2 surgical time was longer; conversion rate was higher; postoperative transfusion and comprehensive complication index were also higher. PS was performed with a cohort of 298 patients (from 18 centers), with 66 and 232 patients with HCC in unfavorable and favorable locations, respectively. After PS matching, 62 patients from group 1 and group 2 each were compared. Operative and postoperative course were similar in patients with HCC in favorable and unfavorable LLR locations. Surgical margins were found to be identical before and after PS.


These results show that LLR in patients with HCC can be safely performed in all segments because of the extensive experience of all surgeons from multiple centers in performing traditional open liver surgery as well as laparoscopic surgery.


Child B; Hepatocellular carcinoma; IGoMILS; Laparoscopic HCC; Laparoscopic liver resection; Posterior segment


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