Long-term outcome of laparoscopic liver resection for hepatocellular carcinoma

We thank Dr. Daniel Seehofer and Robert Sucher for their valuable comments on our article and for their suggestions for further study designs (1). Our responses to the issues raised are outlined hereafter.

Cirrhosis is a topic of interest raised by the current editorial because it also affects survival rates, similar to tumors. In patients with hepatocellular carcinoma (HCC), the background liver is cirrhotic to a certain degree. It is difficult to rank the extent of cirrhosis in a detailed manner based on the current liver damage classification system and because of the different levels of individual compensation to cirrhosis. Therefore, the same category of liver damage according to the Child-Pugh score does not represent the same liver function or extent of cirrhosis. Consequently, collecting a homogenous cohort of patients with cirrhosis is difficult. In all nonrandomized studies evaluating the survival of patients with HCC, this aspect is inevitably observed. However, the impact of cirrhosis does not influence metastatic liver tumors and there are relatively fewer confounding factors. However, the comparison of long-term survival rates in colorectal liver metastases is not available in the only high-quality randomized controlled trial (RCT) to date (2).