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Introduction: Surgical resection for hepatocellular carcinoma (HCC) in patients with cirrhosis is associated with increased intra-operative and post-operative morbidity and mortality. Laparoscopic liver resection (LLR) is gaining acceptance as a safe method of resection. LLR of the cirrhotic liver is technically challenging, but may result in less post operative morbidity, shorter OR time, and shorter length of stay (LOS). Our center is now applying this technique to larger HCC than generally reported. Objective: To assess our initial experience using the first 11 laparoscopic cases of liver resection in cirrhotic patients matched with controls of open liver resection (OLR).Methods: We evaluated resections performed for HCC in patients with cirrhosis within a larger laparoscopic series. Each was matched to 3 open cases for number of segments removed, demographics, co-morbidity indices, and background liver histology. Non-parametric statistical analyses were used to compare surgical outcomes. Model for end-stage liver disease (MELD) and the Charslon co-morbidity index was applied retrospectively. Analyses were performed including and excluding converted cases.Results: Between October 2007 and May 2010, 11 cirrhotic patients underwent LLR for HCC. This included 2 right hemihepatectomies, 1 left hemihepatectomy, 7 left lateral sectionectomies and one trisegmentectomy (segments 5,6,7). Demographic characteristics were similar between groups. Intra-operatively, there were no differences in estimated blood loss, OR time, or transfusion requirement. 3 cases were converted to open (27%); 2 for bleeding and 1 for anatomical uncertainty. All cases were performed for HCC with no positive margins. Median margin distance was similar between LLR and OLR groups at 15mm and 8mm respectively. On radiology, median tumor size in the LLR group was larger at 5.5cm vs. 4.1cm (p=0.02). There were no differences in degree of fibrosis or steatosis in the background liver. Post-operatively, the average LOS in the LLR and OLR groups were 6.6 (range 4-12 days) and 11.1 (range 8-57 days) days respectively. There was no difference in frequency of ICU admission, post-operative transfusion, or number of complications. When converted cases were excluded OR time was lower in the LLR group at 195min vs. 266min (p=0.01). Conclusion: LLR appears to be a feasible approach for HCC in a cirrhotic liver. Our series has shown shorter OR time with similar negative margin rates and post-operative morbidity in a cohort of tumors larger than generally reported for a laparoscopic series. Although limited in power, our data suggest a clinically significant trend towards shorter LOS and OR time with LLR. As radiofrequency ablation is emerging as a curative therapy in the smaller HCC, laparoscopic surgery may play an increasing role in the management of larger resectable lesions.