Comparison of perioperative outcomes between pure laparoscopic surgery and open right hepatectomy in living donor hepatectomy: Propensity score matching analysis

Abstract

Pure laparoscopic donor right hepatectomy (PLDRH) is not a standard procedure for living donor liver transplantation but is safe and reproducible in the hands of experienced surgeons. However, the perioperative outcomes of PLDRH have not been fully evaluated yet. We used propensity score matching to compare the perioperative complications and postoperative short-term outcomes of donors undergoing PLDRH and open donor right hepatectomy (ODRH). A total of 325 consecutive donors who underwent elective, adult-to-adult right hepatectomy were initially screened. After propensity score matching, all patients were divided into two groups: PLDRH (n = 123) and ODRH (n = 123) groups. Perioperative complications and postoperative outcomes were compared between the two groups. Postoperative pulmonary complications were significantly more common in the ODRH than in the PLDRH group (54.5 vs. 31.7%, P < 0.001). The biliary complications (leak and stricture) were higher in PLDRH group than in the ODRH group (8% vs. 3%), but it failed to reach statistical significance (P = 0.167). Overall, surgical complication rates were similar between the two groups (P = 0.730). The opioid requirement during the first 7 postoperative days was higher in the ODRH group (686 vs. 568 mg, P < 0.001). The hospital stay and time to the first meal were shorter in the PLDRH than in the ODRH group (P = 0.003 and P < 0.001, respectively). PLDRH reduced the incidence of postoperative pulmonary complications and afforded better short-term postoperative outcomes compared to ODRH. However, surgical complication rates were similar in both groups.

Figure 1

Flow diagram of the study. ODRH, open donor right hepatectomy; PLDRH, pure laparoscopic donor right hepatectomy; PSM, propensity score matching.

Figure 2

(A) The intraoperative hemodynamic parameters monitored in ODRH and PLDRH patients. (B) The intraoperative respiratory parameters monitored in ODRH and PLDRH patients. MAP, mean arterial pressure; HR, heart rate; PPV, pulse pressure variation; TV, tidal volume; PIP, peak inspiratory pressure; Pplat, plateau airway pressure.

Figure 3

Laboratory findings during the pre- and postoperative periods. (A) Serum aspartate aminotransferase levels; (B) Serum alanine aminotransferase levels; (C) Hemoglobin levels; (D). Platelet counts; (E). Total bilirubin levels; (F). Creatinine levels; (G). International normalized ratios; (H). Activated partial thromboplastin times. PREOP, pre-operative period; POSTOP, immediate postoperative period; POD1, postoperative day 1; POD3, postoperative day 3; POD5, postoperative day 5.