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. 2022 May;26(5):1041-1053.
doi: 10.1007/s11605-021-05226-4. Epub 2022 Jan 21.

Minimally Invasive vs Open Major Hepatectomies for Liver Malignancies: a Propensity Score-Matched Analysis

Ken Min Chin  1 , Yun-Le Linn  1 , Chin Kai Cheong  1   2 , Ye-Xin Koh  1   3   4 , Jin-Yao Teo  1   3 , Alexander Y F Chung  1   3   4 , Chung Yip Chan  1   3   4 , Brian K P Goh  5   6   7
Affiliations

Minimally Invasive vs Open Major Hepatectomies for Liver Malignancies: a Propensity Score-Matched Analysis

Ken Min Chin et al. J Gastrointest Surg. 2022 May.

Abstract

Background: The majority of evidence with regards to minimally invasive liver resection (MILR) favors its application in minor hepatectomies. We conducted a propensity score-matched (PSM) analysis to determine its feasibility and safety in major hepatectomies (MIMH) for liver malignancies.

Methods: Retrospective review of 130 patients who underwent MIMH and 490 patients who underwent open major hepatectomy (OMH) for malignant pathologies was performed. PSM in a 1:1 ratio identified two groups of patients with similar baseline clinicopathological characteristics. Perioperative outcomes were then compared. Major hepatectomies included traditional major (>3 segments) and technical major hepatectomies (right anterior and right posterior sectionectomies).

Results: Both cohorts were well-matched for baseline characteristics after PSM. Of 130 MIMH cases, there were 12 conversions to open. Comparison of perioperative outcomes demonstrated a significant association of MIMH with longer operation time and more frequent application of Pringle's maneuver (PM), but decreased postoperative stay. These results were consistent on a subgroup analysis that only included patients undergoing traditional major hepatectomies. A second subgroup analysis restricted to cirrhotic patients demonstrated that while perioperative outcomes were equivalent, MIMH was similarly associated with a longer operative time. Subset analyses of resections performed after 2015 demonstrated that MIMH was additionally associated with a lower postoperative morbidity compared to OMH.

Conclusion: Comparison of perioperative and short-term oncological outcomes between MIMH and OMH for malignancies demonstrated that MIMH is feasible and safe. It is associated with a shorter hospital stay at the expense of a longer operation time compared to OMH.

Keywords: Laparoscopic major hepatectomy; Laparoscopic major liver resection; Malignancy; Minimally invasive hepatectomy; Robotic hepatectomy.

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