Laparoscopic versus open liver resection of hepatic neoplasms: comparative analysis of short-term results
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- Topal, B., Fieuws, S., Aerts, R. et al. Surg Endosc (2008) 22: 2208. doi:10.1007/s00464-008-0023-9
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Concerns have been raised regarding outcome after laparoscopic resection of hepatic neoplasms. This prospective study compared morbidity and adequacy of surgical margins in laparoscopic (LLR) versus open liver resection (OLR).
Outcome in 359 consecutive patients [male/female ratio 187/172; median age 60 years (range 18–84 years)] who underwent partial hepatectomy was analysed. Cirrhosis was present in 32 patients and preoperative chemotherapy was administered in 141 patients. Comparative analyses were performed using propensity scores for all and for matched patients (n = 76 per group).
Complications occurred in 68/250 (27.2%) patients after OLR and in 6/109 (5.5%) after LLR [odds ratio (OR) 0.16; 95% confidence interval (CI) 0.07–0.37; p < 0.0001]. Median intraoperative blood loss was 500 ml (range 10–7,000 ml) in OLR and 100 ml (range 5–4,000 ml) in LLR (p < 0.0001). Postoperative hospital stay was 8 days (range 0–155 days) after OLR and 6 days (range 0–41 days) after LLR (p < 0.0001). In patients treated for liver malignancy, the surgical resection margin was positive on histopathological examination in 5/237 after OLR and in 1/77 after LLR. The magnitude of the resection margin was 7.5 mm (range 0–45 mm) in OLR and 10.0 mm (range 0–30 mm) in LLR (p = 0.087).
LLR for hepatic neoplasms seems to be noninferior to OLR regarding adequacy of surgical margins, and superior to OLR regarding short-term postoperative outcome.