Comparison of laparoscopic versus open liver tumor resection: a case-controlled study
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Although there are data in the literature about the safety and efficacy of laparoscopic liver resections, there are not many studies comparing laparoscopic versus open approaches in a case-matched design. The purpose of this study is to compare the perioperative outcome of laparoscopic versus open liver resections from a single institution.
Thirty-one patients underwent laparoscopic liver resection between April 1997 and August 2007, with a prospective laparoscopic program started in April 2006 (n = 25). This group of patients was compared with 43 consecutive patients undergoing open resection who were matched by size of the lesion (5 cm or less for malignant and 8 cm or less for benign), anatomical location (segments 2, 3, 4b, 5, 6), and type of resection (wedge resection, segmentectomy, partial liver resection). Data were obtained from medical records as well as from a prospective database. Statistical analysis was performed using t-test and chi-square. All data are expressed as mean ± standard error on the mean (SEM).
Mean age in the laparoscopic group was 57.6 ± 2.7 years versus 61.9 ± 2.3 years in the open group (p = 0.2). There were more women in the laparoscopic group [74% females (n = 23) and 26% males (n = 8)] versus in the open group [40% females (n = 17) and 60% males (n = 26)] (p = 0.003). There were more patients with malignant lesions in the open group (73%) versus in the laparoscopic group (45%) (p = 0.01). Eight patients underwent partial and 23 patients segmental/wedge liver resection in the laparoscopic group versus 15 patients who underwent partial and 28 patients segmental/wedge liver resection in the open group (p = 0.7). Mean tumor size was 3.9 ± 0.4 cm in the laparoscopic group versus 4.2 ± 0.3 cm in the open group (p = 0.5). Ten (32%) out of 31 cases in the laparoscopic group were hand-assisted. Inflow occlusion was used in 1 case (3%) in the laparoscopic group versus 16 (37.2%) in the open group. Mean operating time was 201 ± 15 min for the laparoscopic group and 172 ± 12 min for the open group (p = 0.1). Mean estimated blood loss during the procedure was 122.5 ± 45.4 cc for the laparoscopic group and 299.6 ± 33.6 cc for the open group (p = 0.002). Surgical margin was similar for malignant cases in both groups. Mean hospital stay was 3.2 ± 1.0 days for the laparoscopic group and 6.8 ± 0.7 days for the open group (p = 0.004). The incidence of postoperative complications was 13% (n = 4) in the laparoscopic and 16% (n = 7) in the open group (p = 0.7).
This study shows that, with a longer operative time, the laparoscopic approach, despite the learning curve, offers advantages regarding operative blood loss, postoperative analgesic requirement, time to regular diet, hospital stay, and overall cost compared with the open approach for minor liver resections.
- Gagner M, Rheault M, Dubuc J (1992) Laparoscopic partial hepatectomy for liver tumor. Surg Endosc Abstr 6:99
- Ferzli G, David A, Kiel T (1995) Laparoscopic resection of a large hepatic tumor. Surg Endosc 9:733–735
- Koffron AJ, Auffenberg G, Kung R, Abecassis M (2007) Evaluation of 300 minimally invasive liver resections at a single institution. Ann Surg 246:385–394 CrossRef
- Buell JF, Thomas MJ, Doty TC, Gersin KS, Merchen TD, Gupta M, Rudich SM, Woodle ES (2004) An initial experience and evolution of laparoscopic hepatic resectional surgery. Surgery 136:804–811 CrossRef
- Descottes B, Glineur D, Lachachi F, Valleix D, Paineau J, Hamy A, Morino M, Bismuth H, Castaing D, Savier E, Honore P, Detry O, Legrand M, Azagra JS, Goergen M, Ceuterick M, Marescaux J, Mutter D, de Hemptinne B, Troisi R, Weerts J, Dallemagne B, Jehaes C, Gelin M, Donckier V, Aerts R, Topal B, Bertrand C, Mansvelt B, Van Krunckelsven L, Herman D, Kint M, Totte E, Schockmel R, Gigot JF (2003) Laparoscopic liver resection of benign liver tumors results of a multicenter European experience. Surg Endosc 17:23–30 CrossRef
- Dulucq JL, Wintringer P, Stabilini C, Berticelli J, Mahajna A (2005) Laparoscopic liver resections: a single center experience. Surg Endosc 19:886–891 CrossRef
- Farges O, Jagot P, Kirstetter P, Marty J, Belghiti J (2002) Prospective assessment of the safety and benefit of laparoscopic liver resections. J Hepatobiliary Pancreat Surg 9:242–248 CrossRef
- Lesurtel M, Cherqui D, Laurent A, Tayar C, Fagniez PL (2003) Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg 196:236–242 CrossRef
- Morino M, Morra I, Rosso E, Miglietta C, Garrone C (2003) Laparoscopic vs open hepatic resection a comparative study. Surg Endosc 17:1914–1918 CrossRef
- Simillis C, Constantinides VA, Tekkis PP, Darzi A, Lovegrove R, Jiao L, Antoniou A (2007) Laparoscopic versus open hepatic resections for benign and malignant neoplasms—a meta-analysis. Surgery 141:203–211 CrossRef
- Cherqui D, Laurent A, Tayar C, Chang S, Van Nhieu JT, Loriau J, Karoui M, Duvoux C, Dhumeaux D, Fagniez PL (2006) Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease midterm results and perspectives. Ann Surg 243:499–506 CrossRef
- Belli G, Fantini C, D’Agostino A, Cioffi L, Langelle S, Russolino N, Belli A (2007) Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results. Surg Endosc 21:2004–2011 CrossRef
- Rogula T, Gagner M (2004) Current status of the laparoscopic approach to liver resection. J Long Term Eff Med Implants 14:23–32 CrossRef
- Biettho L, Waage A, Gagner M (2002) Laparoscopic hepatectomy. Ann Chir 127:164–170 CrossRef
- Robles R, Marin C, Abelian B, Lopez A, Pastor P, Parilla P (2008) A new approach to hand assisted laparoscopic liver surgery. Surg Endosc 22(11):2357–2364
- Vibert E, Perniceni T, Levard H, Denet C, Shahri NK, Gayet B (2006) Laparoscopic liver resection. Br J Surg 93:67–72 CrossRef
- Soubrane O, Cherqui D, Scatton O, Stenard F, Bernard D, Branchereau S, Martelli H, Gauthier F (2006) Laparoscopic left lateral sectionectomy in living donors Safety and reproducibility of the technique in single center. Ann Surg 244:815–820 CrossRef
- Comparison of laparoscopic versus open liver tumor resection: a case-controlled study
Volume 23, Issue 4 , pp 847-853
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