World Journal of Surgery

, Volume 42, Issue 8, pp 2627–2634 | Cite as

Laparoscopic Versus Open Approach for Formal Right and Left Hepatectomy: A Propensity Score Matching Analysis

  • Francesca Tozzi
  • Giammauro Berardi
  • Maaike Vierstraete
  • Meidai Kasai
  • Luis Abreu de Carvalho
  • Marco Vivarelli
  • Roberto Montalti
  • Roberto Ivan TroisiEmail author
Original Scientific Report



Laparoscopic liver surgery is expanding worldwide, but further evidence is needed to assess safety and efficacy of laparoscopic major hepatectomy. The study analyzes perioperative outcomes of pure laparoscopic versus open major hepatectomies matched by the propensity score method.


From 2005 to 2017, 268 major hepatectomies were performed of which 73 were laparoscopic. After a 1:1 propensity score matching, 59 laparoscopic right and left hepatectomies were compared to 59 open. The matching was based on age, gender, year of procedure, BMI, ASA score, underlying liver disease, previous abdominal surgery, type of hepatectomy, preoperative chemotherapy, number, dimension and nature of lesions. An intention-to-treat analysis and a per-protocol analysis were carried out.


Mean surgical time was 315 min in the laparoscopic group and 292.5 min in the open group (p = 0.039); conversion rate in laparoscopy was 20.3%; blood loss was 480 ml (50–3000) versus 550 ml (50–2600), respectively, for laparoscopic and open (p = 0.577). Lengths of postoperative analgesia and hospital stay were shorter in the laparoscopic group (p = 0.0001 and 0.024, respectively). Postoperative complications occurred in 11.9% of laparoscopic cases and in 25.4% of open cases (p = 0.098). Median Comprehensive Complication Index was 26.2 (8.7–54.2) in the open group versus 20.9 (8.7–66.2) in open (p = 0.368). Per-protocol analysis showed a better trend in favor of laparoscopy concerning surgical time.


Laparoscopic major hepatectomies are safe and feasible procedures allowing a similar complication rate with a shorter hospital stay and diminished postoperative pain with respect to the standard approach.



The authors wish to thank Prof. Osamu Itano from the Dept. of Gastroenterological Surgery, Kaken Hospital, Ichikawa, Japan for his critical review of the manuscript.

Compliance with ethical standards

Conflict of interest

All the authors declare no conflict of interest.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Francesca Tozzi
    • 1
  • Giammauro Berardi
    • 1
  • Maaike Vierstraete
    • 1
  • Meidai Kasai
    • 1
    • 2
  • Luis Abreu de Carvalho
    • 1
  • Marco Vivarelli
    • 3
  • Roberto Montalti
    • 3
  • Roberto Ivan Troisi
    • 1
    Email author
  1. 1.Department of General, Hepatobiliary and Liver Transplantation SurgeryGhent University Hospital and Medical SchoolGhentBelgium
  2. 2.Abdominal Surgery Aso Iizuka HospitalFukuokaJapan
  3. 3.Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical MedicineUniversità Politecnica delle MarcheAnconaItaly

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