Journal of Gastrointestinal Surgery

, Volume 20, Issue 9, pp 1608–1617 | Cite as

Minimally Invasive vs. Open Hepatectomy: a Comparative Analysis of the National Surgical Quality Improvement Program Database

  • Fabio Bagante
  • Gaya Spolverato
  • Steven M. Strasberg
  • Faiz Gani
  • Vanessa Thompson
  • Bruce L. Hall
  • David J. Bentrem
  • Henry A. Pitt
  • Timothy M. Pawlik
2016 SSAT Poster Presentation



While minimally invasive surgery (MIS) to treat liver tumors has increased, data on perioperative outcomes of MIS relative to open liver resection (O-LR) are lacking. We sought to compare short-term outcomes among patients undergoing MIS vs. O-LR in a nationally representative database.


The National Surgical Quality Improvement Program database was used to identify patients undergoing hepatectomy between January 1 and December 31, 2014. Propensity score matching algorithm was used to balance differences in baseline characteristics among MIS and O-LR groups.


A total of 3064 patients were included in the study. After propensity matching, the baseline characteristics for O-LR and MIS groups were comparable (minimum p value = 0.12). Incidence of superficial surgical site infections, intraoperative or postoperative blood transfusions, and pulmonary embolism was lower among patients in MIS group compared to O-LR (p < 0.02). Liver failure and biliary leakage were also less frequent among patients undergoing MIS (p < 0.01). Similarly, MIS was associated with a shorter length of hospital stay (LOS) compared to O-LR (p < 0.001). Of note, 30-day postoperative mortality and readmission were comparable between the two groups.


Patients undergoing MIS had a lower postoperative morbidity and shorter LOS compared with patients undergoing O-LR. MIS is safe and may be associated with improved short-term outcomes following hepatic surgery.


Liver surgery Minimally invasive surgery Laparoscopic surgery Robotic surgery 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Authors’ Contributions

All authors designed the work, revised the manuscript critically for important intellectual content, approved the final version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Fabio Bagante, Gaya Spolverato, and Timothy M. Pawlik analyzed and interpreted data. Fabio Bagante, Gaya Spolverato, and Timothy M. Pawlik drafted the work.

Supplementary material

11605_2016_3202_MOESM1_ESM.doc (54 kb)
ESM 1 (DOC 53 kb)


  1. 1.
    Belghiti J, Hiramatsu K, Benoist S et al. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 2000;191:38–46.CrossRefPubMedGoogle Scholar
  2. 2.
    Jarnagin WR, Gonen M, Fong Y et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 2002;236:397–406; discussion 406–397.Google Scholar
  3. 3.
    Dimick JB, Wainess RM, Cowan JA et al. National trends in the use and outcomes of hepatic resection. J Am Coll Surg 2004;199:31–38.CrossRefPubMedGoogle Scholar
  4. 4.
    Imamura H, Seyama Y, Kokudo N et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 2003;138:1198–1206; discussion 1206.CrossRefPubMedGoogle Scholar
  5. 5.
    Dimick JB, Pronovost PJ, Cowan JA, Jr. et al. Variation in postoperative complication rates after high-risk surgery in the United States. Surgery 2003;134:534–540; discussion 540–531.Google Scholar
  6. 6.
    Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection. Br J Surg 1998;85:1058–1060.CrossRefPubMedGoogle Scholar
  7. 7.
    Cammu G, Troisi R, Cuomo O et al. Anaesthetic management and outcome in right-lobe living liver-donor surgery. Eur J Anaesthesiol 2002;19:93–98.CrossRefPubMedGoogle Scholar
  8. 8.
    Birkmeyer JD, Dimick JB, Staiger DO. Operative mortality and procedure volume as predictors of subsequent hospital performance. Ann Surg 2006;243:411–417.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Hollenbeck BK, Dunn RL, Miller DC et al. Volume-based referral for cancer surgery: informing the debate. J Clin Oncol 2007;25:91–96.CrossRefPubMedGoogle Scholar
  10. 10.
    Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med 2009;361:1368–1375.CrossRefPubMedGoogle Scholar
  11. 11.
    Ejaz A, Sachs T, He J et al. A comparison of open and minimally invasive surgery for hepatic and pancreatic resections using the nationwide inpatient sample. Surgery. 2014;156(3):538–47Google Scholar
  12. 12.
    Ibrahim S, Chen CL, Wang SH et al. Liver resection for benign liver tumors: indications and outcome. Am J Surg 2007;193:5–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Charny CK, Jarnagin WR, Schwartz LH et al. Management of 155 patients with benign liver tumours. Br J Surg 2001;88:808–813.CrossRefPubMedGoogle Scholar
  14. 14.
    Margonis GA, Ejaz A, Spolverato G et al. Benign Solid Tumors of the Liver: Management in the Modern Era. J Gastrointest Surg. 2015;19(6):1157–68.Google Scholar
  15. 15.
    Mohiuddin K, Swanson SJ. Maximizing the benefit of minimally invasive surgery. J Surg Oncol 2013;108:315–319.CrossRefPubMedGoogle Scholar
  16. 16.
    Attwood SE, Hill AD, Mealy K, Stephens RB. A prospective comparison of laparoscopic versus open cholecystectomy. Ann R Coll Surg Engl 1992;74:397–400.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Glinatsis MT, Griffith JP, McMahon MJ. Open versus laparoscopic cholecystectomy: a retrospective comparative study. J Laparoendosc Surg 1992;2:81–86; discussion 87.CrossRefPubMedGoogle Scholar
  18. 18.
    Nakajima J, Takamoto S, Kohno T, Ohtsuka T. Costs of videothoracoscopic surgery versus open resection for patients with of lung carcinoma. Cancer 2000;89:2497–2501.CrossRefPubMedGoogle Scholar
  19. 19.
    Ohbuchi T, Morikawa T, Takeuchi E, Kato H. Lobectomy: video-assisted thoracic surgery versus posterolateral thoracotomy. Jpn J Thorac Cardiovasc Surg 1998;46:519–522.CrossRefPubMedGoogle Scholar
  20. 20.
    Lacy AM, Garcia-Valdecasas JC, Delgado S et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 2002;359:2224–2229.CrossRefPubMedGoogle Scholar
  21. 21.
    Kaseda S, Aoki T, Hangai N, Shimizu K. Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy. Ann Thorac Surg 2000;70:1644–1646.CrossRefPubMedGoogle Scholar
  22. 22.
    Gumbs AA, Rodriguez Rivera AM, Milone L, Hoffman JP. Laparoscopic pancreatoduodenectomy: a review of 285 published cases. Ann Surg Oncol 2011;18:1335–1341.CrossRefPubMedGoogle Scholar
  23. 23.
    Ammori BJ, Ayiomamitis GD. Laparoscopic pancreaticoduodenectomy and distal pancreatectomy: a UK experience and a systematic review of the literature. Surg Endosc 2011;25:2084–2099.CrossRefPubMedGoogle Scholar
  24. 24.
    Ejaz A, et al. A comparison of open and minimally invasive surgery for hepatic and pancreatic resections using the nationwide inpatient sample. Surgery. 2014;156(3):538–47Google Scholar
  25. 25.
    Rao A, Rao G, Ahmed I. Laparoscopic vs. open liver resection for malignant liver disease. A systematic review. Surgeon 2012;10:194–201.CrossRefPubMedGoogle Scholar
  26. 26.
    Cardinal JS, Reddy SK, Tsung A et al. Laparoscopic major hepatectomy: pure laparoscopic approach versus hand-assisted technique. J Hepatobiliary Pancreat Sci 2013;20:114–119.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Tsung A, Geller DA, Sukato DC et al. Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg 2014;259:549–555.CrossRefPubMedGoogle Scholar
  28. 28.
    Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 2005;19:168–173.CrossRefPubMedGoogle Scholar
  29. 29.
    Kim HH, Hyung WJ, Cho GS et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 2010;251:417–420.CrossRefPubMedGoogle Scholar
  30. 30.
    Nguyen KT, Marsh JW, Tsung A et al. Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch Surg 2011;146:348–356.CrossRefPubMedGoogle Scholar
  31. 31.
    Mesleh MG, Stauffer JA, Bowers SP, Asbun HJ. Cost analysis of open and laparoscopic pancreaticoduodenectomy: a single institution comparison. Surg Endosc 2013;27:4518–4523.CrossRefPubMedGoogle Scholar
  32. 32.
    Cannon RM, Scoggins CR, Callender GG et al. Laparoscopic versus open resection of hepatic colorectal metastases. Surgery 2012;152:567–573; discussion 573-564.CrossRefPubMedGoogle Scholar
  33. 33.
    Henderson WG, Daley J. Design and statistical methodology of the National Surgical Quality Improvement Program: why is it what it is? Am J Surg 2009;198:S19–27.CrossRefPubMedGoogle Scholar
  34. 34.
    ACS NSQIP Data Collection A, and Reporting. Available from: Accessed 30 Jun 2016.
  35. 35.
    Miller PE, Dao H, Paluvoi N, et al. Comparison of 30-Day Postoperative Outcomes after Laparoscopic vs Robotic Colectomy. J Am Coll Surg. 2016. doi: 10.1016/j.jamcollsurg.2016.03.041.
  36. 36.
    Brenkman HJ, Haverkamp L, Ruurda JP, van Hillegersberg R. Worldwide practice in gastric cancer surgery. World J Gastroenterol 2016;22:4041–4048.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Kaplan JR, Lee Z, Eun DD, Reese AC. Complications of Minimally Invasive Surgery and Their Management. Curr Urol Rep 2016;17:47.CrossRefGoogle Scholar
  38. 38.
    Medlin EE, Kushner DM, Barroilhet L. Robotic surgery for early stage cervical cancer: Evolution and current trends. J Surg Oncol 2015;112:772–781.CrossRefPubMedGoogle Scholar
  39. 39.
    Tranchart H, O’Rourke N, Van Dam R et al. Bleeding control during laparoscopic liver resection: a review of literature. J Hepatobiliary Pancreat Sci 2015;22:371–378.CrossRefPubMedGoogle Scholar
  40. 40.
    Hasegawa Y, Nitta H, Sasaki A et al. Long-term outcomes of laparoscopic versus open liver resection for liver metastases from colorectal cancer: A comparative analysis of 168 consecutive cases at a single center. Surgery 2015;157:1065–1072.CrossRefPubMedGoogle Scholar
  41. 41.
    Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection-2,804 patients. Ann Surg 2009;250:831–841.CrossRefPubMedGoogle Scholar
  42. 42.
    Schiffman SC, Kim KH, Tsung A et al. Laparoscopic versus open liver resection for metastatic colorectal cancer: a metaanalysis of 610 patients. Surgery 2015;157:211–222.CrossRefPubMedGoogle Scholar
  43. 43.
    Rose S, Laan MJ. Why match? Investigating matched case-control study designs with causal effect estimation. Int J Biostat 2009;5: Article 1.CrossRefPubMedGoogle Scholar
  44. 44.
    Vitale A, Spolverato G, Bagante F et al. A multi-institutional analysis of elderly patients undergoing a liver resection for intrahepatic cholangiocarcinoma. J Surg Oncol 2016;113:420–426.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2016

Authors and Affiliations

  • Fabio Bagante
    • 1
  • Gaya Spolverato
    • 1
  • Steven M. Strasberg
    • 2
  • Faiz Gani
    • 1
  • Vanessa Thompson
    • 3
  • Bruce L. Hall
    • 2
  • David J. Bentrem
    • 4
  • Henry A. Pitt
    • 5
  • Timothy M. Pawlik
    • 1
  1. 1.Department of SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of SurgeryWashington University in St. LouisSt. LouisUSA
  3. 3.American College of Surgeons - National Surgical Quality Improvement ProgramChicagoUSA
  4. 4.Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoUSA
  5. 5.Department of SurgeryLewis Katz School of Medicine at Temple UniversityPhiladelphiaUSA

Personalised recommendations