Minimally Invasive vs. Open Hepatectomy: a Comparative Analysis of the National Surgical Quality Improvement Program Database
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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.
KeywordsLiver surgery Minimally invasive surgery Laparoscopic surgery Robotic surgery
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no competing interests.
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.
- 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
- 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
- 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
- 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
- 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
- 34.ACS NSQIP Data Collection A, and Reporting. Available from: http://site.acsnsqip.org/program-specifics/data-collection-analysis-and-reporting/. Accessed 30 Jun 2016.
- 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.