Abstract
Background
Patients with hepatocellular adenomas are, in selected cases, candidates for liver resection, which can be approached via laparoscopy or laparotomy. The present study aimed to investigate the effects of the surgical approach on the postoperative morbidities of both minor and major liver resections.
Methods
In this multi-institutional study, all patients who underwent open or laparoscopic hepatectomies for hepatocellular adenomas between 1989 and 2013 in 27 European centers were retrospectively reviewed. A multiple imputation model was constructed to manage missing variables. Comparisons of both the overall rate and the types of complications between open and laparoscopic hepatectomy were performed after propensity score adjustment (via the standardized mortality ratio weighting method) on the factors that influenced the choice of the surgical approach.
Results
The laparoscopic approach was selected in 208 (38%) of the 533 included patients. There were 194 (93%) women. The median age was 38.9 years. After the application of multiple imputation, 208 patients who underwent laparoscopic operations were compared with 216 patients who underwent laparotomic operations. After adjustment, there were 20 (9.6%) major liver resections in the laparoscopy group and 17 (7.9%) in the open group. The conversion rate was 6.3%. The two surgical approaches exhibited similar postoperative morbidity rates and severities. Laparoscopic resection was associated with significantly less blood loss (93 vs. 196 ml, p < 0.001), a less frequent need for pedicle clamping (21 vs. 40%, p = 0.002), a reduced need for transfusion (8 vs. 24 red blood cells units, p < 0.001), and a shorter hospital stay (5 vs. 7 days, p < 0.001). The mortality was nil.
Conclusions
Laparoscopy can achieve short-term outcomes similar to those of open surgery for hepatocellular adenomas and has the additional benefits of a reduced blood loss, need for transfusion, and a shorter hospital stay.
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Collaborators of the AFC-HCA-2013 Study Group
François-René Pruvot Department of Digestive Surgery and Transplantation, Lille University Hospital, Nord de France University, Lille, France. Jean-Michel Fabre Department of Digestive Surgery and Transplantation, St Eloi Hospital, Montpellier, France. Christian Letoublon Clinique d’ Hépatogastroentérologie, pôle DigiDune, Grenoble University Hospital, France. Philippe Bachellier Department of Surgery, University Hospital of Hautepierre, Strasbourg, France. Olivier Farges, Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France. Jean-Yves Mabrut Department of Surgery, Croix Rousse Hospital, Lyon. Yves-Patrice Le Treut Department of Surgery, la Timone Hospital, Marseille, France. Bertrand Suc Department of Digestive Surgery and Transplantation, Rangueil University Hospital, Toulouse, France. Irinel Popescu Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania. Marco Montorsi Department of General Surgery, Humanitas University and Research Hospital, Milano, Italy. Jacques Belghiti, Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France. Jean-Marc Régimbaud – CHU Amiens-Picardie, France. Romain Riboud – CHU Grenoble, France. Alexandra Dili – La Louvière, Hôpital de Jolimont, Belgium. Pierre Allemann – (CHUV), Lausanne, Switzerland. Emmanuel Boleslawski - CHRU Lille, France. Benjamin Darnis – CHU Lyon, France. Mustapha Adham, CHU Lyon, France. Emilie Bollon – CHU Marseille, France. Bernard Pol – Hôpital Saint-Joseph, Marseille, France. Jean-Robert Delpero – Institut Paoli-Calmettes, Marseille, France. Olivier Turrini – Institut Paoli-Calmettes, Marseille, France. Frédéric Borie – CHU-Nimes, France. Mathieu Gonot-Gachard – CHU-Nimes, France. Laura Ornella Perotto – CHU Pitié-Salpétrière, Paris, France. Riccardo Gauzolino – CHU-Poitier, France. Marie Castagnet – CHU-Poitier, France. Reza Kianmanesh – CHU-Reims, France. Daniele Sommacale – CHU-Reims, France. Mikael Chetboun – CHU-Reims, France. Jean-Luc Porcheron – CHU-St-Etienne, France. Alexandre Filippello – CHU-St-Etienne, France. Patrick Pessaux – CHU-Strasbourg, France. Pietro Addeo – CHU-Strasbourg, France. Manuela Cesaretti – CHU-Strasbourg, France.
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Filippo Landi, Nicola de’Angelis, Olivier Scatton, Xavier Vidal, Ahmet Ayav, Fabrice Muscari, Safi Dokmak, Guido Torzilli, Nicolas Demartines, Olivier Soubrane, Daniel Cherqui, Jean Hardwigsen, and Alexis Laurent have no conflicts of interest or financial ties to disclose in relation to the results of the present study.
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Filippo Landi and Nicola de Angelis have contributed equally to this work.
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Landi, F., de’ Angelis, N., Scatton, O. et al. Short-term outcomes of laparoscopic vs. open liver resection for hepatocellular adenoma: a multicenter propensity score adjustment analysis by the AFC-HCA-2013 study group. Surg Endosc 31, 4136–4144 (2017). https://doi.org/10.1007/s00464-017-5466-4
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DOI: https://doi.org/10.1007/s00464-017-5466-4