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Laparoscopic liver resection reduces postoperative infection in patients with hepatocellular carcinoma: a propensity score-based analysis

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Abstract

Background

This study is aimed to compare the occurrence of postoperative infections between patients with hepatocellular carcinoma (HCC) undergoing laparoscopic liver resection (LLR) and those undergoing open liver resection (OLR).

Methods

This study included 446 patients who underwent initial curative liver resection for HCC 5 cm or less in size without macroscopic vascular invasion. To adjust for confounding factors between the LLR and OLR groups, propensity score matching and inverse probability weighting (IPW) analysis were performed. The incidence rates of postoperative infection, including incisional surgical site infection (SSI), organ/space SSI, and remote infection (RI), were compared between the two groups.

Results

An imbalance in several confounding variables, including period of surgery, extent of liver resection, difficult location, proximity to a major vessel, tumor size ≥ 3 cm, and multiple tumors, was observed between the two groups in the original cohort. After matching and weighting, the imbalance between the two groups significantly decreased. Compared with OLR, LLR was associated with a lower volume of intraoperative blood loss (140 vs. 350 mL, P < 0.001 in the matched cohort; 120 vs. 320 mL, P < 0.001 in the weighted cohort) and reduced risk of postoperative infection (2.0% vs. 12%, P = 0.015 in the matched cohort; 2.9% vs. 14%, P = 0.005 in the weighted cohort). Of the types of postoperative infections, organ/space SSI and RI were less frequently observed in the LLR group than in the OLR group in the matched cohort (1.0% vs. 6.0%, P = 0.091 for organ/space SSI; 0% vs. 6.0%, P < 0.001 for RI) and in the weighted cohort (1.2% vs. 7.8%, P < 0.001 for organ/space SSI; 0.3% vs. 5.1%, P = 0.009 for RI).

Conclusions

Compared with OLR, LLR for HCC might reduce postoperative infections, including organ/space SSI and RI.

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Acknowledgements

This work was supported by Health, Labour and Welfare Policy Research Grants from the Ministry of Health, Labour, and Welfare of Japan (Policy Research for Hepatitis Measures [H30-Kansei-Shitei-003]).

Funding

This work was supported by Health, Labour and Welfare Policy Research Grants from the Ministry of Health, Labour, and Welfare of Japan (Policy Research for Hepatitis Measures [H30-Kansei-Shitei-003]).

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Daisuke Shirai, Hiroji Shinkawa, Shigekazu Takemura, Shogo Tanaka, Ryosuke Amano, Kenjiro Kimura, Go Ohira, Kohei Nishio, Jun Tauchi, Masahiko Kinoshita & Shoji Kubo

  2. Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan

    Daijiro Kabata

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  1. Daisuke Shirai
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Correspondence to Hiroji Shinkawa.

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Daisuke Shirai, Hiroji Shinkawa, Daijiro Kabata, Shigekazu Takemura, Shogo Tanaka, Ryosuke Amano, Kenjiro Kimura, Go Ohira, Kohei Nishio, Jun Tauchi, Masahiko Kinoshita, and Shoji Kubo have no conflicts of interest or financial ties to disclose.

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Shirai, D., Shinkawa, H., Kabata, D. et al. Laparoscopic liver resection reduces postoperative infection in patients with hepatocellular carcinoma: a propensity score-based analysis. Surg Endosc 36, 9194–9203 (2022). https://doi.org/10.1007/s00464-022-09403-7

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  • DOI: https://doi.org/10.1007/s00464-022-09403-7

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