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

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS, World Consensus Conference on Laparoscopic S (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830

    Article  PubMed  Google Scholar 

  2. Bryant R, Laurent A, Tayar C, Cherqui D (2009) Laparoscopic liver resection-understanding its role in current practice: the Henri Mondor Hospital experience. Ann Surg 250:103–111

    Article  PubMed  Google Scholar 

  3. Cherqui D, Husson E, Hammoud R, Malassagne B, Stephan F, Bensaid S, Rotman N, Fagniez PL (2000) Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 232:753–762

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Dokmak S, Raut V, Aussilhou B, Fteriche FS, Farges O, Sauvanet A, Belghiti J (2014) Laparoscopic left lateral resection is the gold standard for benign liver lesions: a case-control study. HPB (Oxford) 16:183–187

    Article  Google Scholar 

  5. Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G (2016) Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg 263:761–777

    Article  PubMed  Google Scholar 

  6. McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, Nicholl J, Collaboration B (2009) Surgical innovation and evaluation 3 no surgical innovation without evaluation: the IDEAL recommendations. Lancet 374:1105–1112

    Article  PubMed  Google Scholar 

  7. Wakabayashi G, Cherqui D, Geller DA, Buell JE, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CHD, Edwin B, Choi GH, Aldrighetti LA, Cai XJ, Clemy S, Chen KH, Schon MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629

    PubMed  Google Scholar 

  8. Brown KM, Geller DA (2016) What is the learning curve for laparoscopic major hepatectomy? J Gastrointest Surg 20:1065–1071

    Article  PubMed  Google Scholar 

  9. Cherqui D (2003) Laparoscopic liver resection. Br J Surg 90:644–646

    Article  PubMed  CAS  Google Scholar 

  10. Vigano L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D (2009) The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg 250:772–782

    Article  PubMed  Google Scholar 

  11. Kluger MD, Vigano L, Barroso R, Cherqui D (2013) The learning curve in laparoscopic major liver resection. J Hepatobiliary Pancreat Sci 20:131–136

    Article  PubMed  Google Scholar 

  12. Tomassini F, Scuderi V, Colman R, Vivarelli M, Montalti R, Troisi RI (2016) The single surgeon learning curve of laparoscopic liver resection: a continuous evolving process through stepwise difficulties. Medicine (Baltimore) 95:e5138

    Article  Google Scholar 

  13. Berardi G, Van Cleven S, Fretland AA, Barkhatov L, Halls M, Cipriani F, Aldrighetti L, Abu Hilal M, Edwin B, Troisi RI (2017) Evolution of laparoscopic liver surgery from innovation to implementation to mastery: perioperative and oncologic outcomes of 2,238 patients from 4 European Specialized Centers. J Am Coll Surg 225:639–649

    Article  PubMed  Google Scholar 

  14. van Dam RM, Wong-Lun-Hing EM, van Breukelen GJ, Stoot JH, van der Vorst JR, Bemelmans MH, Olde Damink SW, Lassen K, Dejong CH, Group OIS (2012) Open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery ERAS(R) programme (ORANGE II-trial): study protocol for a randomised controlled trial. Trials 13:54

    Article  PubMed  PubMed Central  Google Scholar 

  15. Abu Hilal M, Di Fabio F, Teng MJ, Lykoudis P, Primrose JN, Pearce NW (2011) Single-centre comparative study of laparoscopic versus open right hepatectomy. J Gastrointest Surg 15:818–823

    Article  PubMed  Google Scholar 

  16. Dagher I, Di Giuro G, Dubrez J, Lainas P, Smadja C, Franco D (2009) Laparoscopic versus open right hepatectomy: a comparative study. Am J Surg 198:173–177

    Article  PubMed  Google Scholar 

  17. Namgoong JM, Kim KH, Park GC, Jung DH, Song GW, Ha TY, Moon DB, Ahn CS, Hwang S, Lee SG (2014) Comparison of laparoscopic versus open left hemihepatectomy for left-sided hepatolithiasis. Int J Med Sci 11:127–133

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Fuks D, Cauchy F, Fteriche S, Nomi T, Schwarz L, Dokmak S, Scatton O, Fusco G, Belghiti J, Gayet B, Soubrane O (2016) Laparoscopy decreases pulmonary complications in patients undergoing major liver resection: a propensity score analysis. Ann Surg 263:353–361

    Article  PubMed  Google Scholar 

  19. Cauchy F, Fuks D, Nomi T, Schwarz L, Barbier L, Dokmak S, Scatton O, Belghiti J, Soubrane O, Gayet B (2015) Risk factors and consequences of conversion in laparoscopic major liver resection. Br J Surg 102:785–795

    Article  PubMed  CAS  Google Scholar 

  20. Takahara T, Wakabayashi G, Konno H, Gotoh M, Yamaue H, Yanaga K, Fujimoto J, Kaneko H, Unno M, Endo I, Seto Y, Miyata H, Miyazaki M, Yamamoto M (2016) Comparison of laparoscopic major hepatectomy with propensity score matched open cases from the National Clinical Database in Japan. J Hepatobiliary Pancreat Sci 23:721–734

    Article  PubMed  Google Scholar 

  21. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  22. Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258:1–7

    Article  PubMed  Google Scholar 

  23. Schultz NA, Larsen PN, Klarskov B, Plum LM, Frederiksen HJ, Christensen BM, Kehlet H, Hillingso JG (2013) Evaluation of a fast-track programme for patients undergoing liver resection. Br J Surg 100:138–143

    Article  PubMed  CAS  Google Scholar 

  24. Soubrane O, Schwarz L, Cauchy F, Perotto LO, Brustia R, Bernard D, Scatton O (2015) A conceptual technique for laparoscopic right hepatectomy based on facts and oncologic principles: the caudal approach. Ann Surg 261:1226–1231

    Article  PubMed  Google Scholar 

  25. Troisi RI, Montalti R (2012) Modified hanging maneuver using the goldfinger dissector in laparoscopic right and left hepatectomy. Dig Surg 29:463–467

    Article  PubMed  Google Scholar 

  26. Parks KR, Kuo YH, Davis JM, O’Brien B, Hagopian EJ (2014) Laparoscopic versus open liver resection: a meta-analysis of long-term outcome. HPB (Oxford) 16:109–118

    Article  Google Scholar 

  27. Laurent A, Cherqui D, Lesurtel M, Brunetti F, Tayar C, Fagniez PL (2003) Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 138:763–769 (discussion 769)

    Article  PubMed  Google Scholar 

  28. Morino M, Morra I, Rosso E, Miglietta C, Garrone C (2003) Laparoscopic vs open hepatic resection: a comparative study. Surg Endosc 17:1914–1918

    Article  PubMed  CAS  Google Scholar 

  29. Troisi RI, Montalti R, Van Limmen JG, Cavaniglia D, Reyntjens K, Rogiers X, De Hemptinne B (2014) Risk factors and management of conversions to an open approach in laparoscopic liver resection: analysis of 265 consecutive cases. HPB (Oxford) 16:75–82

    Article  Google Scholar 

  30. Montalti R, Berardi G, Laurent S, Sebastiani S, Ferdinande L, Libbrecht LJ, Smeets P, Brescia A, Rogiers X, de Hemptinne B, Geboes K, Troisi RI (2014) Laparoscopic liver resection compared to open approach in patients with colorectal liver metastases improves further resectability: oncological outcomes of a case-control matched-pairs analysis. Eur J Surg Oncol 40:536–544

    Article  PubMed  CAS  Google Scholar 

  31. Abu Hilal M, Underwood T, Taylor MG, Hamdan K, Elberm H, Pearce NW (2010) Bleeding and hemostasis in laparoscopic liver surgery. Surg Endosc 24:572–577

    Article  PubMed  Google Scholar 

  32. Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2,804 patients. Ann Surg 250:831–841

    Article  PubMed  Google Scholar 

  33. Halls MC, Cipriani F, Berardi G, Barkhatov L, Lainas P, Alzoubi M, D’Hondt M, Rotellar F, Dagher I, Aldrighetti L, Troisi RI, Edwin B, Hilal MA (2017) Conversion for unfavorable intraoperative events results in significantly worst outcomes during laparoscopic liver resection: lessons learned from a multicenter review of 2861 cases. Ann Surg. https://doi.org/10.1097/SLA.0000000000002332

    Article  PubMed  Google Scholar 

  34. Reddy SK, Barbas AS, Turley RS, Steel JL, Tsung A, Marsh JW, Geller DA, Clary BM (2011) A standard definition of major hepatectomy: resection of four or more liver segments. HPB (Oxford) 13:494–502

    Article  Google Scholar 

  35. Schindl MJ, Redhead DN, Fearon KC, Garden OJ, Wigmore SJ, Edinburgh Liver S, Transplantation Experimental Research G (2005) The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut 54:289–296

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Nomi T, Fuks D, Kawaguchi Y, Mal F, Nakajima Y, Gayet B (2015) Learning curve for laparoscopic major hepatectomy. Br J Surg 102:796–804

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

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.

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Authors and Affiliations

  1. Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000, Ghent, Belgium

    Francesca Tozzi, Giammauro Berardi, Maaike Vierstraete, Meidai Kasai, Luis Abreu de Carvalho & Roberto Ivan Troisi

  2. Abdominal Surgery Aso Iizuka Hospital, Fukuoka, Japan

    Meidai Kasai

  3. Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy

    Marco Vivarelli & Roberto Montalti

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  1. Francesca Tozzi
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  2. Giammauro Berardi
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Correspondence to Roberto Ivan Troisi.

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Tozzi, F., Berardi, G., Vierstraete, M. et al. Laparoscopic Versus Open Approach for Formal Right and Left Hepatectomy: A Propensity Score Matching Analysis. World J Surg 42, 2627–2634 (2018). https://doi.org/10.1007/s00268-018-4524-y

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