Intention to treat laparoscopic versus open hemihepatectomy: a pair-matched case-control study.

Abstract

Background: This study aims to explore potential early postoperative (PO) benefits from a laparoscopic hemihepatectomy (LH). Methods: Each “Intention-to-treat LH between 08/2012 and 10/2015, was pair matched with an open case using graded criteria, including bio-physiological features and laterality of surgery. Measured outcomes (blinded during the matching process) were intraoperative (IO) and overall blood loss (BL), operative time (OT), length of hospital stay (LOS) and high level care (HLC), morbidity (Clavien-Dindo classification), mortality and surgical margins. Results: 40 patients from the laparoscopic group (LG) were matched with 40 open cases (OG). In both groups, 10 patients had left and 30 right HH. 6 cases in the LG were converted to open. Median hospital and high level care stay was significantly less in the completed LG; 6 vs 8 days, p=0.025 and 1 vs. 2, p=0.024, respectively. Median OT was longer in the LG- (420 vs. 305min, p<0.001). Intraoperative blood was similar. Total blood transfusions (BT) were higher in the LG (50 vs 29 units). In the completed LG, BT were less than in the OG (13 vs 26, p=0.29). Overall complication rate was similar between both groups: 22 vs. 24 patients. One patient died in each group. R1 resections were similar (6 vs 7 cases). Conclusion: Laparoscopic HH can reduce hospital stay at the expense of a longer operating time. However, overall morbidity, mortality, and resection margin status was similar between both groups.