Laparoscopic Living Donor Right Hepatectomy Regarding the Anatomical Variation of the Portal Vein: A Propensity Score-Matched Analysis.

Abstract

This study is designed to analyze the feasibility of laparoscopic living donor right hemihepatectomy in living donors with portal vein variation. Living donor liver transplantation cases using a right liver graft during the period of January 2014 to September 2019 were included. Computed tomographic angiographies of the donor were 3-dimensionally reconstructed, and the anatomical variation of the portal vein was classified. To reduce selection bias, a 1:1 ratio propensity score-matched analysis between the laparoscopy group and the open group was performed. Surgical and recovery-related outcomes as well as portal vein complication-free survival, graft survival, and overall survival rates were analyzed. After matching, 171 cases in each group from 444 original cases were compared. The laparoscopy group had a shorter operation time (P<0.001), a smaller number of additional opioids required by the donor (P<0.001), and a shorter hospital stay (P<0.001). There were no differences in the portal vein complication-free survival (P=0.16), graft survival (P=0.26), or overall survival rates (P=0.53). Although portal vein complication-free survival was inferior in portal veins other than type I (P=0.01), the laparoscopy group showed similar portal vein complication-free survival regardless of the anatomical variation of portal vein (P=0.35 in type I and P=0.30 in other types). Laparoscopic living donor right hemihepatectomy can be performed as safely as open surgery regardless of the anatomical variation of the portal vein.