Laparoscopic versus open anatomical liver resection for the centrally located tumor: Case-matched study with propensity score matching

Abstract

Background: Recent advanced technology and an accumulation experience of surgeons have expanded the indications for laparoscopic liver resection (LLR). However, compared with open liver resection (OLR), laparoscopic anatomical liver resection for centrally located tumor (CLT) has not been well established in terms of feasibility. Methods: From September 2005 to April 2015, 136 consecutive anatomical major liver resections for the centrally located tumor were performed, including 12 cases of totally laparoscopic anatomical liver resections. We performed 1:2 match using propensity score matching between laparoscopic and open liver resection. Results: After propensity score matching, 12 and 24 patients were included in the LLR and OLR group, respectively. Surgical time was longer in the LLR (392, range 131 to 632 minutes) than the OLR (272, range 92 to 412 minutes) (P = 0.013), but the hospitalization was shorter (8.9, range 5 to 17 days versus 13, range 5 to 24 days, P = 0.006). The portal triad clamping time was shorter (15 versus 46 minutes, P = 0.105) and mean blood loss was less in LLR (417 versus 431 mL, P = 0.897) but the values were not statistically significant. The morbidity rates were 25% (3 of 12 cases) in the LLR group and 29.2% (7 of 24 cases) in the OLR group. There was no postoperative mortality in either group. Conclusion: Laparoscopic approach for CLT requiring central hepatectomy or right anterior sectionectomy seems feasible with non-inferior outcome perioperative compared to OLR. CLT may be performed safely by totally laparoscopic approach in experienced hands.