Laparoscopic versus open hemihepatectomy: comprehensive comparison of complications and costs at 90\xa0days using a propensity method

Francisco Riquelme,Juan Carlos García-Valdecasas,José Fuster,Fabio Ausania,Raffaele Sandomenico,David Calatayud,Rocío García Pérez,Ferrán Torres,Amelia J Hessheimer,César Muñoz,Joana Ferrer,Constantino Fondevila

doi:10.1007/s13304-020-00854-y

Abstract

Laparoscopic hemihepatectomy (LHH) may offer advantages over open hemihepatectomy (OHH) in blood loss, recovery, and hospital stay. The aim of this study is to evaluate our recent experience performing hemihepatectomy and compare complications and costs up to 90 days following laparoscopic versus open procedures. Retrospective evaluation of patients undergoing hemihepatectomy at our center 01/2010–12/2018 was performed. Patient, tumor, and surgical characteristics; 90-day complications; and costs were analyzed. Inverse probability of treatment weighting (IPTW) was used to balance covariates. A total of 141 hemihepatectomies were included: 96 OHH and 45 LHH. While operative times were longer for LHH, blood loss and transfusions were less. At 90 days, there were similar rates of liver-specific and surgical complications but fewer medical complications following LHH. Medical complications that arose with greater frequency following OHH were primarily pulmonary complications and urinary and central venous catheter infections. Complications at 90 days were lower following LHH (Clavien–Dindo grade ≥ III OHH 23%, LHH 11%, p = 0.130; Comprehensive Complication Index OHH 20.0 ± 16.1, LHH 10.9 ± 14.2, p = 0.001). While operating costs were higher, costs for hospital stay and readmissions were lower with LHH. Patients undergoing LHH experience a significant reduction in postoperative medical complications and costs, resulting in 90-day cost equity compared with OHH.

Highlights

The laparoscopic approach to abdominal interventions better preserves the integrity and function of the abdominal wall and limits exposure and manipulation of abdominal viscera, leading to improved cosmesis and reduced intraabdominal adhesions and wound and wall complications
The indication for hemihepatectomy was malignant tumor in 90% of cases (OHH: 71% metastases, 22% primary liver tumors; laparoscopic hemihepatectomy (LHH): 76% metastases, 9% primary liver tumors); consequentially, the majority of patients had a history of preoperative chemotherapy
We meticulously evaluated complications and costs associated with hemihepatectomy arising between index procedures up to 90 days postoperatively

Summary

Introduction

The laparoscopic approach to abdominal interventions better preserves the integrity and function of the abdominal wall and limits exposure and manipulation of abdominal viscera, leading to improved cosmesis and reduced intraabdominal adhesions and wound and wall complications. In the field of hepatic surgery, the results of clinical retrospective studies, meta-analyses, and one randomized trial indicate that the aforementioned advantages may translate into less perioperative blood loss and improved recovery, with decreased postoperative complications and hospital stay [1,2,3,4]. For these reasons, the laparoscopic approach is considered standard-of-care for the resection of lesions in the left lateral and anterior hepatic segments [5]. A learning curve of at least 55 cases for right hemihepatectomy after prior experience with minor laparoscopic liver resections has been suggested [5, 6]

Objectives

Methods

Results

Conclusion