Laparoscopic versus open major hepatectomies: analysis of surgical outcomes and cost effectiveness in a high-volume centre

Abstract

Background: We compared the clinical and financial outcomes of laparoscopic major hepatectomies (LMH) with open procedures (OMH). Methods: Intra, post and total expenses were considered. Intention-to-treat (ITT) and per-protocol (PP) analysis were undertaken, considering converted patients either in the LMH or OMH group. Results: Patients receiving major hepatectomy (May2014-Dec2016) were identified (132, 80LMH vs. 52OMH). 21 LMH were converted (26.2%), with the commonest reason being oncologic concerns (n=9, 42.8%). At the ITT analysis LMH showed longer operative time (p=0.03), but lower blood loss (p<0.001), transfusions (p=0.01), hospital stay (p=0.006) and morbidity (p=0.03). LMH had less investigations (p=0.004) and interventions (p=0.03). The higher intraoperative costs of LMH (p<0.001) were balanced by lower postoperative expenses (p=0.03), resulting in a total cost neutrality if compared to open (p=0.60). The PP analysis did not confirm longer operative time for LMH (p=0.44), while blood loss/transfusion (p<0.001, p=0.002), morbidity/investigations (p=0.01, p=0.001) and length of stay (p=0.002) were still lower and with increased significance. Higher intraoperative costs for LMH were confirmed (p<0.001), but lower postoperative expenses were exacerbated (p=0.004), now resulting in inferior global costs (p=0.02). Conclusion: Completed LMH provide significant advantages and cost savings compared to OMH. Despite some of these may be jeopardized by conversion, a program of LMH appears worth in a high-volume centre.