Laparoscopic versus Open Right Hemihepatectomy: An Analysis of Data from the Polish National Registry of Minimally Invasive Liver Surgery

Abstract

Introduction: Laparoscopic liver resection is an established surgical approach, however more data is needed to assess its potential benefits and limits in major liver resections. Materials and Methods: A retrospective study of laparoscopic right hemihepatectomies was performed based on data from the Polish National Registry of Minimally Invasive Liver Surgery. Short-term results were compared with a group of patients who underwent open right hemihepatectomy in a tertiary referral center between 01/2017 and 06/2021. Results: Up to 06/2021 there were 49 cases of laparoscopic right hemihepatectomies performed in Poland with a conversion rate of 14.3%. Control group consisted of 103 cases of open right hemihepatectomies. In both groups the most common indication for liver resection were colorectal liver metastases, 73.5% and 50.5%, respectively. Laparoscopy was associated with reduced overall morbidity (31.25% vs. 54.4%; p=0.009), however severe complications in accordance to Clavien-Dindo classification (>2) occurred similarly in both groups (p=0.207), including postoperative mortality (2.1% vs. 1.9%). Postoperative hospital stay was significantly shorter in laparoscopy group (p<0.001) with a median duration of 7 and 9 days, respectively. Although R0 resection was observed more frequently in minimally invasive approach (89.8% vs. 75.7%), the difference was not significant (p=0.05). Conclusion: Laparoscopic approach for major liver resection provides short-term results at least non-inferior to open approach. Reduced postoperative mortality and decreased duration of hospital stay may be observed already before completing the learning curve for major laparoscopic liver resection such as right hemihepatectomy.