Minimally invasive hepatectomy conversions: An analysis of outcomes.

Abstract

430 Background: Surgical approach has been described as a factor influencing morbidity in patients undergoing hepatectomy. Minimally invasive surgery (MIS) converted to open has previously been included in an open hepatectomy cohort of the National Surgical Quality Improvement Program (NSQIP) dataset for analysis. This study sought to compare MIS conversion to open hepatectomy cases and analyze factors leading to conversion. Methods: The NSQIP data set was queried for patients undergoing hepatectomy for liver disease between January 1, 2014 and December 31, 2014. Cases were divided into three cohorts: completely MIS (laparoscopic or robotic), open, or planned MIS converted to open approach according to the dataset definitions. Demographic, clinical-pathologic, and perioperative variables were described and short-term postoperative outcomes were compared between groups. Results: A total of 2,884 patients were identified. Open approach was performed most commonly (80.96%, n = 2,335), followed by minimally invasive (15.05%, n = 434) and MIS converted to open (3.99%, n = 115). Patients undergoing conversion were more likely to have higher BMI, hypertension, and hepatocellular carcinoma. Conversion patients suffered from significantly higher morbidity (p < 0.001) compared to MIS, but had comparable outcomes to open procedures. Conclusions: MIS hepatectomy has been shown to have lower morbidity but similar mortality to open hepatectomy. Conversion procedures appear to have similar outcomes to open procedures, with greater morbidity compared to MIS. Differences in morbidity from previous studies may be partially attributed to the inclusion of conversions in the open hepatectomy cohort.