Minimally invasive versus open right hepatectomy: comparative study with propensity score matching analysis

Vinícius Campos Duarte,Renato Micelli Lupinacci,Paulo Herman,Jaime Arthur Pirola Kruger,Kevin Zuber,Fabricio Ferreira Coelho,Alain Valverde,Divia Danoussou,Gilton Marques Fonseca,Vagner Birk Jeismann

doi:10.1186/s12893-020-00919-0

Abstract

BackgroundMinimally invasive liver resections (MILRs) have been increasingly performed in recent years. However, the majority of MILRs are actually minor or limited resections of peripheral lesions. Due to the technical complexity major hepatectomies remain challenging for minimally invasive surgery. The aim of this study was to compare the short and long-term outcomes of patients undergoing minimally invasive right hepatectomies (MIRHs) with contemporary patients undergoing open right hepatectomies (ORHs)MethodsConsecutive patients submitted to anatomic right hepatectomies between January 2013 and December 2018 in two tertiary referral centers were studied. Study groups were compared on an intention-to-treat basis after propensity score matching (PSM). Overall survival (OS) analyses were performed for the entire cohort and specific etiologies subgroupsResultsDuring study period 178 right hepatectomies were performed. After matching, 37 patients were included in MIRH group and 60 in ORH group. The groups were homogenous for all baseline characteristics. MIRHs had significant lower blood loss (400 ml vs. 500 ml, P = 0.01), lower rate of minor complications (13.5% vs. 35%, P = 0.03) and larger resection margins (10 mm vs. 5 mm, P = 0.03) when compared to ORHs. Additionally, a non-significant decrease in hospital stay (ORH 9 days vs. MIRH 7 days, P = 0.09) was observed. No differences regarding the use of Pringle’s maneuver, operative time, overall morbidity or perioperative mortality were observed. OS was similar between the groups (P = 0.13). Similarly, no difference in OS was found in subgroups of patients with primary liver tumors (P = 0.09) and liver metastasis (P = 0.80).ConclusionsMIRHs are feasible and safe in experienced hands. Minimally invasive approach was associated with less blood loss, a significant reduction in minor perioperative complications, and did not negatively affect long-term outcomes.

Highlights

Invasive liver resections (MILRs) have been increasingly performed in recent years
Robotic-assisted surgery has been described as an alternative to laparoscopy for Minimally invasive liver resections (MILRs), with equivalent results for both short and long-term outcomes [4,5,6]
Due to the complexity of the operation and concerns about safety, major hepatectomies and notably anatomical right hepatectomies remain challenging for minimally invasive surgery [9,10,11]

Summary

Introduction

Invasive liver resections (MILRs) have been increasingly performed in recent years. The aim of this study was to compare the short and long-term outcomes of patients undergoing minimally invasive right hepatectomies (MIRHs) with contemporary patients undergoing open right hepatectomies (ORHs). Robotic-assisted surgery has been described as an alternative to laparoscopy for MILRs, with equivalent results for both short and long-term outcomes [4,5,6]. An impressive outspreading has been observed, most MILRs are minor or limited resections of peripheral lesions, mainly located in the anterolateral segments of the liver [3, 7, 8]. Due to the complexity of the operation and concerns about safety, major hepatectomies (resection of ≥ 3 contiguous segments) and notably anatomical right hepatectomies remain challenging for minimally invasive surgery [9,10,11]

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Conclusion