Minor laparoscopic liver resection as day-case surgery (without overnight hospitalization): a pilot study

Abstract

Introduction: Day-case surgery (DCS) has boomed over recent years, as has laparoscopic liver resection (LLR) for the treatment of liver tumor (benign or malign). The purpose of this prospective study was to show the feasibility of minor LLR as DCS. Material and methods: This was a prospective, intention to treat, non-randomized study of consecutive patients undergoing minor LLR from July 2015 to December 2017. Exclusion criteria were liver resection using laparotomy, major LLR, difficult locations for minor LLR, major abdominal surgery using laparotomy, hepatobiliary procedures without liver parenchyma resection, cirrhosis with Child >A and/or portal hypertension, presence of a significant medical history and exclusion criteria for DCS. Primary endpoint was the unplanned overnight admission rate. Secondary endpoints were criteria for DCS evaluation, satisfaction and compliance to the protocol. Results: During the study period, 167 patients underwent liver resection. On this population, 23 (25%) were included as DCS. Causes for minor LLR were liver metastasis (n=9), hepatic adenoma (n=5), hepatocellular carcinoma (n=4), ciliated hepatic foregut cyst (n=2) and other benign tumors (n=3). All day-case minor LLR excepted two patients consisted of single wedge resection and one patient had left lateral sectionectomy. There were four unplanned overnight admissions (17.4%). There were one unexpected consultations (4.3%), two hospital readmissions (8.6%) and no major complications or mortality. Compliance to the protocol was 69.5%. Satisfaction rate was 91%. Conclusion: In selected patients, day-case minor LLR is feasible and has acceptable complication and readmission rates. Hence, day-case minor LLR can be legitimately implemented for selected patients.