Similar 30-Day Outcomes With Laparoscopic vs Open Partial Hepatectomy in Single-Center Experience


Key Points

  • There were no differences between laparoscopic and open partial hepatectomy groups in 30-day morbidity or mortality, positive margin status, major complication rate, hospital stay, or readmission rate.
  • The open-surgery group had significantly greater intraoperative blood loss and a nonsignificantly greater rate of transfusion.

In a single-center retrospective matched case-control study reported in JAMA Surgery, Franken et al found no significant differences in 30-day morbidity or mortality, positive margin status, major complications, hospital stay, or readmission rates for laparoscopic vs open partial hepatic resection in patients with malignant or benign disease. Intraoperative blood loss was less with laparoscopic surgery.

Study Details

The study involved 104 patients from a tertiary hepatobiliary referral center undergoing partial hepatic resection via laparoscopy (n = 52) or via open surgery (n = 52) who were matched first for extent of resection and pathologic diagnosis and then for age and sex. The primary outcome measures were 30-day morbidity and mortality. Cirrhosis was present in 33% of patients in each group; 54% of patients in the laparoscopy group and 54% in the open-surgery group had hepatocellular carcinoma, 10% and 23% had colorectal cancer metastases, 12% and 8% had other malignant disease, and 25% and 15% had other benign disease.

Surgical and 30-Day Outcomes

Rates of 30-day morbidity were 42% in the laparoscopic group vs 37% in the open-surgery group (P = .70) and 30-day morality rates were 2% vs 4% (P < .99). Rates of major complications were 8% vs 8%, P = .10), and 2% vs 4% had positive surgical margins (P > .99).

Mean operative time was 219 vs 198 minutes (P = .16), mean hospital stay was 5 vs 6 days (P = .13), and readmission rates were 8% vs 10% (P = .70). Estimated mean blood loss was greater in the open-surgery group (237 mL vs 387 mL, P = .049), but the difference between groups in rate of perioperative blood transfusions was not significant (2% vs 10%, P = .20).

The investigators concluded: “Patients who undergo [laparoscopic hepatectomy] have similar short-term outcomes when compared with those who undergo [open hepatectomy]. Laparoscopic hepatectomy was associated with lower intraoperative blood loss, although the clinical significance of this finding is uncertain given the lack of difference in perioperative transfusion or morbidity rates. In addition, we found no difference in margin status between the 2 groups. Future studies are needed to define which patients derive benefit from [laparoscopic hepatectomy] and to determine oncologic equivalence to [open hepatectomy]. “

L. Andrew DiFronzo, MD, of Kaiser Permanente Los Angeles Medical Center, is the corresponding author for the JAMA Surgery article.

The authors reported no conflicts of interest.

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