Laparoscopic Versus Open Liver Resection: a Matched-Pair Case Control Study
Kaori Ito*, Hiromichi Ito, William R. Jarnagin, Yuman Fong, Ronald P. Dematteo, Michael D'Angelica
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
Background: Laparoscopic liver resection (LLR) is an increasingly performed operation, however, data comparing LLR to open liver resection (OLR) are still limited. The aim of this study was to analyze our experience with LLR and conduct a comparative outcome study with matched-pair OLRs.Methods: In general, LLR was restricted to patients in whom tumors were free of major vessels, in accessible segments and amenable to R0 resection with a resection of ≤ 2 segments. 66 patients underwent attempted LLR (1998-2008); 52 of which were completed laparoscopically (conversion rate: 21.2%). Patients who underwent OLR prior to the laparoscopic era (1995 - 1998) were matched to LLR for age, gender, comorbidities, body mass index, pathological diagnosis, size and number of tumors, histopathology of background liver, location of tumors and type of procedures (wedge vs segmental resection, number of resections). Peri- and postoperative outcomes were compared between the LLR group and the matched-pair OLR group. Oncological outcomes were assessed for 28 (53.8%) patients with malignancy. Results: Patient characteristics were comparable in both groups. LLR was associated with significant reductions in estimated blood loss (EBL), transfusion, pringle manuever, mobidity, time to regular diet/oral analgesia, length of hospital stay and incidence of incisional hernia (Table 1). There were no patients with a positive surgical margin or local recurrence. The pattern of recurrence was similar between the two groups (intrahepatic: 21.4% vs 35.7%, p=0.24. extrahepatic: 21.4% vs 17.9%, p=0.74, respectively). Conclusion: For well selected patients, LLR is a feasible procedure without compromising peri- and post operative outcomes including early oncological outcomes for malignancy.
Table 1
| LLR (n=52) | Matched OLR (n=52) | P value | |||
| Median | Range | Median | Range | ||
| OR time (minutes) | 170 | 50-478 | 140 | 67-378 | 0.123 |
| EBL (ml) | 100 | 0-500 | 200 | 0-2500 | 0.002 |
| N | % | N | % | ||
| Pringle performed | 21 | 40.4 | 46 | 88.5 | <0.0001 |
| Transfusion performed | 1 | 1.9 | 13 | 25.0 | 0.001 |
| Median | Range | Median | Range | ||
| Time to regular diet (days) | 2 | 1-6 | 4 | 3-8 | <0.0001 |
| Time to oral analgesia (days) | 2 | 1-7 | 4 | 1-7 | <0.0001 |
| Length of hospital stay (days) | 4 | 1-14 | 6 | 4-15 | <0.0001 |
| N | % | N | % | ||
| Morbidity | 6 | 11.5 | 14 | 26.9 | 0.047 |
| (Incisional hernia) | 0 | 0.0 | 6 | 11.5 | 0.012 |
| Mortality | 0 | 0.0 | 0 | 0.0 | NA |
| N | % | N | % | ||
| Readmission | 1 | 1.9 | 3 | 5.8 | 0.308 |
| Reoperation | 0 | 0.0 | 0 | 0.0 | NA |
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