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Introduction: Laparoscopic liver resection for malignant disease is becoming more frequent due to less blood loss, shorter hospital stay, better pain control, and faster recovery. The purpose of this study was to compare in-house, 30-day, and 1-year morbidity between laparoscopic and open liver resection. Methods: A chart review was conducted to identify all patients who underwent liver resection for malignant disease between April 2006 and October 2009. Patient, operative, and outcomes data at 30-days and 1-year were collected. Statistical analysis was conducted to compare groups. Results: Seventy-six patients underwent liver resection with or without ablation: 49 open and 27 laparoscopic. The open and laparoscopic groups were similar in regards to age, gender, BMI, extent of liver resection, use of ablation therapy, and tumor pathology (all p values >0.05). The laparoscopic group had significantly less blood loss (p 0.004) and shorter hospital stay (p 0.002). During hospitalization, patients treated laparoscopically had fewer complications related to surgery or hospitalization (p NS). Home disposition was similar in the laparoscopic vs open group (96% vs 90%). More patients were readmitted at 30-days in the open group (2 vs 9, p 0.31). Reason for readmission was most commonly related to the surgical procedure (abscess, bile leak, wound infection). At 1 year, more patients were readmitted from the open group (4 v 19, p 0.04). The 19 patients were readmitted a total of 42 times due to either the surgical procedure or disease progression. Observed, all cause 1-year mortality was similar between the laparoscopic and open groups (14.8% vs 10.2%). Conclusion: Laparoscopic liver resection has been shown to improve operative and immediate post-operative outcomes. When looking beyond the initial hospital stay, those benefits appear to continue at 30-days and 1-year with fewer hospital re-admissions despite shorter hospital stays. This may also suggest lower long-term hospital costs for patients and healthcare systems.
Comparison of Laparoscopic and Open Liver Resection Morbidity

	In-House Morbidity		30-day Readmission		1-year Readmission
	Lap*	Open	Lap*	Open	Lap*	Open
Patients (Complications/Readmissions)^	6 (9)	20 (41)	2 (2)	9 (11)	4 (4)	19 (42)
Surgery-related	5	21	1	7	0	22
Hospitalization-related	3	15	0	1	0	2
Disease Process -related	0	0	0	0	2	15
Other	1	3	1	3	2	3

*Conversion to open included in laparoscopic group^Some patients had more than one complication or were admitted more than once