|
Back to 2015 Annual Meeting Program
Laparoscopic Right Hepatectomy: Comparative Analysis of 2013 ACS-NSQIP Data
Steven M. Strasberg*1, Vanessa Thompson2, Xiangju Meng2, Bruce L. Hall3, 2, Henry Pitt4
1HPB Surgery, Washington University in St Louis, St Louis, MO; 2ACS-NSQIP, Chicago, IL; 3Surgery, Washington University in St Louis, St Louis, IL; 4Surgery, Temple University, Philadelphia, PA
In the Balliol Classification of innovative procedures laparoscopic right hepatectomy (LRH) is in the IDEAL 2b or "Exploration" phase. The purpose of this study was to evaluate outcome of this procedure in the USA using 2013 NSQIP data for LRH and open right hepatectomy (ORH).
The 2013 NSQIP database was searched for LRH and ORH. 19 of 54 hospitals performing any right hepatectomy attempted at least one LRH. To avoid confounding by concomitant procedures only cases without additional concomitant procedures or cirrhosis were considered. 456 right hepatectomies were performed; 59 were attempted LRHs (started but not necessarily completed laparoscopically). After elimination of cases with concomitant procedures or cirrhosis 278 procedures remained, 47 (16.9%) of which were attempted LRHs. In all 19/47 LRH were completed by pure laparoscopy, 12/47 by hand assist, and 16/47 were converted to ORH from one of the former techniques. The conversion rate to ORH was 34%. Data were evaluated as intention to treat.
Preoperative LFTs including AST, serum albumin, and ALP were significantly higher in ORH patients as was the ASA class. For instance, the preoperative ALP was abnormally high in 6.4% of patients having LRH and 23.4% of patients having ORH (p=0.01). But BMI was significantly higher and dyspnea significantly more common in LRH patients. There was a significant difference in the likelihood of LRH vs ORH to be performed for benign vs secondary disease in the liver with benign/secondary ratio higher in LRH (p<0.05).
Drains were used less commonly in LRH 14/44 (31.8%) than in ORH 144/228 (63.2%)p=0.0002. There were no 30 day mortalities in LRH and 4 in ORH (NS). SSIs were significantly less common in LRH (p=0.004) predominantly due to fewer organ space infections, LRH (0%) vs ORH (8.2%) p=0.0509. LOS was significantly shorter in LRH, 5.5 days (2.9SD) vs 8.2 (8.1), p=0.0001.
Based on ACS-NSQIP data LRH seems to be diffusing into wide use. Approximately one in three procedures started laparoscopically was converted to an open procedure. Based on 30 day outcomes, advantages of LRH in infection rates and LOS seem likely although some of the apparent advantages may be related to baseline differences between groups. Continued cautious introduction including close tracking of outcomes is indicated before entry into IDEAL phase 3 status.
Back to 2015 Annual Meeting Program
|
