Laparoscopic Versus Open Liver Resection for Lesions Adjacent to Major Vessels: A Propensity Score Matched Analysis

• Published in: Journal of laparoendoscopic & advanced surgical techniques. Part A Vol. 27; no. 10; p. 1002
• Main Authors: Xu, Hong-Wei, Li, Hong-Yu, Liu, Fei, Wei, Yong-Gang, Li, Bo
• Format: Journal Article
• Language: English
• Published: United States 01.10.2017
• Subjects: Adolescent; Adult; Aged; Female; Hepatectomy - adverse effects; Hepatectomy - methods; Humans; Laparoscopy - adverse effects; Laparoscopy - methods; Length of Stay - statistics & numerical data; Liver - blood supply; Liver - surgery; Liver Neoplasms - mortality; Liver Neoplasms - surgery; Male; Middle Aged; Operative Time; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Propensity Score; Retrospective Studies; Survival Rate; Treatment Outcome; Young Adult; laparoscopy; liver resection; major vessel
• ISSN: 1557-9034
• DOI: 10.1089/lap.2017.0326

Laparoscopic liver resection (LLR) for lesions adjacent to major vessels was still associated with difficulty and challenge. This study aimed to compare outcomes after LLR and open liver resection (OLR) of lesions adjacent to major vessels. A retrospective analysis of patients with hepatic tumors close to main or second branches of Glisson's tree, to the major hepatic vein, or to the inferior vena cava within 1 cm between January 2015 and January 2017 was performed based on the propensity score matching (PSM) method. Perioperative and oncological outcomes were then evaluated. A total of 64 patients underwent LLR and 86 patients had OLR. After 1:1 PSM, well-matched 40 patients in each group were obtained. The operative time (240 versus 210 minutes, P = .012) in the LLR group was significantly longer than that in the OLR group, whereas blood loss (200 versus 400 mL, P = .003) was less in the laparoscopic group. The median hospital stay for LLR (6 versus 8 days, P = .032) was shorter than for the open procedure. No statistical differences was noted according to overall postoperative complications, but the OLR group tended to be vulnerable to more severe complications. For patients with hepatocellular carcinoma, the comparable oncological results in terms of 2-year overall survival (P = .898) and disease-free survival (P = .992) were observed. LLR for tumors adjacent to major vessels appears to be feasible and safe in selected patients. LLR is associated with less blood loss, shorter hospital stay, and similar oncological outcomes compared with OLR.