Comparing the Clinical and Economic Impact of Laparoscopic Versus Open Liver Resection

Department of Surgery, Jewish General Hospital, McGill University, Montreal, Canada.
Annals of Surgical Oncology (Impact Factor: 3.93). 04/2010; 17(4):998-1009. DOI: 10.1245/s10434-009-0839-0
Source: PubMed


Laparoscopic liver resection has thus far not gained widespread acceptance among liver surgeons. Valid questions remain regarding the relative clinical superiority of the laparoscopic approach as well as whether laparoscopic hepatectomy carries any economic benefit compared with open liver surgery.
The aim of this work is to compare the clinical and economic impact of laparoscopic versus open left lateral sectionectomy (LLS).
Between May 2002 and July 2008, 44 laparoscopic LLS and 29 open LLS were included in the analysis. Deviation-based cost modeling (DBCM) was utilized to compare the combined clinical and economic impact of the open and laparoscopic approaches.
The laparoscopic approach compared favorably with the open approach from both a clinical and economic standpoint. Not only was the median length of stay (LOS) shorter by 2 days in the laparoscopic group (3 versus 5 days, respectively, P = 0.001), but the laparoscopic cohort also benefited from a significant reduction in postoperative morbidity (P = 0.001). Because the groups differed significantly in age and ratio of benign to malignant disease, a subgroup analysis limited to patients with malignant disease was undertaken. The same reduction in LOS and postoperative morbidity was evident within the malignant subgroup undergoing laparoscopic LLS (P = 0.003). The economic impact of the laparoscopic approach was noteworthy, with the laparoscopic approach US$1,527-2,939 more cost efficient per patient compared with the open technique.
Our study seems not only to corroborate the safety and clinical benefit of the laparoscopic approach but also suggests a fiscally important cost advantage for the minimally invasive approach.

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Available from: T. Clark Gamblin, Jul 11, 2014
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    • "Hence, LLR may very likely outweigh the higher costs of the laparoscopic technique. Although we did not compare the costs between the two procedures due to inadequate data, a recent deviation-based cost modeling study compared the economic impact of laparoscopic versus open left lateral sectionectomy and found that the cost of each patient undergoing LLR was US$ 2,939 less than that of a patient undergoing a similar open operation on average [25]. "
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    ABSTRACT: The safety and efficacy of laparoscopic liver resection (LLR) for colorectal liver metastasis (CLM) remain to be established. A meta-analysis was undertaken to compare LLR and open liver resection (OLR) for CLM with respect to surgical and oncologic outcomes. An electronic search was performed to retrieve all relevant articles published in the English language by the end of March 2013. Data were analyzed using Review Manager version 5.0. A total of 8 nonrandomized controlled studies with 695 subjects were analyzsed. Intra-operative blood loss, the proportion of patients requiring blood transfusion, morbidity and the length of hospital stay were all significantly reduced after LLR. Postoperative recurrence, 5-year overall and disease-free survivals were comparable between two groups. LLR for CLM is safe and efficacious. It improves surgical outcomes and uncompromises oncologic outcomes as compared with OLR.
    Full-text · Article · Oct 2013 · BMC Surgery
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    • "Although LLR was initially described for the treatment of small, peripheral, benign lesions, experienced teams are now safely performing more advanced LLRs including right hemihepatectomy, left hemihepatectomy, central hepatectomy, and extended right and left hepatectomy for the treatment of both benign and malignant lesions. Paralleling these advances in the technical feasibility of LLR, there is increasing acceptance of the minimally invasive approach for the treatment of larger tumors [3]. "
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    ABSTRACT: Although laparoscopic liver resection has developed rapidly and gained widespread acceptance for the treatment of benign liver diseases and hepatocellular carcinoma with a small tumor size, its usefulness for the treatment of large tumors is less clear, due to concerns about compromising oncological principles and patient safety. The purpose of this study was to explore the safety and feasibility of laparoscopic liver resection for the treatment of hepatocellular carcinoma with a tumor size of 5–10 cm.
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    • "Similarly, efforts examining laparoscopic versus open liver resection of benign and malignant tumors have demonstrated efficacy and safety in utilizing a laparoscopic approach [28-30]. Laparoscopic liver resection is associated with decreased hospitalization and costs [28,29,31,32], with the average postoperative hospital stay reported as 1.7 to 3.2 days [29,33-35]. "
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