Clinical and Economic Comparison of Laparoscopic to Open Liver Resections Using a 2-to-1 Matched Pair Analysis: An Institutional Experience
Division of General Surgery, University Health Network, 200 Elizabeth Street, Toronto, Ontario, Canada. Journal of the American College of Surgeons
(Impact Factor: 5.12).
12/2011; 214(2):184-95. DOI: 10.1016/j.jamcollsurg.2011.10.020
Surgical resection of hepatic lesions is associated with intraoperative and postoperative morbidity and mortality. Our center has introduced a laparoscopic liver resection (LLR) program over the past 3 years. Our objective is to describe the initial clinical experience with LLR, including a detailed cost analysis.
We evaluated all LLRs from 2006 to 2010. Each was matched to 2 open cases for number of segments removed, patient age, and background liver histology. Model for End-Stage Liver Disease (MELD) and the Charlson comorbidity index were calculated retrospectively. Nonparametric statistical analysis was used to compare surgical and economic outcomes. Analyses were performed including and excluding converted cases.
Fifty-seven patients underwent attempted LLR. Demographic characteristics were similar between groups. Estimated blood loss was lower in the LLR vs the open liver resection (OLR) group, at 250 mL and 500 mL, respectively (p < 0.001). Median operating room times were 240 minutes and 270 minutes in the LLR and OLR groups, respectively (p = 0.14). Eight cases were converted to open (14%): 2 for bleeding, 2 for anatomic uncertainty, 1 for tumor size, 1 for margins, 1 for inability to localize the tumor, and 1 for adhesions. Median length of stay was lower for LLR at 5 days vs 6 days for OLR (p < 0.001). There was no difference in frequency of ICU admission, reoperation, 30-day emergency room visit, or 30-day readmission rates. Median overall cost for LLR was lower at $11,376 vs $12,523 for OLR (p = 0.077).
Our experience suggests that LLR confers the clinical advantages of reduced operating room time, estimated blood loss, and length of stay while decreasing overall cost. LLR, therefore, appears to be a clinically and fiscally advantageous approach in properly selected patients.
Available from: Shafiq Rehman
- "However, recent advances in the surgical techniques and development of more laparoscopic devices have largely overcome these problems to a certain extent       . Nevertheless, its long-term oncological outcome and added benefit of improving quality of life are still yet to be proven     . Perhaps for most enthusiasts in the field minor LLRs have obvious advantages although major hepatectomy is still very controversial. "
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ABSTRACT: Background. Laparoscopic liver resection (LLR) has emerged as an alternative procedure to open liver resection in selected patients. The purpose of this study was to describe our initial experience of 100 patients undergoing LLR.
Methods. We analysed a prospectively maintained hepatobiliary database of 100 patients who underwent LLR between August 2007 and August 2012. Clinicopathological data were reviewed to evaluate surgical outcomes following LLR. Results. The median age was 64 and median BMI 27. Patients had a liver resection for either malignant lesions (n = 74) or benign lesions (n = 26). Commonly performed procedures were segmentectomy/metastectomy (n = 55), left lateral sectionectomy (LLS) (n = 26), or major hepatectomy (n = 19). Complete LLR was performed in 84 patients, 9 were converted to open and 7 hand-assisted. The most common indications were CRLM (n = 62), followed by hepatic adenoma (n = 9) or hepatocellular carcinoma (n = 7). The median operating time was 240 minutes and median blood loss was 250 mL. Major postoperative complications occurred in 9 patients. The median length of stay (LOS) was 5 days. One patient died within 30 days of liver resection. Conclusions. LLR is a safe and oncologically feasible procedure with comparable short-term perioperative outcomes to the open approach. However, further studies are necessary to determine long-term oncological outcomes.
Available from: Amit Singal
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ABSTRACT: Although most laparoscopic hepatic procedures are performed for benign disease, an increasing fraction is for malignant disease, including primary and metastatic liver tumors. Data suggest that minor and major hepatic resections are feasible and can be performed safely. The limited data currently available suggest that survival in patients with hepatocellular carcinoma and colorectal metastatic disease may be comparable to that achieved with open hepatectomy. The benefits of the laparoscopic approach seem to be shorter hospitalization, smaller incisions, and less blood loss. Despite the progress to date, concern continues about the potential for significant intraoperative hemorrhagic complications and oncologic outcomes.
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