Laparoscopic major hepatectomies: current trends and indications. A comparison with the open technique

Abstract

Diffusion of laparoscopic major hepatectomies is experiencing a steady increasing trend, although slower compared to minor resections. The aim of this single-center study is to discuss current trends and indications in the application of minimally invasive techniques to major hepatic resections. Preoperative patients and disease characteristics of 49 laparoscopic major hepatectomies (LPS group), performed between 2005 and 2015, were compared with 585 open hepatectomies (Open group) to analyze differences in patients recruitment. Factors which were found to be differently distributed between groups were used as covariates in a propensity score-based case-matched analysis with a 1:3 ratio between LPS group and 147 patients from the Open group (constituting Open-mat group). Short-term outcome was analyzed in matched groups. ASA score, previous abdominal surgery, previous interventional procedures, indication, lesion size and associated procedures were significantly different between the LPS and the Open group. Short-term outcome analysis revealed that blood loss (200 vs 350 mL, p = 0.044) and time for functional recovery (3 vs 4 days, p = 0.05) were reduced in the LPS compared to the Open-mat group, in spite of longer length of surgery (260 vs 170 min, p = 0.041) and comparable oncological adequacy. Even though data on technical feasibility of laparoscopic major resections and their benefits in terms of blood loss and functional recovery support the diffusion of minimally invasive approach, the limit of the technique is still represented by the reduced pool of suitable candidates.

Laparoscopic versus open major hepatectomy: a systematic review and meta-analysis of individual patient data

“…All retrospective studies comparing between the laparoscopic and open approach for major hepatectomies were selected in accordance with the inclusion criteria (n = 13). [12][13][14][15][16][17][18][19][20][21][22][23] As two institutions had published two consecutive articles with duplication of patients, only the most recent article was considered. 10,11 The 11 retained articles had a retrospective design and were published between 2009 and 2017.…”

“…13,22,23 As such, the eight remaining studies were included in the meta-analysis with IPD (Table 1). [14][15][16][17][18][19][20][21] No disclosure of results from any prospective, randomized, controlled trial was identified.…”

“…Five of the eight studies included patients with both malignant and benign diseases. 14,15,[17][18][19] One study focused on colorectal liver metastases (CRLM), and two focused on hepatocellular carcinoma (HCC). 16,20,21 Five studies reported on mid-and long-term oncological outcomes.…”

“…Although some series have shown that LMHs are associated with shorter hospitalization, fewer complications, decreased blood loss volume, and similar operative costs, others failed to document clear additional benefits over the open approach. [12][13][14][15][16][17][18][19][20][21][22][23] Randomized controlled trials would play a critical role by providing optimal levels of evidence on the actual benefit of laparoscopy for liver resections. Accordingly, the ORANGE 2 PLUS Trial is steadily recruiting patients undergoing LMHs or open major hepatectomies (OMHs).…”

Influence of body habitus on feasibility and outcome of laparoscopic liver resections: a prospective study

“…Several series reporting procedures involving all liver segments are currently available in the literature and even major hepatectomies and resections of postero‐superior segments are reported , even though with a different profile of difficulty as compared to procedures involving the so‐called “laparoscopic segments”. During the Second International Consensus Conference for Laparoscopic Liver Resection , held in Morioka in 2014, a difficulty index (DI), which is the cumulative score comprising scores for five individual items (lesion size and location, proximity to vessels, extent of hepatectomy and liver function) , was developed in an effort to predict preoperatively the difficulty of procedures, in an assessment and educational perspective.…”