Minimally invasive versus open right anterior sectionectomy and central hepatectomy for central liver malignancies: a propensity‐score‐matched analysis

Abstract

Background The utility of minimally‐invasive liver resection (MILR) for deep centrally located tumours (CLT) remains controversial. We aimed to review our institution's experience and outcomes with minimally invasive central hepatectomy (CH) and right anterior sectionectomy (RAS) for CLT in a propensity score‐matched (PSM) analysis. Methods Retrospective review of a prospectively maintained surgical database revealed 23 patients who underwent MILR (6 CH, 17 RAS) and 53 patients who underwent open liver resection (OLR; 24 CH, 29 RAS) for CLT. PSM in a 1:1 ratio identified two groups of patients with similar baseline clinicopathological characteristics. Peri‐operative outcomes were then compared. Results There was one laparoscopic‐assisted, one robot‐assisted and two laparoscopic‐converted‐open procedures in the MILR cohort. Across the unmatched cohort, there was only one mortality (MILR) and five patients with major morbidity (all OLR). MILR was associated with a longer operating time (P < 0.001), but shorter post‐operative hospital stay (P = 0.002) and decreased morbidity (P = 0.018) in the unmatched cohort. Examination of peri‐operative outcomes after PSM revealed that MILR was similarly associated with a longer operating time (P = 0.001) and shortened post‐operative hospital stay (P = 0.043). OLR was associated with a significantly reduced application of Pringle manoeuvre (P = 0.004). There were no significant differences between MILR and OLR with regards to blood loss, blood transfusions, morbidity and margin status in the PSM analysis. Conclusion MILR for CLT is safe and feasible when performed by experienced surgeons. It is associated with shorter hospital stays but at the expense of longer operation times and more frequent application of Pringle manoeuver.

Minimally invasive mesohepatectomy for centrally located liver lesions—a case series

“…Furthermore, all patients who had specific posthepatectomy complications were managed by conservative treatment only. None of the included patients developed posthepatectomy liver failure or died within 90 days after surgery which is consistent to previous studies [ 12 , 33 – 35 ].…”

“…Several reports exist in the literature that minimally invasive hepatectomy after prior open abdominal surgeries is not associated with a higher morbidity rate compared to open hepatectomy, but a higher rate of adhesions and conversions to open surgery are discussed [ 36 , 37 ]. The conversion rate of our study was comparable to results in literature for the treatment of centrally located lesions [ 12 , 33 – 35 ]. In our study, one patient required a conversion to laparotomy.…”

“…In 2018, these guidelines were updated and suggested similar perioperative outcomes if advanced expertise in minimally invasive surgery is present [ 32 ]. Thereafter, the number of published retrospective cohort studies comparing minimally invasive and open liver resections for centrally located liver lesions increased [ 12 , 33 – 35 ]. However, these reports included mixed cohorts of isolated central segmentectomies or any combinations of resected central segments as well as non-anatomic resections.…”

Laparoscopic versus open caudate lobe liver resections: a 1:2 propensity score‐matched controlled study based on a single institution experience

“…41 Our institutional experience has also significantly grown during this period with an increased proportion of cases being done laparoscopically, including more complex resections, repeat resections after previous OLR or LLR as well as difficult segments such as caudate lobe and posterior segment lesions. [42][43][44][45] This explains the increased number of caudate lobe lesion being done as L-CLR versus O-CLR in recent years. As with all retrospective analysis, there is a potential for information and selection bias despite our attempts to mitigate this with a 1: 2 propensity scoring which showed no significant difference in results after matching.…”

“…During this period, LLR has made significant advances since the Louisville statement 41 . Our institutional experience has also significantly grown during this period with an increased proportion of cases being done laparoscopically, including more complex resections, repeat resections after previous OLR or LLR as well as difficult segments such as caudate lobe and posterior segment lesions 42–45 . This explains the increased number of caudate lobe lesion being done as L‐CLR versus O‐CLR in recent years.…”