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Original Investigation | Pacific Coast Surgical Association

Comparison of Short-term Outcomes in Laparoscopic vs Open Hepatectomy

Cara Franken, MD1; Briana Lau, MD1; Krishna Putchakayala, MD1; L. Andrew DiFronzo, MD1
[+] Author Affiliations
1Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
JAMA Surg. 2014;149(9):941-946. doi:10.1001/jamasurg.2014.1023.
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Importance  Despite the increasing role of laparoscopy in partial hepatic resection, its short-term benefit compared with traditional open surgery remains unclear.

Objective  To compare short-term (30-day) outcomes between laparoscopic (LH) and open (OH) partial hepatectomies.

Design, Setting, and Participants  Retrospective matched case-control study from April 1, 2004, to March 31, 2013, in a tertiary hepatobiliary referral center. Patients who underwent partial hepatic resection (OH or LH) for benign or malignant disease were matched first by extent of resection, then by pathological diagnosis, and finally by age and sex to the extent possible.

Exposure  Partial hepatectomy for liver disease.

Main Outcomes and Measures  Thirty-day morbidity and mortality rates.

Results  After the matching process, we included 104 patients (52 undergoing LH and 52 undergoing OH) in the study. Patients were evenly matched with respect to age, sex, extent of resection, and diagnosis. Cirrhosis was present in 17 patients (33%) in each group. We found no difference in positive margin status (1 patient [2%] for LH vs 2 patients [4%] for OH; P > .99). Although the estimated blood loss differed significantly between groups (237 mL for LH vs 387 mL for OH; P = .049), we found no difference in the rate of perioperative blood transfusion (1 patient [2%] for LH vs 5 [10%] for OH; P = .20). Operative time (219 minutes for LH vs 198 minutes for OH; P = .16), hospital length of stay (5 days for LH vs 6 days for OH; P = .13), and readmission rate (4 patients [8%] for LH vs 5 [10%] for OH; P = .70) were similar in both groups. The rates of major complications (4 patients [8%] for LH vs 4 patients [8%] for OH; P = 10), overall 30-day morbidity (22 patients [42%] for LH vs 19 [37%] for OH; P = .70), and 30-day mortality (1 patient [2%] for LH vs 2 [4%] for OH; P > .99) were not significantly different.

Conclusions and Relevance  Patients who undergo LH have similar short-term outcomes when compared with those who undergo OH. Laparoscopic hepatectomy was associated with lower intraoperative blood loss, although the clinical significance of this finding is uncertain given the lack of difference in perioperative transfusion or morbidity rates. In addition, we found no difference in margin status between the 2 groups. Future studies are needed to define which patients derive benefit from LH and to determine oncologic equivalence to OH.

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