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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 7/2019

01-07-2019 | Original Article

Early Morbidity and Mortality after Minimally Invasive Liver Resection for Hepatocellular Carcinoma: a Propensity-Score Matched Comparison with Open Resection

Authors: Dimitrios Xourafas, Timothy M. Pawlik, Jordan M. Cloyd

Published in: Journal of Gastrointestinal Surgery | Issue 7/2019

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Abstract

Background

The impact of minimally invasive surgery on the short-term outcomes of patients with hepatocellular carcinoma (HCC) undergoing liver resection remains poorly defined.

Methods

The ACS-NSQIP-targeted hepatectomy database was used to identify patients who underwent liver resection for HCC during 2014–2016. A 1:1 propensity score matching was created between patients who underwent open (OLR) vs. minimally invasive liver resection (MILR) based on age, ASA score, liver resection type, liver texture, and stage of disease. The short-term outcomes of patients undergoing OLR vs. MILR were compared.

Results

Among a total cohort of 1816 patients, propensity score matching resulted in 728 liver resections: 364 (50%) OLR and 364 (50%) MILR. Overall morbidity (29% vs. 23%, P = 0.04) was greater among patients undergoing OLR compared with MILR, whereas mortality did not differ between the two approaches (2% vs 1%, P = 0.57). MILR was associated with significant reductions in hospital LOS (6 vs. 4 days, P < 0.0001) but no difference in operative time (188 vs. 171 min, P = 0.13). On multivariate logistic regression analysis, age ≥ 65 (OR:1.6, 95%CI: 1.1–2.3, P = 0.0065), ASA class ≥ 3 (OR:2.7, 95%CI: 1.5–4.7, P = 0.0003), preoperative blood transfusion (OR:9.7, 95%CI: 1.06–90.3, P = 0.04), T ≥ 3 (OR:1.9, 95%CI: 1.09–3.4, P = 0.02), operative time > 200 min (OR:1.8, 95%CI: 1.2–2.5, P = 0.0011), and OLR (OR:1.4, 95%CI: 1.002–2.03, P = 0.04) were associated with increased odds of overall morbidity.

Conclusions

MILR for HCC is associated with a shorter hospital LOS and reduced postoperative complication rates, even after controlling for important patient and clinicopathologic confounders, compared to OLR. Efforts to expand the use of MILR for hepatobiliary surgery are warranted.
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Metadata
Title
Early Morbidity and Mortality after Minimally Invasive Liver Resection for Hepatocellular Carcinoma: a Propensity-Score Matched Comparison with Open Resection
Authors
Dimitrios Xourafas
Timothy M. Pawlik
Jordan M. Cloyd
Publication date
01-07-2019
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 7/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-018-4016-2

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