Abstract

Introduction: Minimally invasive surgery (MIS) to treat liver disease has increased in prevalence over the past decade; however, little data exists comparing outcomes between MIS and open hepatectomies. We sought to compare preoperative and postoperative outcomes between MIS and open hepatectomies performed for hepatobiliary malignancies.

Methods: The National Surgical Quality Improvement Program (NSQIP) Database was used to analyze all patients who underwent hepatectomies between January 1 and December 31, 2015. Hepatectomies were divided into three groups (open, laparoscopic, robotic). Preoperative variables such as pringle maneuver usage, concurrent ablation, concurrent hepaticojejunostomy, whether neoadjuvant therapy was used were compared between MIS and open hepatectomies. Perioperative outcomes such as conversion from laparoscopic or robotic to open, bile leakage, drain placement, INR, bilirubin (drain and serum), number of days of drain removal after surgery, post-hepatectomy liver failure, need for invasive intervention postoperatively, and pathology results were are compared. Groups were further dichotomized into major (> 3 liver segments resected) versus minor (1 - 2 liver segments resected) liver hepatectomies.

Results: A total of 1,010 patients were analyzed. Hepatocellular carcinoma comprised 58.91% (Drain placement, peak postoperative bilirubin, need for invasive intervention postoperatively, bile leakage, post-hepatectomy liver failure were all significantly lower in MIS hepatectomies compared to open (< 0.0001).

Conclusion: Overall, MIS hepatectomies performed for hepatobiliary malignancies were found to have lower complication rate in both major and minor hepatic resections. When possible, MIS surgery should be attempted in all hepatectomy patients.

Keywords:Minimally Invasive Surgery (MIS); National Surgical Quality Improvement Program (NSQIP); Open Surgical Techniques

References

1. 1. Jin S.,et al. “Management of post-hepatectomy complications”. World Journal of Gastroenterology 44 (2013): 7983-7991.
   2. Tzeng CW., et al. “Predictors of morbidity and mortality after hepatectomy in elderly patients: analysis of 7621 NSQIP patients”. HPB5 (2014): 459-468.
   3. Nanashima A.,et al. “Reducing the incidence of post-hepatectomy hepatic complications by preoperatively applying parameters predictive of liver function”. Journal of Hepato-Biliary-Pancreatic Sciences 6 (2010): 871-878.
   4. Tomuş C.,et al. “[Liver resection for benign hepatic lesion: mortality, morbidity and risk factors for postoperative complications]”. Chirurgia3 (2009): 275-280.
   5. Aloia TA.,et al. “Predicting poor outcome following hepatectomy: analysis of 2313 hepatectomies in the NSQIP database”. HPB 6 (2009): 510-515.
   6. Dan RG.,et al. “Postoperative morbidity and mortality after liver resection. Retrospective study on 133 patients”. Chirurgia 6 (2012): 737-741.
   7. Vibert E.,et al. “Actual incidence and long-term consequences of posthepatectomy liver failure after hepatectomy for colorectal liver metastases”. Surgery 1 (2014): 94-105.
   8. Rahbari NN.,et al. “Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS)”. Surgery 5 (2011): 713-724.
   9. Van den Broek MA.,et al. “Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment”. Liver International 6 (2008): 767-780.
   10. Ribeiro HS.,et al. “Extended preoperative chemotherapy, extent of liver resection and blood transfusion are predictive factors of liver failure following resection of colorectal liver metastasis”. European Journal of Surgical Oncology 4 (2013): 380-385.
   11. Hammond JS.,et al. “Prediction, prevention and management of postresection liver failure”. British Journal of Surgery 9 (2011): 1188-1200.
   12. Wibmer A.,et al. “Liver failure after major liver resection: risk assessment by using preoperative Gadoxetic acid-enhanced 3-T MR imaging”. Radiology 3 (2013): 777-786.
   13. Jin YJ.,et al. “Prediction of postoperative liver failure using gadoxetic acid-enhanced magnetic resonance imaging in patients with hepatocellular carcinoma”. European Journal of Gastroenterology and Hepatology 7 (2016): 1349-1356.
   14. De Liguori Carino N.,et al. “Perioperative use of the LiMON method of indocyanine green elimination measurement for the prediction and early detection of post-hepatectomy liver failure”. European Journal of Surgical Oncology 9 (2009): 957-962.
   15. Sugimoto H.,et al. “Early detection of liver failure after hepatectomy by indocyanine green elimination rate measured by pulse dye-densitometry”. Japanese Society of Hepato-Biliary-Pancreatic Surgery 6 (2006): 543-548.
   16. Vibert E.,et al. “Actual incidence and long-term consequences of posthepatectomy liver failure after hepatectomy for colorectal liver metastases”. Surgery 155 (2014): 94-105.
   17. Bagante Fabio., et al. "Minimally invasive vs. open hepatectomy: a comparative analysis of the national surgical quality improvement program database”. Journal of Gastrointestinal Surgery9 (2016): 1608-1617.
   18. Wang, Hai-Qing., et al. “Bile leakage test in liver resection: a systematic review and meta-analysis”. World Journal of Gastroenterology: WJG45 (2013): 8420.