Propensity score-matched analysis of laparoscopic-assisted and hand-assisted laparoscopic liver resection versus pure laparoscopic liver resection: an international multicenter study.
Krenzien, Felix Schmelzle, Moritz Pratschke, Johann Syn, Nicholas L Sucandy, Iswanto Chiow, Adrian K H Marino, Marco V Gastaca, Mikel Wang, Xiaoying Lee, Jae Hoon
Krenzien, Felix
Schmelzle, Moritz
Pratschke, Johann
Syn, Nicholas L
Sucandy, Iswanto
Chiow, Adrian K H
Marino, Marco V
Gastaca, Mikel
Wang, Xiaoying
Lee, Jae Hoon
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2023-04-12
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Abstract
Background: Laparoscopic-assisted (LALR) and hand-assisted (HALR) liver resections have been utilized during the early adoption phase by surgeons when transitioning from open surgery to pure LLR. To date, there are limited data reporting on the outcomes of LALR or HALR compared to LLR. The objective was to compare the perioperative outcomes after LALR and HALR versus pure LLR.
Methods: This is an international multicentric analysis of 6609 patients undergoing minimal-invasive liver resection at 21 centers between 2004 and 2019. Perioperative outcomes were analyzed after propensity score matching (PSM) comparison between LALR and HALR versus LLR.
Results: 5279 cases met study criteria of whom 5033 underwent LLR (95.3%), 146 underwent LALR (2.8%) and 100 underwent HALR (1.9%). After 1:4 PSM, LALR was associated with inferior outcomes as evidenced by the longer postoperative stay, higher readmission rate, higher major morbidity rate and higher in-hospital mortality rate. Similarly, 1:6 PSM comparison between HALR and LLR also demonstrated poorer outcomes associated with HALR as demonstrated by the higher open conversion rate and higher blood transfusion rate. All 3 approaches technical variants demonstrated the same oncological radicality (R1 rate).
Conclusion: LALR and HALR performed during the learning curve was associated with inferior perioperative outcomes compared to pure LLR.
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Krenzien F, Schmelzle M, Pratschke J, Syn NL, Sucandy I, Chiow AKH, Marino MV, Gastaca M, Wang X, Lee JH, Chong CC, Fuks D, Choi GH, Efanov M, Kingham TP, D'Hondt M, Troisi RI, Choi SH, Sutcliffe RP, Liu R, Cheung TT, Tang CN, Han HS, Goh BKP; International robotic and laparoscopic liver resection study group investigators. Propensity score-matched analysis of laparoscopic-assisted and hand-assisted laparoscopic liver resection versus pure laparoscopic liver resection: an international multicenter study. Surg Endosc. 2023 Apr 12. doi: 10.1007/s00464-023-10028-7. Epub ahead of print.
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