Brian K Goh, Ser Yee Lee, Jin Yao Teo, Juinn Huar Kam, Peng Chung Cheow, Prema Raj Jeyaraj, Pierce K Chow, London L Ooi, Alexander Y Chung, Chung Yip Chan. Singapore General Hospital
Objectives: This study studies the changing trends, safety and outcomes associated with the adoption of minimally-invasive hepatectomy (MIH) at a single center.
Methods: This is a retrospective review of a prospective database of 400 consecutive patients who underwent MIH over a 11-year period from 2006 to 2017 at a single institution. In order to analyze the evolution of MIH, the study population was stratified into 4 equal cohorts of 100 patients
Results: Four hundred patients underwent MIH and the types of MIH approach adopted included totally laparoscopic/robotic in 379(94.8%), hand-assisted laparoscopic in 6(1.5%) and laparoscopic assisted in 15(3.8%). The indication for MIH was for malignancy in 316(79%) and the most common malignancy was hepatocellular carcinoma in 203(50.8%) patients. 116(29.0%) patients had underlying cirrhosis. 88(22.0%) patients underwent a major hepatectomy and 160(40.0%) had resection of tumors located in the difficult posterosuperior segments. The median operation time was 220 (range, 40-825) minutes and 71(17.8%) patients had intra-operative blood transfusions. There were 40(10%) open conversions. The median postoperative stay was 4 (range, 1-65) days. Major postoperative morbidity (> grade 2) occurred in 20(5.0%) patients. There were 2(0.5%) 30-day and 4(1%) in-hospital mortalities. Comparison of MIH across the 4 groups demonstrated that there was an increase in the frequency of MIH performed. There was a statistically significant increase in major hepatectomies (10% vs 18% vs 32% vs 28%, P= .001), increase in repeat liver resections (0 vs 6% vs 9% vs 9%, P=.023), and decrease in open conversion rates (17% vs 6% vs 11% vs 6%, P=.028). There was no difference in intra-operative blood loss, operation time, intra-operative blood transfusion rate, postoperative stay and postoperative morbidity.
Conclusion: MIH is feasible and can be safely adopted. Over the study period, the case volume of MIH increased rapidly at our institution. Although, there was a significant increase in the frequency of major hepatectomies and repeat liver resections performed, there was a decrease in open conversion rates. There was also no significant difference in other perioperative outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88605
Program Number: S064
Presentation Session: Liver/Pancreas Session
Presentation Type: Podium