Comparison of Laparoscopic versus Open Liver Resection: A Case-Controlled Study

Background: Although there is data in the literature about the safety and efficacy of laparoscopic liver resections, there are not many studies comparing laparoscopic versus open approaches in a case-matched design. The purpose of this study is to compare the perioperative outcome of laparoscopic versus open liver resections from a single institution.
Methods: Twenty-two patients underwent laparoscopic liver resection between April 1997 and August 2007, with 16 of these treated within a prospective laparoscopic program started in April 2006. This group of patients was compared to 22 consecutive patients undergoing open resection who were matched by size of the lesion (5cm or less for malignant and 8 cm or less for benign), anatomical location (segments 2, 3, 4b, 5, 6), and type of resection (wedge resection, segmentectomy, partial liver resection). Data was obtained from medical records as well as from a prospective database. Statistical analysis was performed using t-test and Chi square. All data are expressed as mean +/- SEM.
Results: The mean age in the laparoscopic group was 54.9 +/- 3.5 years vs 63.6 +/- 2.7 years in the open group (p=0.97). There was no difference between the groups regarding gender. There were more patients with malignant lesions in the open group (68%) versus the laparoscopic group (32%) (p=0.01). Seven patients underwent partial, 1 patient segmental and 14 patients wedge liver resection in the laparoscopic group versus 8 patients who underwent partial, 8 patients segmental and 6 patients wedge liver resection in the open group (p=NS). The mean tumor size was 4.7 +/-0.6 cm in the laparoscopic group versus 4.2+/-0.3 cm in the open group (p=0.25). Seven (32%) out of 22 cases in the laparoscopic group were hand-assisted. Inflow occlusion was used in 1 case (5%) in the laparoscopic group versus 9 (41%) in the open group. The mean operating time was 164.6+/-13.0 min for the laparoscopic group and 129.9+/-9.5 min for the open group (p=0.02). The mean estimated blood loss during the procedure was 120.0+/-42.3 cc for the laparoscopic group and 263.0+/-41.3 cc for the open group (p=0.02). The mean weight of the resection specimen was 106.9+/-19.8 g for the laparoscopic group and 132.8+/-21.9 g for the open group (p=0.4). Surgical margin was less than 5 mm in 57% of the malignant tumors in the laparoscopic group and in 33% in the open group. The mean hospital stay was 3.7+/-0.4 days for the laparoscopic group and 6.0+/-0.4 days for the open group (p


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Program Number: P334

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