Takehiro Noda, MD, PhD1, Hidetoshi Eguchi, MD, PhD1, Hirishi Wada, MD, PhD1, Yoshifumi Iwagami, MD, PhD1, Daisaku Yamada, MD, PhD1, Tadafumi Asaoka, MD, PhD1, Kunihito Gotoh, MD, PhD1, Koji Umeshita, MD, PhD2, Yuichiro Doki, MD, PhD1, Masaki Mori, MD, PhD1. 1Department of Gastroenterological Surgery, Osaka University, 2Department of Health Sciences, Osaka Univeristy
Background/Purpose: Minimally invasive liver resection is considered as safe and feasible treatment for malignant liver tumors. However, few studies have investigated the surgical outcomes of minimally invasive liver resection in patients with impaired liver function. Liver damage is one of the classifications for evaluation of liver function and is used for consideration of hepatectomy in the surgical fields. In this study, we examined the efficacy of minimally invasive liver resection compared with open liver resection for patients with impaired liver function by using the propensity score matching.
Methods: Between 2001 and 2015, 225 patients with liver damage B underwent hepatic resection in the Department of Surgery, Osaka University Hospital. From these patients, 99 patients receiving non-anatomical resection or left lateral sectionectomy were selected because only non-anatomical liver resection or left lateral sectionectomy is covered by medical insurance in Japan. Ninety nine patients were divided into two groups of minimally invasive liver resection group (MILR group, n=24) and open liver resection group (OLR group, n=75). A propensity score was calculated from following covariates: gender, age, tumor type, hepatitis B virus, hepatitis C virus, prothrombin activity, total bilirubin, albumin, indocyanine green retention rate at 15 minutes, platelet values, Child-Pugh classification, American Society of Anesthesiologists classification, number of tumors, tumor size, tumor location, alpha-fetoprotein level, protein induced by Vitamin K absence or antagonists-II level. After matching of a propensity score, we compared 36 patients’ clinicopathological features and surgical outcomes of 18 patients per group.
Results: In 24 patients treated by minimally invasive liver resection, 19 patients underwent pure laparoscopic liver resection, 4 underwent hybrid laparoscopic liver resection, and 1 underwent hand-assisted laparoscopic liver resection. After matching of a propensity score, 36 patients of 18 patients from each group were selected and the patients’ characteristics and tumor characteristics were similar between the two groups. Blood loss (184 ml vs. 500 ml, P=.0163) and complication rate (5.5% vs. 38.9%, P=.0162) were significantly lower in MILR group. The complications were observed in 8 patients including one patient in MILR group and 7 patients in OLR group. These complications were superficial incisional surgical site infection (n=4), organ/space surgical site infection (n=2), acute cholecystitis (n=1), ascites (n=1), acute pancreatitis (n=1) and portal thrombosis (n=1). The postoperative hospital stay was significantly shortened in MILR group (P=.0118).
Conclusions: Minimally invasive liver resection might be effective for patients with impaired liver function. It reduces surgical complications and consequently shortens hospitalization time.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79407
Program Number: S057
Presentation Session: HPB
Presentation Type: Podium