Scott Revell, MD1, Joshua Parreco1, Rishi Rattan, MD2, Alvaro Castillo, MD1. 1U. Miami – JFK GME Consortium, 2University of Miami, Miller School of Medicine
Introduction: Over the last two decades the increasing incidence of benign liver tumors has led to the expanded need for clinicians to make therapeutic decisions regarding the utilization of open, minimally invasive and ablative techniques. The purpose of this study was to compare outcomes of the management of benign liver disease based on operative approach and pathology.
Methods: Patients aged 18 years or older who underwent liver surgery for benign liver tumors from 2010 to 2014 were identified in the Nationwide Readmissions Database. Patients were compared based on liver pathology, resection versus ablation, and an open versus laparoscopic/robotic approach. The outcomes of interest were in-hospital mortality, prolonged length of stay (LOS) >7 days, and readmission within 30-days. Univariable analysis was performed for these outcomes and multivariable logistic regression was performed using the variables with a p-value <0.05 on univariable analysis. Results were weighted for national estimates.
Results: There were 6,173 patients undergoing surgery for benign hepatic tumors in the US during the study period. The most common pathology was benign neoplasm (62.1%) followed by hemangioma (28.9%), and congenital cystic disease (9.1%). Resection alone was performed in 72.8%, ablation alone in 21.1%, and resection with ablation in 6.1%. A laparoscopic/robotic approach was used in 10.3% of cases. The overall mortality rate was 0.3%, a prolonged LOS was found in 14.7%, and readmission within 30 days occurred in 8.1%. An increased risk for mortality was found with hemangioma (OR 12.34, p=0.03) and congenital cystic disease (OR 11.43, p=0.03). Resection with ablation was associated with an increased risk of prolonged LOS (OR 2.22, p<0.01), while a laparoscopic/robotic approach was a protective factor for prolonged LOS (OR 0.39, p<0.01). Patients treated with ablation alone were at decreased risk for readmission (OR 0.59, p<0.01).
Conclusions: The surgical management of benign liver tumors continues to be a safe and effective option. Minimally invasive techniques are associated with a decreased length of stay and ablative techniques are associated with decreased readmission rates.
Kim Y, Amini N, He J, Margonis GA, Weiss M, Wolfgang CL, Makary M, Hirose K, Spolverato G, Pawlik TM (2015) National trends in the use of surgery for benign hepatic tumors in the United States. Surgery 157:1055–1064.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88069
Program Number: P542
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster