Laparoscopic major hepatectomies: clinical outcomes and classification

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Surgical Outcomes Research

Background:

• Laparoscopic major hepatectomy encompasses diverse procedures, from traditional resections to challenging posterosuperior segment removals.
• The Louisville Statement categorizes these procedures, but clinical validity requires assessment.

Purpose of the Study:

• To compare clinical outcomes between laparoscopic traditional major hepatectomy (LTMH) and laparoscopic posterosuperior major hepatectomy (LPMH).
• To determine if the current classification of laparoscopic major hepatectomy needs revision based on clinical outcomes.

Main Methods:

• A prospectively collected database of 390 pure laparoscopic liver resections was reviewed.
• 156 patients undergoing laparoscopic major hepatectomy were categorized into LTMH (n=127) and LPMH (n=29) based on resected segments.
• Demographics, intraoperative variables, and postoperative outcomes were compared between LTMH and LPMH subgroups.

Main Results:

• LTMH had longer operation times (330 vs. 210 min) and greater blood loss (500 vs. 300 ml) compared to LPMH.
• Postoperative complication rates (22% vs. 17%) and mortality (1.6% vs. 0%) were observed, with LPMH showing a shorter hospital stay (4 vs. 5 days).
• Conversion rates were 9% for LTMH and 0% for LPMH.

Conclusions:

• Distinct subcategories for laparoscopic major hepatectomy, specifically LTMH and LPMH, are clinically appropriate.
• These subcategories better reflect significant differences in intraoperative and postoperative outcomes.