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Updated: Apr 18, 2026
Laparoscopic Anterior Right Hepatectomy: A Single-Center Experience
Published on: December 4, 2023
Laparoscopy Decreases Pulmonary Complications in Patients Undergoing Major Liver Resection: A Propensity Score
David Fuks1, François Cauchy, Samir Ftériche
1*Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France †Université Paris Descartes, Paris, France ‡Department of Hepatobiliary and Liver Transplantation, Hôpitaux de Paris Hôpital Saint Antoine, Paris, France §Université Pierre et Marie Curie Paris 6, Paris, France ¶Department of Hepatobiliary and Liver Transplantation, Hôpitaux de Paris Hôpital Beaujon, Beaujon, Clichy, France ||Université Paris 7 Diderot, Paris, France.
Objective:
To compare both incidence and types of postoperative pulmonary complications (PPCs) between laparoscopic major hepatectomy (LMH) and open major hepatectomy (OMH).
Background:
LMHs are increasingly performed. Yet, the benefits of laparoscopy over laparotomy regarding PPCs remain unknown.
Methods:
In this multi-institutional study, all patients undergoing OMH or LMH between 1998 and 2013 were retrospectively reviewed. Risk factors for PPCs were analyzed on multivariate analysis. Comparison of both overall rate and types of PPCs between OMH and LMH patients was performed after propensity score adjustment on factors influencing the choice of the approach.
Results:
LMH was performed in 226 (18.6%) of the 1214 included patients. PPCs occurred in 480 (39.5%) patients including symptomatic pleural effusion in 366 (30.1%) patients, respiratory insufficiency in 141 (11.6%), acute respiratory distress syndrome in 84 (6.9%), pulmonary infection in 80 (6.5%), and pulmonary embolism in 47 (3.8%) patients. On multivariate analysis, preoperative hypoprotidemia [hazard ratio (HR): 1.341, 95% confidence interval (CI): 1.001-1.795; P = 0.049], open approach (HR: 2.481, 95% CI: 1.141-6.024; P = 0.024), right-sided hepatectomy (HR: 2.143, 95% CI: 1.544-2.975; P < 0.001), concomitant extrahepatic procedures (HR: 1.742, 95% CI: 1.103-2.750; P = 0.017), transfusion (HR: 2.851, 95% CI: 2.067-3.935; P < 0.001), and operative time more than 6 hours (HR: 1.510, 95% CI: 1.127-2.022; P = 0.006) were independently associated with PPCs. After propensity score matching, the overall incidence of PPCs (13.2% vs 40.5%, P < 0.001), symptomatic pleural effusion (11.6% vs 26.4%, P = 0.003), pleural effusion requiring drainage (1.7% vs 9.9%, P = 0.006), and acute respiratory distress syndrome (1.7% vs 9.9%, P = 0.006) were significantly lower in the laparoscopy group than in the open group.
Conclusions:
Pure laparoscopy allows reducing PPCs in patients requiring major liver resection.
Insights
Laparoscopic major hepatectomy significantly reduces postoperative pulmonary complications compared to open surgery. This includes fewer cases of pleural effusion and acute respiratory distress syndrome, improving patient outcomes.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Pulmonary Complications
Background:
- Laparoscopic major hepatectomy (LMH) is increasingly utilized.
- The comparative impact of LMH versus open major hepatectomy (OMH) on postoperative pulmonary complications (PPCs) remains unclear.
Purpose of the Study:
- To compare the incidence and types of PPCs between LMH and OMH.
- To identify risk factors associated with PPCs in major hepatectomy patients.
Main Methods:
- Retrospective review of 1214 patients undergoing OMH or LMH (1998-2013).
- Multivariate analysis to identify PPC risk factors.
- Propensity score matching to compare PPC rates and types between surgical approaches.
Main Results:
- PPCs occurred in 39.5% of patients; common types included pleural effusion, respiratory insufficiency, and ARDS.
- Independent risk factors for PPCs included open approach, longer operative time, and transfusion.
- After propensity score matching, LMH showed significantly lower rates of overall PPCs (13.2% vs. 40.5%), symptomatic pleural effusion, and ARDS compared to OMH.
Conclusions:
- Laparoscopic major hepatectomy is associated with a significant reduction in postoperative pulmonary complications.
- Pure laparoscopy offers an advantage in minimizing PPCs for patients undergoing major liver resections.
