Short-term Outcomes of Laparoscopic versus Open Formal Anatomical Hepatectomy: A Case Matched Control Study

Variability in extent and complexity of hepatic resection complicates prior laparoscopic (LH) and open (OH) hepatectomy comparisons. This study compares the 30-day outcomes of formal anatomical LH and OH by matching patients by location and extent of resection. A retrospective review was conducted for patients undergoing formal anatomical hepatectomies from January 2008 to November 2014. Of 580 liver procedures, 78 formal OH and 47 LH meeting criteria were identified. A total of 26 pairs were strictly matched based on resection extent and location, underlying pathology, age, and gender. The primary outcome was complication rate. Secondary outcomes were intraoperative blood loss estimated blood loss, procedure time, transfusion, and hospital stay. The groups were similar with regard to patient demographics. Right or left hepatectomy were most common (14 pairs, 53.8%). On average, 2.8 liver segments were resected. Nine LH cases (36%) were converted to open. Using intention to treat analysis, there were no significant differences in overall complications (46% vs 54%, P = 0.274) or major (Clavien ≥ 3) complications (19% vs 8%, P = 0.223), mean estimated blood loss (386 vs 556 mL, P = 0.216), procedure time (269 vs 255 minutes, P = 0.406, or hospital stay (6.0 vs 5.6 days, P = 0.643). When appropriately matched, there were equivalent short-term outcomes between formal LH and OH.