Intention to Treat Laparoscopic Versus Open Hemi-Hepatectomy: A Paired Case-Matched Comparison Study

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• The comparative benefits of laparoscopic hemi-hepatectomy versus open hemi-hepatectomy are not well-established.
• Clarifying these differences is crucial for surgical decision-making.

Purpose of the Study:

• To compare the outcomes of laparoscopic hemi-hepatectomy with open hemi-hepatectomy.
• To share institutional experience with the laparoscopic approach.

Main Methods:

• Matched-cohort study comparing 40 laparoscopic hemi-hepatectomy cases with open hemi-hepatectomy cases.
• Matching criteria included laterality, pathology, ASA score, BMI, bilirubin, neoadjuvant chemotherapy, additional procedures, PVE, and cirrhosis.
• Outcomes assessed included blood loss, operative time, hospital stay, morbidity, mortality, and oncological results using Clavien-Dindo classification.

Main Results:

• Laparoscopic hemi-hepatectomy showed significantly shorter hospital (6 vs 8 days) and high dependency unit stays (1 vs 2 days).
• Operative time was longer in the laparoscopic group (420 vs 305 min), with similar intra-operative blood loss but higher transfusion requirements (p=0.36).
• Morbidity (18 vs 20 patients), mortality (2.5%), positive resection margins (18% vs 21%), and survival rates (1-year: 87.5% vs 92.5%; 3-year: 70% vs 72.5%) were comparable.

Conclusions:

• Laparoscopic hemi-hepatectomy leads to reduced hospital and high dependency unit stays.
• The laparoscopic approach is associated with longer operative times and a trend towards increased blood transfusions.
• No significant differences were observed in morbidity, mortality, or oncological outcomes between laparoscopic and open hemi-hepatectomy.