Impact of non-liver-related previous abdominal surgery on the difficulty of minimally invasive liver resections: a propensity score-matched controlled study
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Yvette Chong1, Ye-Xin Koh1, Jin-Yao Teo1
1Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Level 5, 20 College Road, Academia, Singapore, 169856, Singapore.
Introduction:
The presence of previous abdominal surgery (PAS) has traditionally been considered to add difficulty to and increase risk of complications of laparoscopic procedures. This study aims to analyse the impact of non-liver-related PAS on the difficulty of minimally invasive liver resections (MILRs).
Materials And Methods:
After exclusion of patients with concomitant major surgical procedures as well as previous liver resections, 515 consecutive patients undergoing MILR in Singapore General Hospital from 2006 to 2019 were analysed, consisting of 161 MILR in patients with previous abdominal surgery (WPAS) and 354 MILR in patients without previous abdominal surgery (WOPAS). Propensity score-matched (PSM) comparison was performed between WPAS and WOPAS groups. In addition, subgroup analysis was made comparing previous upper or lower abdominal surgery and open versus minimally invasive approach of PAS. Outcomes measured include those associated with operative difficulty such as open conversion rates, operative time, blood loss, as well as morbidity and mortality rates.
Results:
MILR outcomes in patients WPAS are not inferior to those WOPAS. Overall open conversion rate was 8.2%, higher in patients WOPAS compared to patients WPAS (11.9% versus 3.5%, p = 0.015). Operating time (p = 0.942), blood loss (p = 0.063), intraoperative blood transfusion (p = 0.750), length of hospital stay (p = 0.206), morbidity (p = 0.217) and 30- and 90-day mortality (p = 1 & p = 0.367) were comparable between the two groups and subgroup analysis.
Conclusion:
Outcomes of MILR in patients with previous non-liver-related abdominal surgery are not inferior to patients without previous abdominal surgery.
Insights
Previous abdominal surgery (PAS) does not worsen outcomes for minimally invasive liver resections (MILRs). Studies show comparable operative times, blood loss, and mortality rates between patients with and without prior abdominal surgery, indicating similar safety and efficacy.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Previous abdominal surgery (PAS) is often perceived to increase complexity and complication risks in laparoscopic procedures.
- The specific impact of non-liver-related PAS on minimally invasive liver resections (MILRs) requires detailed analysis.
Purpose of the Study:
- To evaluate the influence of prior non-liver-related abdominal surgery on the difficulty and outcomes of MILRs.
- To compare the safety and efficacy of MILRs in patients with and without a history of abdominal surgery.
Main Methods:
- A retrospective analysis of 515 patients undergoing MILR between 2006 and 2019.
- Comparison between patients with previous abdominal surgery (WPAS) and without (WOPAS) using propensity score matching.
- Subgroup analysis based on the location and approach of prior abdominal surgery.
Main Results:
- MILR outcomes in WPAS patients were not inferior to WOPAS patients.
- Overall open conversion rate was 8.2%, with a significantly lower rate in WPAS (3.5%) compared to WOPAS (11.9%).
- Operating time, blood loss, transfusion rates, hospital stay, morbidity, and mortality were comparable between groups.
Conclusions:
- Minimally invasive liver resections can be performed safely and effectively in patients with a history of non-liver-related abdominal surgery.
- Previous abdominal surgery does not appear to be a contraindication for MILR, with comparable outcomes to patients without such history.
