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Updated: Oct 11, 2025
Laparoscopic Anterior Right Hepatectomy: A Single-Center Experience
Published on: December 4, 2023
Outcome of major hepatectomy in cirrhotic patients; does surgical approach matter? A propensity score matched
Andrea Benedetti Cacciaguerra1,2,3, Burak Görgec1,2,4, Jacopo Lanari5
1Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy.
Insights
Major laparoscopic liver resection (mjLLR) offers short-term benefits for cirrhotic patients compared to open liver resection (mjOLR), including fewer complications and shorter hospital stays. Long-term outcomes remain similar between both surgical approaches for liver cancer patients.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Gastroenterology
Background:
- Major hepatectomy in cirrhotic patients presents significant surgical challenges.
- The choice of surgical approach may influence patient outcomes.
Purpose of the Study:
- To investigate the clinical impact of major hepatectomy in cirrhotic patients.
- To assess whether laparoscopic versus open liver resection affects outcomes.
Main Methods:
- A multicenter retrospective study (2009-2020) included cirrhotic patients undergoing major laparoscopic liver resection (mjLLR) and major open liver resection (mjOLR).
- Propensity score matching (PSM) was used to compare clinical, demographic, and perioperative data.
- Long-term outcomes after resection for hepatocellular carcinoma were analyzed.
Main Results:
- After PSM, 88 patients were matched in each group (mjLLR vs. mjOLR).
- mjLLR was associated with less blood loss, fewer overall and severe complications (e.g., surgical site infection, acute kidney injury, liver failure), and shorter hospital stays.
- Laparoscopic advantages were more pronounced in left hepatectomy; benefits diminished in right hepatectomy.
- No significant difference in long-term survival was observed between mjLLR and mjOLR for hepatocellular carcinoma.
Conclusions:
- Major laparoscopic liver resection (mjLLR) shows potential short-term advantages over major open liver resection (mjOLR) in cirrhotic patients.
- These benefits are achieved without compromising long-term outcomes.
- Findings suggest implications for managing patients with chronic liver disease.
Objective:
Major hepatectomy in cirrhotic patients still represents a great challenge for liver surgeons. Hence, the aim in the present study is to investigate the clinical impact of major hepatectomy and to assess whether the surgical approach influences the outcome of cirrhotic patients.
Methods:
Multicenter retrospective study including cirrhotic patients undergoing major laparoscopic (mjLLR) and open liver resection (mjOLR) in 14 Western liver centers was performed (2009-2020). Clinical, demographic, and perioperative data were compared using propensity score matching (PSM). Long-term outcome after resection for hepatocellular carcinoma was analyzed.
Results:
Overall, 352 patients were included; 108 after mjLLR and 244 after mjOLR. After PSM, 88 patients were matched in each group. In the mjLLR group, compared to mjOLR, less blood loss (P = .042), lower overall and severe complication (P < .001, .020), such as surgical site infection, acute kidney injury and liver failure were observed, parallel to a shorter length of hospital stay. Stratifying patients based on the type of resection, less severe complications was observed only after laparoscopic left hepatectomy (P = .044), while the advantages of laparoscopy tend to decrease during right hepatectomy. Subgroup analysis of long-term survivals following liver resection for hepatocellular carcinoma showed no difference between mjLLR and mjOLR.
Conclusions:
This multicenter experience suggests potential short-term benefits of mjLLR in cirrhotic patients compared to mjOLR, without compromising long-term outcome. These findings might have interesting clinical implications for the management of patients with chronic liver disease.
