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Multicenter Belgian prospective registry on minimally invasive and open liver surgery (BReLLS): experience from 1342
Roberto Ivan Troisi1,2, Gianluca Rompianesi3, Mathieu D'Hondt4
1Faculty of Medicine, Ghent University, Ghent, Belgium. roberto.troisi@unina.it.
Purpose:
Minimally invasive liver surgery (MILS) still appears to be adopted with significant variability. We aimed to investigate the diffusion, indications, and short-term outcomes of MILS compared to the open approach.
Methods:
A prospective registry of all liver resections performed for any indication and using any technique between January 1, 2017, and December 31, 2019, was established (BReLLS) and analyzed.
Results:
A total of 1342 consecutive liver resections were included, 684 (51%) MILS and 658 (49%) open procedures. MILS was not attempted due to technical complexity in the 46.2% of cases, followed by previous abdominal surgery (22.5%). Patients undergoing MILS had a higher proportion of benign indications and of hepatocellular carcinomas, patients affected by liver cirrhosis with portal hypertension and a lower proportion of major hepatectomies (all p < 0.001). After propensity-score matching, MILS showed better results in terms of surgery duration (p < 0.001), blood loss (p = 0.015), complication rate (p < 0.001), rate of Clavien-Dindo grade ≥ 3 complications (p = 0.012), comprehensive complication index (p < 0.001), length of stay (p < 0.001), readmissions (p = 0.016). Centers performing over 50 liver resections per year had a higher proportion of overall MILS cases (p < 0.001), a similar proportion of major resections (p = 0.362), but a higher prevalence of MILS major resections (p = 0.004), lower 90-day mortality rates (p < 0.001), lower overall complication rates (p < 0.001), and shorter hospital length of stay (p < 0.001).
Conclusion:
MILS was the preferred technique in half of the cases, particularly in patients with cirrhosis and portal hypertension, and benign lesions. It provided superior short-term outcomes compared to the open approach for both minor and major liver resections in selected patients.
Insights
Minimally invasive liver surgery (MILS) is preferred in half of liver resections, especially for cirrhosis patients. MILS demonstrates superior short-term outcomes, including reduced complications and shorter hospital stays, compared to open surgery.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Gastroenterology
Background:
- Minimally invasive liver surgery (MILS) adoption varies significantly.
- Understanding MILS indications and outcomes is crucial for surgical practice.
Purpose of the Study:
- To investigate the adoption, indications, and short-term outcomes of MILS versus open liver surgery.
- To compare the effectiveness and safety of MILS against traditional open procedures.
Main Methods:
- Prospective registry (BReLLS) of liver resections from January 2017 to December 2019.
- Analysis of 1342 liver resections, comparing MILS (684) and open (658) approaches.
- Propensity-score matching to control for patient and procedure variables.
Main Results:
- MILS was not attempted in 46.2% due to complexity and 22.5% due to prior surgery.
- MILS patients had more benign indications, hepatocellular carcinomas, and cirrhosis with portal hypertension.
- Propensity-score matched MILS showed reduced surgery duration, blood loss, complications, hospital stay, and readmissions.
- High-volume centers (>50 resections/year) performed more MILS, with better outcomes and lower mortality.
Conclusions:
- MILS is a preferred technique for approximately half of liver resections, particularly for patients with cirrhosis and benign lesions.
- MILS offers superior short-term outcomes for both minor and major liver resections in selected patients.
- MILS adoption and outcomes are positively influenced by high-volume surgical centers.
