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Standardized comparison of open vs minimally invasive surgery in patients undergoing hepatectomy through the textbook
J Gonzalez-Fajardo1, H Facundo2, M Núñez3
1Unit of Gastrointestinal and Hepatopancreatobiliary Surgery, Instituto Nacional de Cancerología, Bogotá Distrito Capital, Colombia; Department of Surgery, Universidad Nacional de Colombia, Bogotá Distrito Capital, Colombia.
Background:
Textbook outcome (TO) is a composite measure developed to evaluate postoperative outcomes. By definition, TO is the ideal postoperative course. A comparative study between open surgery (OS) and minimally invasive surgery (MIS) was conducted in a cancer referral center in Colombia using TO in liver surgery (TOLS) as a comprehensive primary outcome.
Methods:
Patients who underwent hepatic resection between 2009 and 2023 were retrospectively analyzed. Of note, each patient in the MIS group was matched with 1 patient in the OS group through a propensity score calculated using clinically relevant preoperative covariates. The primary outcome was TOLS. Factors correlated with non-TOLS achievement were analyzed using a multivariate logistic regression model.
Results:
A total of 333 patients who underwent hepatic resection were included. Overall, TO was achieved in 57.6% of the cohort, 67.2% in the MIS group, and 52.7% in the OS group. Patients who underwent MIS had a higher American Society of Anesthesiologists score of 3 to 4 (92% in the MIS group vs 67.7% in the OS group; P <.01), more incidence of colorectal metastasis (54% in the MIS group vs 35.5% in the OS group; P <.01), smaller preoperative tumor sizes (median: 25 mm [IQR, 17-35] in the MIS group vs 30 mm [IQR, 20-53] in the OS group; P <.01), and a higher incidence of minor resections (85% in the MIS group vs 63.6% in the OS group; P <.01). After propensity score matching, TOLS was achieved in 64.0% and 43.6% of cases in the MIS and OS groups, respectively, with an odds ratio (OR) of 2.59 (P <.01) for OS to noncompliance of TOLS. In contrast, in the multivariate analysis, nonachievement of TOLS was associated with male sex (OR, 1.76 [95% CI, 1.10-2.83]; P =.019), history of diabetes mellitus (OR, 2.42 [95% CI, 1.10-5.30]; P =.028), colorectal liver metastasis (OR, 1.76 [95% CI, 1.06-2.90]; P =.028), OS (OR, 1.81 [95% CI, 1.05-3.13]; P =.034), and major liver resection (OR, 2.19 [95% CI, 1.30-3.69]; P <.01).
Conclusion:
MIS was associated with higher TOLS achievement, lower rates of major complications, and shorter hospital stays than OS.
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