Minimal invasive surgery for major liver resection associated with lower morbidity, mortality

Patients who underwent hepatectomy via minimally invasive surgery were less likely to experience serious morbidities or mortality compared with patients who underwent hepatectomy via open surgery, according to data presented at the 2016 Clinical Congress of the American College of Surgeons.

“This study is a large multi-institutional study looking at major liver surgery which is typically performed in an open fashion. …This data helps provide evidence for safety of this emerging technique for high-risk liver surgery,” Lucas W. Thornblade, MD, a general surgery resident at the University of Washington, Seattle, and study investigator, told Healio.com/Hepatology.

Lucas W. Thornblade

Thornblade and colleagues evaluated 1,015 hepatectomies performed at 65 hospitals that participated in the American College of Surgeons National Surgical Quality Improvement Program Hepatopancreaticobiliary Collaborative in 2014. Of the procedures, 13% were performed via minimally invasive surgery (n = 132) and the rest were open operations.

“By using data from more than 60 hospitals across the country we were able to compare outcomes among over a thousand major hepatectomies,” Thornblade said.

The researchers measured serious morbidity or mortality including organ-space infection, bleeds and organ failure, as well as liver-specific complications such as bile leak and liver failure.

Analysis showed the risk for serious morbidity or mortality was lower in patients who underwent minimally invasive surgery (relative risk [RR] = 0.46; 95% CI, 0.22-0.95).

“After controlling for differences between patients, we found that the odds of a serious complication or death were lower among patients who had laparoscopic or robotic surgeries compared with open surgery,” Thornblade said.

The decision to offer minimally invasive surgery to a patient may be influenced by multiple factors not mentioned in the study, such as surgeon experience or patient-specific factors, according to the researchers; however, these findings suggest minimally invasive surgery is safe and may offer additional benefit to these patients.

“Despite being the largest study of major liver resections to date, more research is needed to determine whether use of minimally invasive surgery leads to the same rates of survival as open approaches.” Thornblade said. “We look forward to data from randomized trials that will help us understand the long-term efficacy of minimally invasive surgery for cancer in the liver.” – by Melinda Stevens

Reference:

Thornblade LW, et al. Abstract #68764. Presented at: Clinical Congress of the American College of Surgeons; Oct. 16-20, 2016; Washington, D.C.

Disclosure: The researchers report no relevant financial disclosures.