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Minimally invasive liver resection reduces blood loss, complications

Minimally invasive liver resection may be effective for patients with impaired liver function, as results from a recently published study showed that the procedure reduced blood loss and had lower complication rates that led to shorter hospital stays compared with open liver resection.

“Impaired liver function is widely considered a risk factor for postoperative complications such as intractable ascites, wound infection, and liver failure,” Takehiro Noda, MD, from the Osaka University, Japan, and colleagues wrote. “These complications lead to longer postoperative hospitalizations or even to hospital readmission. Minimally invasive liver resection (MILR) represents a natural extension of minimally invasive surgery in general and laparoscopic liver surgery in particular.”

Noda and colleagues retrospectively reviewed the data of 99 patients who underwent hepatectomy for hepatocellular carcinoma (n = 96) or combined HCC and cholangiocarcinoma (n = 3). Twenty-four patients had liver damage grade B and underwent MILR, whereas the other patients underwent open liver resection (OLR).

Those who underwent MILR were significantly older than those in the OLR group. However, patients in the OLR group were more likely to have multiple tumors and large tumor size compared with the MILR group. Otherwise, sex, tumor type, hepatitis C and hepatitis B status, prothrombin activity, total bilirubin, albumin, indocyanine green retention test and platelet counts were not significantly different between the two groups.

Patients in the MILR group had significantly lower blood loss (151 vs. 576 mL; P < .0001), lower rates of operative complications (4.2% vs. 33.3%; P = .0047) and shorter postoperative hospital stay (13.5 vs. 22.1 days; P = .0017) than the OLR group. Operative time was similar between the two groups.

After the propensity score matching, the researchers selected 18 patients from each group for further subset analysis. Similarly, the patients who underwent MILR had significantly lower blood loss (184 vs. 500 mL; P = .0163), lower rates of operative complications (5.5% vs. 38.9%; P = .0162) and shorter postoperative hospital stay (14.1 vs. 23.7 days; P = .0118) compared with patients who underwent OLR.

Overall, the survival and disease-free rates between the two groups were not significantly different. – by Talitha Bennett

Disclosure: The authors report relevant financial disclosures.