Short-term outcomes of laparoscopic, open hepatectomy similar

Last Updated: 2014-08-05

By James E. Barone MD

NEW YORK (Reuters Health) - Laparoscopic and open hepatectomy have similar short-term results in select patients, according to a new report from surgeons at Kaiser Permanente in Los Angeles.

Their matched case-control study, online July 30 in JAMA Surgery, found no significant differences in operative duration, perioperative blood transfusion, hospital length of stay, rate of readmissions, or 30-day morbidity and mortality.

"Anecdotally I was observing that patients having laparoscopic hepatectomy were still having significant pulmonary complications, so I decided to study it," senior author Dr. L. Andrew DiFronzo told Reuters Health by email.

The study included 104 matched patients who had had open (52) or laparoscopic (52) partial hepatectomy for malign or benign disease. All surgeries were done by Dr. DiFronzo.

More cases were done laparoscopically in the later years of the study. "As experience increased we felt more comfortable offering laparoscopic hepatectomy to more patients -- in particular offering more major hepatic resections," said Dr. DiFronzo.

The patients were matched by an investigator who was blinded regarding the outcome of each case. Matching was based on the extent of the hepatic resection, the preoperative diagnosis, sex, and age.

Except for body mass index, which was significantly higher in the laparoscopic group at 29.5 kg/m2 vs. 26.3 kg/m2 in the open group, the groups did not differ in patient demographics, tumor characteristics, or operative variables. At least 75% of cases were done for malignancies in both groups.

The operative time for the laparoscopic patients was 219 minutes and 198 minutes for the open group (p=0.16). Blood loss was higher in the latter group (387 mL vs. 237 mL, p=0.049), but the percentage of patients requiring perioperative blood transfusion did not differ significantly (10% vs. 2%, respectively, p=0.7)

"Although the clinical difference of about 150 mL wasn't that great in our study, perhaps in a different subset of patients -- one with patients having all major hepatectomies -- you might observe a difference in blood loss that is important," Dr. DiFronzo noted.

Readmission rates did not differ by group (8% for laparoscopic patients vs. 10% for open), nor did the length of hospital stays (five days for laparoscopic patients vs. six days for open).

The same was true for the numbers of patients with major complication (8% in both groups), overall 30-day morbidity (42% for laparoscopic vs. 37% for open patients) and 30-day mortality (2% for laparoscopic vs. 4% for open patients).

In an invited commentary, Dr. Thomas R. Biehl of the Virginia Mason Medical Center in Seattle praised the study but pointed out that despite the authors' attempts to eliminate bias, it was still present due to issues with the matching process.

"I think Dr. Biehl is absolutely correct in his observation that we tried hard to reduce bias, but in the end our study still suffers from it," said Dr. DiFronzo.

"After our study, I have been slightly less inclined to advise a laparoscopic operation since the data are a little less convincing now," he added.

However, he still considers it in highly selected patients and hopes further study will clarify the advantages of this approach.

SOURCE: http://bit.ly/1uP5DTH

JAMA Surgery 2014.