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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2016; 8(9): 643-650
Published online Sep 27, 2016. doi: 10.4240/wjgs.v8.i9.643
Short-term and middle-term evaluation of laparoscopic hepatectomies compared with open hepatectomies: A propensity score matching analysis
Xavier Untereiner, Audrey Cagnet, Riccardo Memeo, Vito De Blasi, Stylianos Tzedakis, Tullio Piardi, Francois Severac, Didier Mutter, Reza Kianmanesh, Jacques Marescaux, Daniele Sommacale, Patrick Pessaux
Xavier Untereiner, Riccardo Memeo, Vito De Blasi, Stylianos Tzedakis, Francois Severac, Didier Mutter, Jacques Marescaux, Patrick Pessaux, Department of Digestive Surgery, University Hospital of Strasbourg, 67091 Strasbourg, France
Xavier Untereiner, Riccardo Memeo, Vito De Blasi, Stylianos Tzedakis, Francois Severac, Didier Mutter, Jacques Marescaux, Patrick Pessaux, IHU-Strasbourg, Institute for Image-Guided Surgery, 67091 Strasbourg, France
Xavier Untereiner, Riccardo Memeo, Vito De Blasi, Stylianos Tzedakis, Francois Severac, Didier Mutter, Jacques Marescaux, Patrick Pessaux, INSERM, UMR 1110, 67091 Strasbourg, France
Audrey Cagnet, Tullio Piardi, Reza Kianmanesh, Daniele Sommacale, Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, 51100 Reims, France
Author contributions: Untereiner X, Cagnet A, De Blasi V and Piardi T were responsible for data collection and study design; Severac F performed the statistical analysis; Untereiner X and Memeo R prepared the manuscript; Memeo R conceptualized the study; Tzedakis S, Mutter D, Marescaux J, Kianmanesh R, Sommacale D and Pessaux P performed data interpretation and critical review of the manuscript; all co-authors approved the final manuscript.
Institutional review board statement: It’s a retrospective study. It’s not necessary to have the agreement of the Ethics committee.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Patrick Pessaux, Professor, Head of the Hepatobiliary and Pancreatic Surgical Unit Nouvel Hôpital Civil (NHC) 1, Department of Digestive Surgery, University Hospital of Strasbourg, place de l’hôpital, 67091 Strasbourg, France.
patrick.pessaux@chru-strasbourg.fr
Telephone: +33-3-69551563 Fax: +33-3-69551521
Received: January 13, 2016
Peer-review started: January 16, 2016
First decision: January 30, 2016
Revised: June 1, 2016
Accepted: July 11, 2016
Article in press: July 13, 2016
Published online: September 27, 2016
Processing time: 255 Days and 18.9 Hours
AIM
To compare short-term results between laparoscopic hepatectomy and open hepatectomy using a propensity score matching.
METHODS
A patient in the laparoscopic liver resection (LLR) group was randomly matched with another patient in the open liver resection (OLR) group using a 1:1 allocated ratio with the nearest estimated propensity score. Patients of the LLR group without matches were excluded. Matching criteria included age, gender, body mass index, American Society of Anesthesiologists score, potential co-morbidities, hepatopathies, size and number of nodules, preoperative chemotherapy, minor or major liver resections. Intraoperative and postoperative data were compared in both groups.
RESULTS
From January 2012 to January 2015, a total of 241 hepatectomies were consecutively performed, of which 169 in the OLR group (70.1%) and 72 in the LLR group (29.9%). The conversion rate was 9.7% (n = 7). The mortality rate was 4.2% in the OLR group and 0% in the LLR group. Prior to and after propensity score matching, there was a statistically significant difference favorable to the LLR group regarding shorter operative times (185 min vs 247.5 min; P = 0.002), less blood loss (100 mL vs 300 mL; P = 0.002), a shorter hospital stay (7 d vs 9 d; P = 0.004), and a significantly lower rate of medical complications (4.3% vs 26.4%; P < 0.001).
CONCLUSION
Laparoscopic liver resections seem to yield better short-term and mid-term results as compared to open hepatectomies and could well be considered a privileged approach and become the gold standard in carefully selected patients.
Core tip: This is a retrospective study to compare short-term results between laparoscopic hepatectomy and open hepatectomy using a propensity score matching. Each patient in the laparoscopic liver resection group was randomly matched with another patient in the open liver resection group using a 1:1 allocated ratio with the nearest estimated propensity score. Prior to and after propensity score matching, results were in favour of laparoscopic liver resection. Laparoscopic liver resections seem to yield better short-term and mid-term results as compared to open approach and could well be considered a privileged approach and become the gold standard in carefully selected patients.
