Differential Benefits of Open and Laparoscopic Approach for Left and Right Hemi-Hepatectomies

Background: Benefits over the open technique are demonstrated for laparoscopic liver resections. Whether the degree of advantage is different among left and right hemi-hepatectomies is investigated in this retrospective monocentric study. Methods: The institutional database was retrospectively analyzed for the study period (from January 2004 to December 2020), reviewing cases of hemi-hepatectomies. 933 procedures were identified and dichotomized into left and right hepatectomies and then stratified according to the approach into laparoscopic and open hepatectomies. After propensity-score applying a 1:1 ratio, 129 laparoscopic and open left hepatectomies and 140 laparoscopic and open right hepatectomies were available for the comparison. The degree of advantage was compared between left and right hepatectomies and expressed as delta of differences (Δ-difference). Results: A higher degree of advantage for LRH was observed in the risk-adjusted differential benefit after excluding open conversions, in terms of reduced blood loss (Δ-difference: 150 mL, p<0.05), morbidity rate (Δ-difference: 6.8%, p<0.05) and post-operative stay (Δ-difference: 2 days, p<0.05). However, no significant advantage was observed whilst comparing the left and the right group in the pure differential benefit analysis. Conclusion: Right hepatectomies are the procedures that benefit more of the laparoscopic approach among major resections in comparison to the left counterparts. Conversion to open result in a loss of advantage over the open approach, suggesting an accurate case selection must be loaned for cases candidate to laparoscopic right hepatectomies.