Open vs Laparoscopic Approach for Major Hepatectomy: Comparative Study with Propensity Score Matching Analysis

Introduction: Applications of laparoscopic hepatectomies (LH) continues increasing worldwide. Compared to open resection (OR), it has better surgical outcomes and has proven to be safe and feasible for major hepatectomies. We aim to compare the perioperative results of patients undergoing major hepatectomies (MH) under LH or OR. Patiends and Methods: Retrospective analysis of patients who underwent MH between 2010 and 2021. From 403 hepatectomies, 151 (37%) were MH. Hepatectomies for living donor were excluded. 109 were OR (77%) and 32 LH (23%). A 1:1 propensity score matching (PSM) analysis was performed based on age, gender, BMI, benign/malignant tumour, neoadjuvant chemotherapy, number of resections, anatomical vs non-anatomical resections. After PSM, 25 hepatectomies were included in each group. Intraoperative and postoperative overall and major (DC >IIIb) complications and outcomes were analysed. Results: After PSM, no statistical difference regarding operative time and the use of Pringle manoeuvre (OH:4 vs. LH:7 hrs). LH needed less blood transfusion than OR (2 vs. 13 RPBC, p=0.001), and had fewer overall complications (28% vs. 64%; p=0.01), but similar major complications (12% vs 24%; p=NS). ICU stay was 5±8 days in OR vs. 2±1 in LH (p=0.004) and total hospital stay was 15±18 days vs. 4±2 respectively (p=0.001). While reoperation rate was higher in the OH group (40% vs. LH 8%) (p=008), 90-day post-operative mortality was similar (p=NS). Conclusion: Our results suggest that MH through LH is a feasible procedure and with fewer reoperation and complication rate and faster recovery, which have a significantly impact on hospital stay.