Laparoscopic versus open right posterior sectionectomy: an international, multicenter, propensity score-matched evaluati
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and Other Interventional Techniques
Laparoscopic versus open right posterior sectionectomy: an international, multicenter, propensity score‑matched evaluation Nicky van der Heijde1,2 · Francesca Ratti3 · Luca Aldrighetti3 · Andrea Benedetti Cacciaguerra4,5 · Mehmet F. Can6 · Mathieu D’Hondt7 · Fabrizio Di Benedetto8 · Arpad Ivanecz9 · Paolo Magistri8 · Krishna Menon10 · Michail Papoulas10 · Marco Vivarelli4 · Marc G. Besselink2 · Mohammed Abu Hilal1,5 Received: 4 August 2020 / Accepted: 16 October 2020 © The Author(s) 2020
Abstract Background Although laparoscopic liver resection has become the standard for minor resections, evidence is lacking for more complex resections such as the right posterior sectionectomy (RPS). We aimed to compare surgical outcomes between laparoscopic (LRPS) and open right posterior sectionectomy (ORPS). Methods An international multicenter retrospective study comparing patients undergoing LRPS or ORPS (January 2007— December 2018) was performed. Patients were matched based on propensity scores in a 1:1 ratio. Primary endpoint was major complication rate defined as Accordion ≥ 3 grade. Secondary endpoints included blood loss, length of hospital stay (LOS) and resection status. A sensitivity analysis was done excluding the first 10 LRPS patients of each center to correct for the learning curve. Additionally, possible risk factors were explored for operative time, blood loss and LOS. Results Overall, 399 patients were included from 9 centers from 6 European countries of which 150 LRPS could be matched to 150 ORPS. LRPS was associated with a shorter operative time [235 (195–285) vs. 247 min (195–315) p = 0.004], less blood loss [260 (188–400) vs. 400 mL (280–550) p = 0.009] and a shorter LOS [5 (4–7) vs. 8 days (6–10), p = 0.002]. Major complication rate [n = 8 (5.3%) vs. n = 9 (6.0%) p = 1.00] and R0 resection rate [144 (96.0%) vs. 141 (94.0%), p = 0.607] did not differ between LRPS and ORPS, respectively. The sensitivity analysis showed similar findings in the previous mentioned outcomes. In multivariable regression analysis blood loss was significantly associated with the open approach, higher ASA classification and malignancy as diagnosis. For LOS this was the open approach and a malignancy. Conclusion This international multicenter propensity score-matched study showed an advantage in favor of LRPS in selected patients as compared to ORPS in terms of operative time, blood loss and LOS without differences in major complications and R0 resection rate. Keywords Laparoscopic surgery · Liver surgery · Minimally invasive surgery · Operative outcomes · Propensity score matching · Surgical procedure
Marc G. Besselink and Mohammed Abu Hilal share senior last authorship. This work was presented at the European African Hepato Pancreato Biliary Association (E-AHPBA) meeting in Amsterdam, June 2019 during the Best of the best paper session. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-08109-y) contains supplementary material,
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