Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy.
Faculty of Medicine, University Vita-Salute San Raffaele, 20132, Milan, Italy.
Surg Endosc. 2023 Nov;37(11):8204-8213. doi: 10.1007/s00464-023-10382-6. Epub 2023 Aug 30.
The correlation between technical feasibility and short-term clinical advantage provided by laparoscopic over open technique for major hepatectomies is unclear. This monocentric retrospective study investigates the possible differences in the benefit provided by minimally invasive approach between left and right hepatectomy, deepening the concept of differential benefit in the setting of anatomical major resections.
All hemihepatectomies performed from January 2004 to December 2021 were identified in the institutional database. A propensity score method was used to match minimal invasive (MILS) and open pairs in the left hemihepatectomies (LH) and right hemihepatectomies (RH) groups with a 1:1 ratio to adjust any potential selection bias. The differential benefit for left and right hepatectomy provided by laparoscopic over open technique was evaluated in a pure analysis (i.e., including cases converted to open) and a risk-adjusted analysis (i.e., after excluding open conversion from the laparoscopic series).
The analysis of the risk-adjusted differential benefit demonstrated better result of the MILS in the RH group than in the LH group, in terms of blood loss (∆ blood loss - 150 and - 350, respectively; differential benefit: 200 mL, p < 0.05), morbidity (∆ rate of morbidity - 11.3% and - 18.1%, respectively; differential benefit: 6.8%, p < 0.05) and length of stay, LOS (∆ LOS - 1 day and - 3 days, respectively; differential benefit: 2 days, p < 0.05).
While MILS is associated with improved clinical outcomes both in left and right hepatectomy procedures, the greater advantage provided by laparoscopy was documented in patients undergoing right hepatectomy, i.e. for more technically demanding procedures. A MILS program should include the broadest range of liver resections to ensure the full benefits of the laparoscopic technique.
腹腔镜技术相对于开腹技术在左、右半肝切除术中提供的技术可行性和短期临床优势之间的相关性尚不清楚。本单中心回顾性研究探讨了微创方法在左、右半肝切除术中提供的不同获益，深化了解剖性肝切除术的差异获益概念。
在机构数据库中确定了 2004 年 1 月至 2021 年 12 月期间进行的所有半肝切除术。使用倾向评分法将左半肝切除术（LH）和右半肝切除术（RH）组的微创（MILS）和开腹（OS）组进行 1:1 配对匹配，以调整任何潜在的选择偏倚。在纯分析（即包括转为开腹的病例）和风险调整分析（即排除腹腔镜系列中转开腹病例）中评估腹腔镜相对于开腹技术在左、右半肝切除术中提供的差异获益。
风险调整后的差异获益分析表明，在 RH 组中，MILS 的结果优于 LH 组，在出血量（分别为-150 和-350 毫升；差异获益：200 毫升，p<0.05）、发病率（分别为-11.3%和-18.1%；差异获益：6.8%，p<0.05）和住院时间方面，MILS 也具有优势，差异获益分别为-1 天和-3 天（差异获益：2 天，p<0.05）。
虽然 MILS 与左、右半肝切除术的临床结局改善相关，但在右半肝切除术患者中，腹腔镜提供了更大的优势，即对于技术要求更高的手术。MILS 计划应包括最广泛的肝切除术，以确保充分受益于腹腔镜技术。
