Troisi Roberto Ivan, Rompianesi Gianluca, D'Hondt Mathieu, Vanlander Aude, Bertrand Claude, Hubert Catherine, Detry Olivier, Van den Bossche Bert, Malvaux Philippe, Weerts Joseph, Sablon Thibault, Vermeiren Koen, Biglari Mehrdad, Gryspeerdt Filip, De Meyere Celine, Dili Alexandra, Boterbergh Kim, Lucidi Valerio
Faculty of Medicine, Ghent University, Ghent, Belgium.
Federico II University Hospital, via S. Pansini 5, 80131, Naples, Italy.
Langenbecks Arch Surg. 2025 Mar 3;410(1):86. doi: 10.1007/s00423-025-03661-4.
Minimally invasive liver surgery (MILS) still appears to be adopted with significant variability. We aimed to investigate the diffusion, indications, and short-term outcomes of MILS compared to the open approach.
A prospective registry of all liver resections performed for any indication and using any technique between January 1, 2017, and December 31, 2019, was established (BReLLS) and analyzed.
A total of 1342 consecutive liver resections were included, 684 (51%) MILS and 658 (49%) open procedures. MILS was not attempted due to technical complexity in the 46.2% of cases, followed by previous abdominal surgery (22.5%). Patients undergoing MILS had a higher proportion of benign indications and of hepatocellular carcinomas, patients affected by liver cirrhosis with portal hypertension and a lower proportion of major hepatectomies (all p < 0.001). After propensity-score matching, MILS showed better results in terms of surgery duration (p < 0.001), blood loss (p = 0.015), complication rate (p < 0.001), rate of Clavien-Dindo grade ≥ 3 complications (p = 0.012), comprehensive complication index (p < 0.001), length of stay (p < 0.001), readmissions (p = 0.016). Centers performing over 50 liver resections per year had a higher proportion of overall MILS cases (p < 0.001), a similar proportion of major resections (p = 0.362), but a higher prevalence of MILS major resections (p = 0.004), lower 90-day mortality rates (p < 0.001), lower overall complication rates (p < 0.001), and shorter hospital length of stay (p < 0.001).
MILS was the preferred technique in half of the cases, particularly in patients with cirrhosis and portal hypertension, and benign lesions. It provided superior short-term outcomes compared to the open approach for both minor and major liver resections in selected patients.
微创肝脏手术（MILS）的采用情况似乎仍存在显著差异。我们旨在研究MILS与开放手术相比的推广情况、适应证及短期疗效。
建立并分析了一个前瞻性登记系统，该系统纳入了2017年1月1日至2019年12月31日期间因任何适应证采用任何技术进行的所有肝脏切除术（BReLLS）。
共纳入1342例连续的肝脏切除术，其中684例（51%）为MILS，658例（49%）为开放手术。46.2%的病例因技术复杂性未尝试MILS，其次是既往腹部手术史（22.5%）。接受MILS的患者中良性适应证和肝细胞癌的比例较高，肝硬化伴门静脉高压患者比例较高，而大肝切除术比例较低（所有p<0.001）。倾向得分匹配后，MILS在手术时间（p<0.001）、失血量（p=0.015）、并发症发生率（p<0.001）、Clavien-Dindo≥3级并发症发生率（p=0.012）、综合并发症指数（p<0.001）、住院时间（p<0.001）、再入院率（p=0.016）方面显示出更好的结果。每年进行超过50例肝脏切除术的中心，MILS病例在总体中所占比例更高（p<0.001），大切除术比例相似（p=0.362），但MILS大切除术的患病率更高（p=0.004），90天死亡率更低（p<0.001），总体并发症发生率更低（p<0.001），住院时间更短（p<0.001）。
在一半的病例中，MILS是首选技术，尤其是在肝硬化伴门静脉高压和良性病变患者中。与开放手术相比，对于特定患者的小肝切除术和大肝切除术，MILS均提供了更好的短期疗效。
