Article Abstract

A multi-institutional analysis of minimally invasive liver resections

Authors: Alison Smith, Ioannis T. Konstantinidis, Yuman Fong, John Martinie, David Iannitti, Joseph F. Buell


Background: As minimally invasive liver resection (MILR) gains acceptance, techniques, and outcomes must be analyzed in multi-institution series comparing both laparoscopic and robotic approaches to open liver resections (OLRs). The objective of this study was to describe the experience with MILR at three high volume centers.
Methods: Retrospective tri-institutions analysis of MILR from 2000 to 2016. Patient demographics, tumor characteristics, and outcomes were analyzed for statistical significance compared to OLR.
Results: A total of 1,323 patients were included with 746 OLR (56.4%) and 577 MILR (530 laparoscopic, 40.1%, and 47 robotic liver resections, 3.6%). MILRs increased during the study period (0.5%, year 2000, vs. 40.5%, year 2016, P<0.001). Compared to OLR, MILR had significantly decreased estimated blood loss (634.2±33.4 vs. 275.9±18.4 mL, P<0.0001), post-operative complications (35.5% vs. 16.1%, P<0.0001), hospital length of stay (8.7±0.3 vs. 4.2±0.2 days, P<0.0001), and re-admissions (10.2% vs. 4.0% P<0.0001) with no increase in bile leak (P=0.42) or re-operation P=0.20). There was no difference in 90-day patient mortality (OLR, 2.4% vs. MILR, 1.0%, P=0.09).
Conclusions: The current study evaluates the steady adoption of MILR in high volume centers. This data confirms MILR, whether performed laparoscopically or robotically, confers significant patient benefits.