Laparoscopic liver resection (LLR) has undergone cautious adoption. This investigation analyzes the initial experience at our institution, comparing LLR to open liver resection (OLR) with respect to safety, length of stay, and oncologic outcomes. 

All liver resections from 2007 to 2015 were reviewed retrospectively. Major hepatectomy was defined as resection of 3 or more contiguous segments, per Brisbane classification. Laparoscopy was analyzed on an intent-to-treat basis. Comparison of major to minor resections and LLR to OLR was made using parametric and nonparametric statistical methods. Multivariable logistic regression was performed to determine factors associated with postoperative complications and 90-day mortality. 

464 hepatectomies were performed, with 236 (51%) LLR [209 (45%) completed; 27 (6%) converted], and 228 (49%) open. Demographic and clinical characteristics were similar between all groups. Equivalent major hepatectomies were performed laparoscopically and open (128 and 118, respectively; p=0.62). Operative length was similar for minor resections (LLR 222 vs. OLR 212 min., p=0.50) and slightly longer for major laparoscopic resections (LLR 371 vs. OLR 339 min, p=0.04). LLR patients experienced a shorter median length of stay for both minor and major hepatectomies (4 vs. 6 days, p<0.01; 6 vs. 7 days, p<0.01). Multivariable analysis demonstrated increased odds of 90-day all-cause mortality for major resection (odds ratio 5.43, 95% confidence interval 1.56-18.84; p<0.01). Age-adjusted comorbidity and major resection were associated with increased odds of postoperative morbidity (1.03 [1.01-1.04], p<0.01; 1.20 [1.10-1.31], p<0.01, respectively). R0 resection rates for LLR and OLR were 87.6 and 84.8% for minor resections, and 92.5 and 86.4% (p=0.68) for major resections, respectively. 

Minor and major hepatectomy were performed with equal frequency laparoscopically and open in this series. On retrospective analysis, LLR was oncologically equivalent to OLR and decreased length of stay. Laparoscopic approach is not associated with increased postoperative morbidity or mortality.

Laparoscopic versus Open Liver Resection: A Single-Centre Study