Laparoscopic Versus Open Right Hemihepatectomy: an Analysis of Data from the Polish National Registry of Minimally Invasive Liver Surgery

Purpose: Laparoscopic liver resection is an established surgical approach, however more data is needed to assess its potential benefits and limits in major liver resections. Method: A retrospective study of laparoscopic major liver resections was performed based on data from the Polish National Registry of Minimally Invasive Liver Surgery. The registry includes all laparoscopic liver resections performed in Poland since its implementation in our country. Data were collected from 6 departments, where laparoscopic major liver resection is performed. Short-term results were compared with a group of patients who underwent open major liver resection in a tertiary referral center. Results: Up to 01/01/2023 there were 102 cases of laparoscopic major liver resection (≥3 segments) performed in Poland with a conversion rate of 15.7%. There were 71 (69.6%) right and 31 (30.4%) left laparoscopic hemihepatectomies. Control group consisted of 220 cases of open right (159; 72.3%) and left (61; 27.7%) hemihepatectomies. In both groups the most common indication for liver resection were colorectal liver metastases, in 59 (57.8%) and 98 (44.5%) cases, respectively. Postoperative complications and severe complications (≥3 in accordance to Clavien-Dindo classification) occurred similarly in 25.5% vs. 35.5% (p=0.095) and 14.7% vs. 8.6% (p=0.117), respectively. Postoperative stay was significantly shorter in laparoscopic group (p<0.001) with median duration of 7 and 8 days, respectively. Although R0 resection was observed more frequently in minimally invasive approach (87.0% vs. 79.5%), the difference was not significant (p=0.152). Conclusion: Laparoscopic approach for major liver resection provides short-term results at least non-inferior to open approach. Despite the nonsignificant difference in postoperative complication rate, duration of hospital stay is significantly decreased. Resection margin status is not compromised by minimally invasive approach.