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Short-term outcomes of laparoscopic vs. open liver resection for hepatocellular adenoma: a multicenter propensity score adjustment analysis by the AFC-HCA-2013 study group

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Abstract

Background

Patients with hepatocellular adenomas are, in selected cases, candidates for liver resection, which can be approached via laparoscopy or laparotomy. The present study aimed to investigate the effects of the surgical approach on the postoperative morbidities of both minor and major liver resections.

Methods

In this multi-institutional study, all patients who underwent open or laparoscopic hepatectomies for hepatocellular adenomas between 1989 and 2013 in 27 European centers were retrospectively reviewed. A multiple imputation model was constructed to manage missing variables. Comparisons of both the overall rate and the types of complications between open and laparoscopic hepatectomy were performed after propensity score adjustment (via the standardized mortality ratio weighting method) on the factors that influenced the choice of the surgical approach.

Results

The laparoscopic approach was selected in 208 (38%) of the 533 included patients. There were 194 (93%) women. The median age was 38.9 years. After the application of multiple imputation, 208 patients who underwent laparoscopic operations were compared with 216 patients who underwent laparotomic operations. After adjustment, there were 20 (9.6%) major liver resections in the laparoscopy group and 17 (7.9%) in the open group. The conversion rate was 6.3%. The two surgical approaches exhibited similar postoperative morbidity rates and severities. Laparoscopic resection was associated with significantly less blood loss (93 vs. 196 ml, p < 0.001), a less frequent need for pedicle clamping (21 vs. 40%, p = 0.002), a reduced need for transfusion (8 vs. 24 red blood cells units, p < 0.001), and a shorter hospital stay (5 vs. 7 days, p < 0.001). The mortality was nil.

Conclusions

Laparoscopy can achieve short-term outcomes similar to those of open surgery for hepatocellular adenomas and has the additional benefits of a reduced blood loss, need for transfusion, and a shorter hospital stay.

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Collaborators of the AFC-HCA-2013 Study Group

François-René Pruvot Department of Digestive Surgery and Transplantation, Lille University Hospital, Nord de France University, Lille, France. Jean-Michel Fabre Department of Digestive Surgery and Transplantation, St Eloi Hospital, Montpellier, France. Christian Letoublon Clinique d’ Hépatogastroentérologie, pôle DigiDune, Grenoble University Hospital, France. Philippe Bachellier Department of Surgery, University Hospital of Hautepierre, Strasbourg, France. Olivier Farges, Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France. Jean-Yves Mabrut Department of Surgery, Croix Rousse Hospital, Lyon. Yves-Patrice Le Treut Department of Surgery, la Timone Hospital, Marseille, France. Bertrand Suc Department of Digestive Surgery and Transplantation, Rangueil University Hospital, Toulouse, France. Irinel Popescu Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania. Marco Montorsi Department of General Surgery, Humanitas University and Research Hospital, Milano, Italy. Jacques Belghiti, Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France. Jean-Marc Régimbaud – CHU Amiens-Picardie, France. Romain Riboud – CHU Grenoble, France. Alexandra Dili – La Louvière, Hôpital de Jolimont, Belgium. Pierre Allemann – (CHUV), Lausanne, Switzerland. Emmanuel Boleslawski - CHRU Lille, France. Benjamin Darnis – CHU Lyon, France. Mustapha Adham, CHU Lyon, France. Emilie Bollon – CHU Marseille, France. Bernard Pol – Hôpital Saint-Joseph, Marseille, France. Jean-Robert Delpero – Institut Paoli-Calmettes, Marseille, France. Olivier Turrini – Institut Paoli-Calmettes, Marseille, France. Frédéric Borie – CHU-Nimes, France. Mathieu Gonot-Gachard – CHU-Nimes, France. Laura Ornella Perotto – CHU Pitié-Salpétrière, Paris, France. Riccardo Gauzolino – CHU-Poitier, France. Marie Castagnet – CHU-Poitier, France. Reza Kianmanesh – CHU-Reims, France. Daniele Sommacale – CHU-Reims, France. Mikael Chetboun – CHU-Reims, France. Jean-Luc Porcheron – CHU-St-Etienne, France. Alexandre Filippello – CHU-St-Etienne, France. Patrick Pessaux – CHU-Strasbourg, France. Pietro Addeo – CHU-Strasbourg, France. Manuela Cesaretti – CHU-Strasbourg, France.

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Authors and Affiliations

  1. Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Paris Est University, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France

    Filippo Landi, Nicola de’ Angelis & Alexis Laurent

  2. Department of Liver Transplantation and HPB Surgery, Pitié-Salpêtrière Hospital, Paris, France

    Olivier Scatton

  3. Department of Clinical Pharmacology, Vall d’Hebron University Hospital, Universidad Autonoma de Barcelona, Barcelona, Spain

    Xavier Vidal

  4. Department of Digestive, Hepato-Biliary, Endocrine Surgery, and Surgical Oncology, Nancy University Hospital, Lorraine University, Lorraine, France

    Ahmet Ayav

  5. Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France

    Fabrice Muscari

  6. Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France

    Safi Dokmak & Olivier Soubrane

  7. Department of General Surgery, Humanitas University and Research Hospital, Milan, Italy

    Guido Torzilli

  8. Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland

    Nicolas Demartines

  9. Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France

    Daniel Cherqui

  10. Department of Surgery, la Timone Hospital, Aix-Marseille University, Marseille, France

    Jean Hardwigsen

  11. INSERM, UMR 955, Créteil, France

    Alexis Laurent

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  1. Filippo Landi
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  2. Nicola de’ Angelis
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  3. Olivier Scatton
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  4. Xavier Vidal
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  5. Ahmet Ayav
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  6. Fabrice Muscari
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  7. Safi Dokmak
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  8. Guido Torzilli
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  9. Nicolas Demartines
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  10. Olivier Soubrane
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  11. Daniel Cherqui
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  12. Jean Hardwigsen
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  13. Alexis Laurent
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Correspondence to Alexis Laurent.

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Disclosure

Filippo Landi, Nicola de’Angelis, Olivier Scatton, Xavier Vidal, Ahmet Ayav, Fabrice Muscari, Safi Dokmak, Guido Torzilli, Nicolas Demartines, Olivier Soubrane, Daniel Cherqui, Jean Hardwigsen, and Alexis Laurent have no conflicts of interest or financial ties to disclose in relation to the results of the present study.

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Filippo Landi and Nicola de Angelis have contributed equally to this work.

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Landi, F., de’ Angelis, N., Scatton, O. et al. Short-term outcomes of laparoscopic vs. open liver resection for hepatocellular adenoma: a multicenter propensity score adjustment analysis by the AFC-HCA-2013 study group. Surg Endosc 31, 4136–4144 (2017). https://doi.org/10.1007/s00464-017-5466-4

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