Laparoscopic major hepatectomies: current trends and indications. A comparison with the open technique.

Diffusion of laparoscopic major hepatectomies is experiencing a steady increasing trend, although slower compared to minor resections. The aim of this single-center study is to discuss current trends and indications in the application of minimally invasive techniques to major hepatic resections. Preoperative patients and disease characteristics of 49 laparoscopic major hepatectomies (LPS group), performed between 2005 and 2015, were compared with 585 open hepatectomies (Open group) to analyze differences in patients recruitment. Factors which were found to be differently distributed between groups were used as covariates in a propensity score-based case-matched analysis with a 1:3 ratio between LPS group and 147 patients from the Open group (constituting Open-mat group). Short-term outcome was analyzed in matched groups. ASA score, previous abdominal surgery, previous interventional procedures, indication, lesion size and associated procedures were significantly different between the LPS and the Open group. Short-term outcome analysis revealed that blood loss (200 vs 350 mL, p = 0.044) and time for functional recovery (3 vs 4 days, p = 0.05) were reduced in the LPS compared to the Open-mat group, in spite of longer length of surgery (260 vs 170 min, p = 0.041) and comparable oncological adequacy. Even though data on technical feasibility of laparoscopic major resections and their benefits in terms of blood loss and functional recovery support the diffusion of minimally invasive approach, the limit of the technique is still represented by the reduced pool of suitable candidates.