Masaki Kaibori1, Nao Ichihara2, Hiroaki Miyata2, Yoshihiro Kakeji3, Atsushi Nanashima4, Yuko Kitagawa5, Hiroki Yamaue1, Masakazu Yamamoto1, Itaru Endo1. 1. Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan. 2. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 3. Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan. 4. Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan. 5. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
Abstract
BACKGROUND/ PURPOSE: Laparoscopic (repeat) liver resection (LRLR) is a well-established liver tumor treatment. However, since its outcomes and comparison with open repeat liver resection (ORLR) in recurrent liver cancer remain inadequately studied, this study then aimed to compare their short-term outcomes for liver cancers (hepatocellular carcinoma, intrahepatic cholangiocellular carcinoma, and metastatic liver cancer). METHODS: Repeat liver resection cases between 2013 and 2017 from Japan's National Clinical Database were extracted. We used propensity score matching (PSM) to compare the proportion of patients with postoperative complications of Clavien-Dindo classification grade II or higher (CD2+) (primary endpoint), as well as the operative time, intraoperative bleeding volume, and intraoperative transfusion implementation rate (secondary endpoints). RESULTS: Of 2902 patients (ORLR, 2476; LRLR, 426), 712 (356 per type) with comparable backgrounds remained via PSM. Before and after PSM, the postoperative CD2+ complication rate was significantly lower in the LRLR group, who had shorter operative time, smaller intraoperative bleeding volume, and lower intraoperative transfusion rate, than in the ORLR group (after matching, 7.6% vs 18.3%, P < 0.0001). CONCLUSIONS: LRLR showed better short-term outcomes than ORLR, making it a safer and more effective liver cancer treatment.
BACKGROUND/ PURPOSE: Laparoscopic (repeat) liver resection (LRLR) is a well-established liver tumor treatment. However, since its outcomes and comparison with open repeat liver resection (ORLR) in recurrent liver cancer remain inadequately studied, this study then aimed to compare their short-term outcomes for liver cancers (hepatocellular carcinoma, intrahepatic cholangiocellular carcinoma, and metastatic liver cancer). METHODS: Repeat liver resection cases between 2013 and 2017 from Japan's National Clinical Database were extracted. We used propensity score matching (PSM) to compare the proportion of patients with postoperative complications of Clavien-Dindo classification grade II or higher (CD2+) (primary endpoint), as well as the operative time, intraoperative bleeding volume, and intraoperative transfusion implementation rate (secondary endpoints). RESULTS: Of 2902 patients (ORLR, 2476; LRLR, 426), 712 (356 per type) with comparable backgrounds remained via PSM. Before and after PSM, the postoperative CD2+ complication rate was significantly lower in the LRLR group, who had shorter operative time, smaller intraoperative bleeding volume, and lower intraoperative transfusion rate, than in the ORLR group (after matching, 7.6% vs 18.3%, P < 0.0001). CONCLUSIONS: LRLR showed better short-term outcomes than ORLR, making it a safer and more effective liver cancer treatment.
Keywords:
Japanese National Clinical Database; laparoscopic repeat liver resection; national survey; open repeat liver resection; recurrent liver cancers