Are Hybrid Liver Resections Truly Minimally Invasive? A Propensity Score Matching Analysis

J Laparoendosc Adv Surg Tech A. 2017 Dec;27(12):1236-1244. doi: 10.1089/lap.2017.0074. Epub 2017 May 12.

Abstract

Background: Hybrid liver resection is considered a modality of minimally invasive surgery; however, there are doubts regarding loss of benefits of laparoscopy due to the use of an auxiliary incision. We compared perioperative results of patients undergoing hybrid × open and hybrid × pure laparoscopic resections.

Methods: Consecutive patients undergoing liver resection between June 2008 and January 2016 were studied. Study groups were compared after propensity score matching (PSM).

Results: Six hundred forty-four resections were included in the comparative analysis: 470 open, 120 pure laparoscopic, and 54 hybrids. After PSM, 54 patients were included in each group. Hybrid × open: hybrid technique had shorter operative time (319.5 ± 108.6 × 376.2 ± 155.8 minutes, P = .033), shorter hospital stay (6.0 ± 2.7 × 8.1 ± 5.6 days, P = .001), and lower morbidity (18.5% × 40.7%, P = .003). Hybrid × pure laparoscopic: hybrid group had lower conversion rate (0% × 13%, P = .013). There was no difference regarding estimated blood loss, transfusion rate, hospital stay, complications, or mortality.

Conclusions: Hybrid resection has better perioperative results than the open approach and is similar to pure laparoscopy. The hybrid technique should be considered a minimally invasive approach.

Keywords: comparative study [publication type]; hepatectomy; laparoscopy; liver neoplasm/surgery; propensity score.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Conversion to Open Surgery / statistics & numerical data
  • Female
  • Hepatectomy / adverse effects
  • Hepatectomy / methods*
  • Humans
  • Length of Stay / statistics & numerical data
  • Liver / surgery
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / adverse effects
  • Minimally Invasive Surgical Procedures / methods*
  • Operative Time
  • Postoperative Complications / epidemiology
  • Propensity Score
  • Prospective Studies