Laparoscopic Liver Resection Can Speed Patient Recovery Time

TOPLINE:

Laparoscopic surgery led to a substantial reduction in functional recovery time and postoperative hospital stay compared with open surgery in patients undergoing parenchyma-preserving resection of lesions in posterosuperior liver segments.

METHODOLOGY:

• Lesions in the posterosuperior segments of the liver were initially deemed unsuitable for laparoscopic resection; however, recent improvements in technology and surgical techniques have enabled increased adoption of laparoscopic surgery for these procedures, although robust evidence was lacking.
• This clinical trial, involving 17 centers in five European countries, compared the outcomes of laparoscopic vs open liver surgery in 246 patients requiring a parenchyma-sparing liver resection in one or two of segments 4a, 7, or 8 or a segment 6/7. The majority (91.5%) of patients had a preoperative diagnosis of cancer.
• Patients were randomly assigned to laparoscopic surgery (n = 122; median age, 68 years; 66.4% men) or open surgery (n = 124; median age, 68 years; 71% men).
• The primary endpoint was time to functional recovery measured in postoperative days. Patients were deemed functionally recovered when they had adequate pain control, preoperative-level independent mobility, 24-hour solid food tolerance, independence from intravenous fluids, and normal or normalizing liver function tests.
• The secondary endpoints were operative time, blood loss, length of postoperative hospital stay, 90-day readmissions, liver-specific morbidity and mortality, and oncological outcomes for those with cancer.

TAKEAWAY:

• Laparoscopic surgery was associated with reductions of more than 20% in the median time to functional recovery (3 days vs 4 days) and the median postoperative hospital stay (4 days vs 5 days) compared with open surgery (both P <.001).
• The median operative time was longer in the laparoscopic group than in the open surgery group (240 vs 200 minutes; adjusted difference, 20.4%; P <.001).
• No significant differences were observed between the groups in terms of blood loss; 90-day overall morbidity, severe morbidity, or liver-specific morbidity; mortality; and readmission rates. Oncological outcomes also were not significantly different.
• Subgroup analysis showed that laparoscopic surgery was associated with a better treatment effect in women, patients not treated with preoperative chemotherapy, and those with an American Society of Anesthesiologists grade of 2 (all P < .001).

IN PRACTICE:

“This study demonstrates that the laparoscopic approach can be considered a valid alternative for these complex resections in centers that have gained sufficient experience in laparoscopic hemi hepatectomy and resections in the anterolateral segments of the liver,” the authors wrote.

SOURCE:

The study, led by Jasper P. Sijberden, MD, PhD, and Christoph Kuemmerli, MD, from the Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy, was published online in The Lancet Regional Health – Europe.

LIMITATIONS:

This trial lacked a uniform perioperative protocol across all the centers due to its pragmatic nature. Although the participating surgeons had substantial experience in both types of liver resections, the potential effect of the learning curve could not be excluded. Additionally, potential bias might have been introduced because the operating theatre staff were not blinded to the surgical approach.

DISCLOSURES:

This trial received funding from Ethicon (Johnson & Johnson), Cancer Research United Kingdom, the National Institute for Health and Care Research Southampton Biomedical Research Centre, and the Maastricht University Medical Centre+. The authors declared having no competing financial interests relevant to this study. Two authors reported receiving grants, consulting fees, speaker honoraria, and travel support and having other ties with several healthcare and pharmaceutical companies outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.