Laparoscopic versus open hemihepatectomy: a randomized controlled trial
Zeitschrift für Gastroenterologie, vol. 60, pp. e407–e408
Abstract
Background and goal Surgical resection forms the mainstay of curative treatment for liver cancers. The laparoscopic approach in major liver resections is increasingly being performed. Randomized evidence to show superiority of laparoscopic compared to open hemihepatectomy for perioperative and oncological outcomes is lacking. Methods Patients undergoing hemihepatectomy were randomized in a 1:1 ratio to laparoscopic or open surgery, stratified for hemihepatectomy side and center, in 16 centers across Europe with established enhanced recovery programs. The primary endpoint was time to functional recovery, defined as being independently mobile with adequate oral intake, oral pain relief, no intravenous fluids, and normalized blood biochemistry. Secondary outcomes included length of hospital stay, postoperative 90-day morbidity, 90-day mortality and disease-free and overall survival. Results : From October 2013 to January 2019, 352 out of 829 eligible patients underwent randomization, 177 patients to laparoscopic and 175 patients to open hemihepatectomy, 119 left and 213 right. Excluding patients who could not proceed to surgery, a total of 332 patients were included in the intention-to-treat analysis. Malignancy was diagnosed in 281 (85%) patients of whom 166 (59%) had colorectal liver metastases. Median time to functional recovery was 4 days (interquartile range 3 to 5) in the laparoscopic group compared to 5 days (interquartile range 4 to 6) in the open group (mean difference, -17.5%; 96% confidence interval -25.6 to -8.4; P<0.001). Median length of hospital stay was 5 days (interquartile range 4 to 7) in the laparoscopic group compared to 6 days (interquartile range 5 to 7) in the open group (mean difference, -16.4%; 99% confidence interval -27.7 to -3.9; P=0.002). Operation time was 310 minutes in the laparoscopic group compared to 254 minutes in the open group (P<0.001). There were no significant differences in postoperative 90-day morbidity, mortality, and overall survival. Conclusions: Laparoscopic hemihepatectomy is superior to open hemihepatectomy in terms of time to functional recovery and length of hospital stay within an enhanced recovery setting without differences in morbidity and mortality. Publication History Article published online: 19 August 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany
Authors 19
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Maastricht University Medical Centre
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Maastricht University Medical Centre, Maastricht, Niederlande
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San Raffaele, Milan, Italien
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Fondazione Poliambulanza Istituto Ospedaliero
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Poliambulanzia hospital, Brescia, Italien
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University of Naples Federico II
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Federico II University, Napels, Italien
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Univeristy Hospital Birmingham, Birmingham, Vereinigtes Königreich
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Amsterdam UMC Location University of Amsterdam
Affiliation as printed
AMC, Amsterdam, Niederlande
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National Health Service · Plymouth Hospital
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Plymouth Hospital NHS, Plymouth, Vereinigtes Königreich
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King's College Hospital NHS, London, Vereinigtes Königreich
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Oslo University Hospital, Oslo, Norwegen
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AZ Groeninge, Kortrijk, Belgien
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Hopitaux Universitaires de Bruxelles, Brussels, Belgien
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TF Ulmer Aachen
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Uniklinik RWTH Aachen, Aachen, Deutschland
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UP Neumann Aachen
Maastricht University Medical Centre · Universitätsklinikum Aachen
Affiliation as printed
Maastricht University Medical Centre, Maastricht, Niederlande
Uniklinik RWTH Aachen, Aachen, Deutschland
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Affiliation as printed
Aintree University Hospital NHS, Liverpool, Vereinigtes Königreich
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University of Oxford · Oxford University Hospitals NHS Trust
Affiliation as printed
Oxford University Hospital NHS, Oxford, Vereinigtes Königreich
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Affiliation as printed
Newcastle Upon Tyne Hospitals NHS, Newcastle, Vereinigtes Königreich
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Affiliation as printed
Jessa Hospital, Hasselt, Belgien
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Bram Olij Aachen
Maastricht University Medical Centre · Universitätsklinikum Aachen
Affiliation as printed
Maastricht University Medical Centre, Maastricht, Niederlande
Uniklinik RWTH Aachen, Aachen, Deutschland
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University Hospital Southampton NHS Foundation Trust
Affiliation as printed
Southampton University Hospital NHS, Southampton, Vereinigtes Königreich
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