Laparoscopic versus open hemihepatectomy: does side matter? A post-hoc analysis of the ORANGE II PLUS randomized controlled trial
Surgical Endoscopy, vol. 40, pp. 4195–4205
Abstract
BACKGROUND: Laparoscopic liver surgery offers several benefits, yet the adoption of laparoscopic right hemihepatectomy (RH) is slow, owing to its high degree of technical complexity. It is uncertain whether the general benefits of laparoscopy also extend to RH. This study evaluates perioperative outcomes of laparoscopic vs open RH, and illustrates differences in laparoscopic RH and left hemihepatectomy (LH) within the international, multicentre, double-blinded ORANGE-II-PLUS randomized trial. METHODS: Patients were randomly assigned to open (n = 166) or laparoscopic hemihepatectomy (n = 166). The present post-hoc subgroup analysis compares perioperative and oncological outcomes of laparoscopic RH (n = 105) vs open RH (n = 108). In addition, interaction between surgical approach (open or laparoscopic) and hemihepatectomy laterality (RH; n = 213 vs LH; n = 119) was assessed. RESULTS: There was a higher proportion of malignancy, including more colorectal liver metastases, and more preoperative portal vein embolization in patients undergoing RH compared to LH, other characteristics were well-balanced. The laparoscopic approach was associated with shorter time to functional recovery compared to open surgery for RH (median 5 vs 5 days, p = .004) and shorter length of hospital stay (median 5 vs 6 days, p = .014). Except for longer operating times in laparoscopy (332 vs 263 min, p < .001), no differences were found in other perioperative and oncological outcomes between laparoscopic and open RH. For all outcomes, interaction testing between surgical approach and laterality did not reach significance, suggesting that approach did not affect RH and LH differently. Though patients requiring laparoscopic RH needed longer operating time (332 vs 225 min) and time to functional recovery (median 5 vs 3 days) than patients requiring laparoscopic LH. CONCLUSION: Patients undergoing RH showed modest, population-level, benefits from a laparoscopic approach with regard to time to functional recovery and hospital length of stay, despite higher technical complexity and a more pronounced postoperative impact on the patient. Interaction testing between RH and LH did not reach significance, suggesting the effect of the approach on outcomes were consistent regardless of resection laterality. These results support the implementation of the laparoscopic approach for RH if surgeons are experienced. CLINICAL TRIAL INFORMATION: NCT01441856.
Authors 34
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Bram Olij corresponding
Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Surgery and Transplantation, Maastricht University Medical Centre+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. Bram.olij@mumc.nl
GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands. Bram.olij@mumc.nl
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Amsterdam UMC Location University of Amsterdam · Cancer Center Amsterdam
Affiliation as printed
Cancer Centre Amsterdam, Amsterdam, The Netherlands
Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
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Affiliation as printed
Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
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University of Jordan · University Hospital Southampton NHS Foundation Trust · NIHR Southampton Biomedical Research Centre · University of Southampton
Affiliation as printed
Department of Surgery, School of Medicine, The University of Jordan, Amman, 11942, Jordan
University Surgery and Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
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Federico II University Hospital · University of Naples Federico II
Affiliation as printed
Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Transplantation Service, Federico II University, Naples, Italy
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University Hospitals Birmingham NHS Foundation Trust
Affiliation as printed
HPB and Liver Transplant Unit, University Hospitals Birmingham NHS Trust, Birmingham, UK
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Amsterdam UMC Location University of Amsterdam · Cancer Center Amsterdam
Affiliation as printed
Cancer Centre Amsterdam, Amsterdam, The Netherlands
Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
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Plymouth Hospital · University Hospitals Plymouth NHS Trust
Affiliation as printed
Department of Surgery, Plymouth Hospitals NHS Trust, Plymouth, UK
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King's College Hospital NHS Foundation Trust · King's College Hospital
Affiliation as printed
Department of Liver Transplant and HPB Surgery, Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
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Affiliation as printed
Intervention Centre and Department of Hepatic, Pancreatic and Biliary Surgery, Oslo University Hospital and Institute of Clinical Medicine, University Hospital of Oslo, Oslo, Norway
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Affiliation as printed
Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge, Kortrijk, Belgium
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Affiliation as printed
Department of Digestive Surgery, Unit of Hepatobiliary Surgery and Transplantation, Hôpitaux Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
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Maastricht University Medical Centre · Essen University Hospital · Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Department of Surgery and Transplantation, Maastricht University Medical Centre+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
Department of Surgery and Transplantation, University Hospital Essen, Essen, Germany
Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
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Aintree University Hospitals NHS Foundation Trust · Aintree University Hospital
Affiliation as printed
Department of Hepato-Biliary Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
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Oxford University Hospitals NHS Trust
Affiliation as printed
Department of Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Newcastle upon Tyne Hospitals NHS Foundation Trust
Affiliation as printed
Department of Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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Jessa Hospital · Hasselt University
Affiliation as printed
Department of Abdominal Surgery, Jessa Hospital, Hasselt, Belgium
Faculty of Medicine and Life Sciences, UHasselt, Hasselt, Belgium
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University Hospital Southampton NHS Foundation Trust · NIHR Southampton Biomedical Research Centre · University of Southampton
Affiliation as printed
University Surgery and Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Surgery and Transplantation, Maastricht University Medical Centre+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
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Affiliation as printed
Department of General Surgery, Santa Maria delle Grazie Hospital, ASL Napoli2 Nord, Napoli, Italy
Department of General, HPB and Liver Transplantation Surgery, Ghent University Hospital, Ghent, Belgium
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Affiliation as printed
Department of General, HPB and Liver Transplantation Surgery, Ghent University Hospital, Ghent, Belgium
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Affiliation as printed
Department of General, HPB and Liver Transplantation Surgery, Ghent University Hospital, Ghent, Belgium
Department of Surgery, Free University Hospital, AZ Jette Hospital, Brussels, Belgium
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University Hospitals Birmingham NHS Foundation Trust
Affiliation as printed
HPB and Liver Transplant Unit, University Hospitals Birmingham NHS Trust, Birmingham, UK
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Amsterdam UMC Location University of Amsterdam · Cancer Center Amsterdam
Affiliation as printed
Cancer Centre Amsterdam, Amsterdam, The Netherlands
Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
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Maastricht University Medical Centre
Affiliation as printed
Department of Surgery and Transplantation, Maastricht University Medical Centre+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Surgery and Transplantation, Maastricht University Medical Centre+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
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Affiliation as printed
Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
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Maastricht University Medical Centre · Essen University Hospital · Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Department of Surgery and Transplantation, Maastricht University Medical Centre+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
Department of Surgery and Transplantation, University Hospital Essen, Essen, Germany
Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
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Maastricht University Medical Centre
Affiliation as printed
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Affiliation as printed
Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
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Affiliation as printed
Intervention Centre and Department of Hepatic, Pancreatic and Biliary Surgery, Oslo University Hospital and Institute of Clinical Medicine, University Hospital of Oslo, Oslo, Norway
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University Hospital Southampton NHS Foundation Trust · NIHR Southampton Biomedical Research Centre · University of Southampton
Affiliation as printed
University Surgery and Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
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Maastricht University Medical Centre · Maastricht University · Essen University Hospital · Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Department of Surgery and Transplantation, Maastricht University Medical Centre+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. r.van.dam@mumc.nl
Department of Surgery and Transplantation, University Hospital Essen, Essen, Germany. r.van.dam@mumc.nl
Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany. r.van.dam@mumc.nl
GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands. r.van.dam@mumc.nl
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