Perioperative outcomes of laparoscopic versus open radiofrequency ablation for the primary treatment of hepatic malignancies: A population-based appraisal

Introduction: Radiofrequency ablation (RFA) is an effective treatment in appropriately selected patients with primary and metastatic cancer in the liver. We sought to compare the perioperative outcomes of patients undergoing open versus laparoscopic RFA of primary and metastatic liver tumors. Methods: We examined patients in the Nationwide Inpatient Sample from 2006–2011 undergoing to RFA as the primary admission procedure, excluding patients who underwent combined gastrointestinal or liver resection resections and percutaneous RFA. Logistic regression, linear regression, and 1:1 propensity score matching were employed to examine the influence of an open versus laparoscopic approach on postoperative outcomes. Results: 1145 patients underwent RFA for primary or metastatic liver cancer: 508 (44.4%) open and 637 (55.6%) laparoscopic. On multivariate analysis, the laparoscopic approach was independently associated with decreased postoperative complications (OR = 0.51, p < 0.001), blood transfusions (OR = 0.35, p < 0.001)), length of stay (net difference = – 3.4 days, p < 0.001), and total hospital charges (net difference = – $27,877, p < 0.001). In the 1:1 propensity score-matched analysis (n = 814 patients), compared to patients who underwent open RFA, patients who underwent laparoscopic RFA had a complication rate of 12.8% versus 22.1%(p < 0.001), a transfusion rate of 5.2% vs 13.5%(p < 0.001), a length of stay of 2.9 vs 6.0 days (p < 0.001), and total hospital charges of $51,270 vs $73,771 (p < 0.001). Conclusion: In this population-based study, laparoscopic RFA appears safe and may have improved short term perioperative outcomes compared to open RFA. Further study is needed to determine if this association is causal as well as to study the long term oncologic outcomes.