O-098: Comparative Short-term Outcomes of Laparoscopic Anatomical Liver Resection for the Centrally Located Tumor: Case-matched Study with Propensity Score Matching

Aims: Recent advanced technology and an accumulation experience of surgeons have expanded the indications for laparoscopic liver resection. However, compared with open liver resection, laparoscopic anatomical liver resection for centrally located tumor has not been well established in terms of feasibility. The aim of our study was to assess the feasibility and safety of laparoscopic anatomical major liver resection for the centrally located tumor. Methods: From September 2005 to April 2015, 138 consecutive anatomical major liver resections for the centrally located tumor such as central hepatectomy (CH) and right anterior sectionectomy (RAS) were performed, including 14 cases of totally laparoscopic anatomical liver resections. In order to compensate the selection bias, we performed one or/and up to five match using propensity score matching between laparoscopic and open liver resection. Results: After propensity score matching, 14 and 39 patients were included in the Laparoscopic liver resection (LLR) and Open liver resection (OLR) group, respectively. Surgical time was longer in the LLR group (393, range 131 to 661 minutes) than the OLR group (270, range 92 to 500 minutes) (p = 0.001), but the hospitalization was shorter (8, range 5 to 24 days versus 11, range 5 to 183 days, p = 0.061). The portal triad clamping time was shorter (15 versus 25 minutes, p = 0.833) and mean blood loss was less in LLR (471 versus 489 mL, p = 0.603) but the values were not statistically significant. The morbidity rates were 36% (5 of 14 cases) in the LLR group and 28% (11 of 39 cases) in the OLR group. There was no postoperative mortality in either group. Conclusions: Laparoscopic approach for CLT requiring CH or RAS seems feasible with non-inferior outcome perioperative compared to OLR. CLT may be performed safely by totally laparoscopic approach in experienced hands.