Predictors of recurrence following laparoscopic minor hepatectomy for hepatocellular carcinoma in the UK

Comparison of textbook outcomes between laparoscopic and open liver resection for patients with hepatocellular carcinoma: a multicenter study

OBJECTIVE

We aimed to clarify whether laparoscopic liver resection (LLR) is better than open liver resection (OLR) concerning textbook outcome (TO) achievement for patients with hepatocellular carcinoma (HCC).

METHODS

Data from HCC patients who underwent liver resection from a multicenter database were retrospectively reviewed (n = 2617). Propensity score matching (PSM) was used to balance the baseline characteristics of the two groups. Logistic regression analysis was performed to identify the risk factors that are independently associated with TO.

RESULTS

Before PSM, more aggressive biological characteristics were observed in patients who underwent OLR. After PSM, 771 patients in each group were matched. The overall rate of TO achievement in patients with LLR (78.2%) was higher than that in patients with OLR (71.7%; P < 0.001) after PSM. Subgroup analysis further revealed that LLR was associated with a greater incidence of TO achievement than OLR was in patients who underwent minor liver resection (after PSM; LLR: 83.8% vs. OLR: 73.0%, respectively; P < 0.001) but was similar in those who underwent major liver resection (after PSM; LLR: 68.8% vs. OLR: 65.7%; P = 0.468). Multivariate logistic regression analysis suggested that the LLR (OR = 0.471, 95% CI 95% CI = 0.361-0.614, P < 0.001) was an independent protective factor against non-TO in patients who underwent minor liver resection but not in those who underwent major liver resection. After PSM, the 5-year overall survival (OS) rates of patients who underwent OLR (74.6%) and LLR (73.9%) were similar (P = 0.485). Patients with TO had significantly better OS than those without TO, regardless of whether they underwent LLR (TO: 76.5% vs. non-TO: 65.7%, P = 0.005) or OLR (TO: 76.8% vs. non-TO: 69.1%, P = 0.042).

CONCLUSION

LLR favored TO achievement in HCC patients who received minor liver resection but not in those who underwent major liver resection. Patients who achieved TO had better OS regardless of LLR or OLR.

Comparative study of operative expenses: robotic vs. laparoscopic vs. open liver resections at a university hospital in the UK

Robotic liver resections (RLR) are increasingly being performed and has previously been considered more costly. The aim is to explore the cost of RLR compared with laparoscopic and open liver resection in a single National Health Service (NHS) hospital. A retrospective review of patients who underwent RLR, LLR, and OLR from April 2014 to December 2022 was conducted. The primary outcomes were the cost of consumables and median income, and the secondary outcomes were the overall length of stay and mortality at 90 days. Overall, 332 patients underwent liver resections. There were 204 males (61.4%) and 128 females (38.6%), with a median age of 62 years (IQR: 51-77 years). Of these, 60 patients (18.1%) underwent RLR, 21 patients (6.3%) underwent LLR, and 251 patients (75.6%) underwent OLR. Median consumables cost per case was £3863 (IQR: £3458-£5061) for RLR, £4326 (IQR: £4273-£4473) for LLR, and £4,084 (IQR: £3799-£5549) for the OLR cohort (p = 0.140). Median income per case was £7999 (IQR: £4509-£10,777) for RLR, £7497 (IQR: £2407-£14,576) for LLR, and £7493 (IQR: £2542-£14,121) for OLR. The median length of stay (LOS) for RLR was 3 days (IQR: 2-4.7 days) compared to 5 days for LLR (IQR: 4.5-7 days) and 6 days for OLR (IQR: 5-8 days, p < 0.001). Within the NHS, RLR has consumable costs comparable to OLR and LLR. It is also linked with a shorter LOS and generates similar income for patients undergoing OLR and LLR.