Early and Long-term Outcomes of Laparoscopic and Robot-assisted Liver Resections. Specialized Center’s Experience

摘要

Aim . To compare early and long-term outcomes of laparoscopic and robot-assisted liver resections with open procedures. Material and Methods. Retrospective case-control study was performed. Pseudo-randomization was used to compare homogeneous data. We have assessed survival in patients with various forms of cholangiocellular carcinoma and colorectal cancer metastases after minimally invasive liver resections. Results. For the period 2013–2017 two hundred and fifteen minimally invasive liver resections were performed including 49 robot-assisted and 166 laparoscopic ones. Malignant tumors were in 45% of cases, benign tumors – in 42%, parasitic neoplasms – in 13%. Early results of minimally invasive resections and 70 comparable open liver resections were compared. All procedures were carried out within the same period at one institution. Immediate results were significantly better after minimally invasive liver resections both before pseudo-randomization and after that. There were 60 pairs of patients after pseudo-randomization. In groups of minimally invasive and open resections blood loss was 396 (0–3400) and 853 (20–6000) ml respectively, time of surgery – 319 (85–580) and 376 (180–775) min, incidence of severe (Clavien–Dindo II and over) complications – 10% (n = 6) and 23% (n = 14), length of postoperative hospital-stay – 9 (3–90) and 12 (2–39) days, respectively. 3-year survival after mini-invasive liver resections for colorectal cancer metastases was 70%, various forms of cholangiocellular carcinoma – 40%. Conclusion. Conventional liver resections can be successfully performed in laparoscopic or robot-assisted fashion in certain patients at specialized center of surgical hepatology with sufficient experience in open and laparoscopic liver surgery.