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Purpose <p>Minimally invasive liver surgery (MILS) still appears to be adopted with significant variability. We aimed to investigate the diffusion, indications, and short-term outcomes of MILS compared to the open approach.</p> Methods <p>A prospective registry of all liver resections performed for any indication and using any technique between January 1, 2017, and December 31, 2019, was established (BReLLS) and analyzed.</p> Results <p>A total of 1342 consecutive liver resections were included, 684 (51%) MILS and 658 (49%) open procedures. MILS was not attempted due to technical complexity in the 46.2% of cases, followed by previous abdominal surgery (22.5%). Patients undergoing MILS had a higher proportion of benign indications and of hepatocellular carcinomas, patients affected by liver cirrhosis with portal hypertension and a lower proportion of major hepatectomies (all <i>p</i> &lt; 0.001). After propensity-score matching, MILS showed better results in terms of surgery duration (<i>p</i> &lt; 0.001), blood loss (<i>p</i> = 0.015), complication rate (<i>p</i> &lt; 0.001), rate of Clavien-Dindo grade ≥ 3 complications (<i>p</i> = 0.012), comprehensive complication index (<i>p</i> &lt; 0.001), length of stay (<i>p</i> &lt; 0.001), readmissions (<i>p</i> = 0.016). Centers performing over 50 liver resections per year had a higher proportion of overall MILS cases (<i>p</i> &lt; 0.001), a similar proportion of major resections (<i>p</i> = 0.362), but a higher prevalence of MILS major resections (<i>p</i> = 0.004), lower 90-day mortality rates (<i>p</i> &lt; 0.001), lower overall complication rates (<i>p</i> &lt; 0.001), and shorter hospital length of stay (<i>p</i> &lt; 0.001).</p> Conclusion <p>MILS was the preferred technique in half of the cases, particularly in patients with cirrhosis and portal hypertension, and benign lesions. It provided superior short-term outcomes compared to the open approach for both minor and major liver resections in selected patients.</p>

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Multicenter Belgian prospective registry on minimally invasive and open liver surgery (BReLLS): experience from 1342 consecutive cases

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月3日

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  • Roberto Ivan Troisi,
  • Gianluca Rompianesi,
  • Mathieu D’Hondt,
  • Aude Vanlander,
  • Claude Bertrand,
  • Catherine Hubert,
  • Olivier Detry,
  • Bert Van den Bossche,
  • Philippe Malvaux,
  • Joseph Weerts,
  • Thibault Sablon,
  • Koen Vermeiren,
  • Mehrdad Biglari,
  • Filip Gryspeerdt,
  • Celine De Meyere,
  • Alexandra Dili,
  • Kim Boterbergh,
  • Valerio Lucidi

摘要

Purpose

Minimally invasive liver surgery (MILS) still appears to be adopted with significant variability. We aimed to investigate the diffusion, indications, and short-term outcomes of MILS compared to the open approach.

Methods

A prospective registry of all liver resections performed for any indication and using any technique between January 1, 2017, and December 31, 2019, was established (BReLLS) and analyzed.

Results

A total of 1342 consecutive liver resections were included, 684 (51%) MILS and 658 (49%) open procedures. MILS was not attempted due to technical complexity in the 46.2% of cases, followed by previous abdominal surgery (22.5%). Patients undergoing MILS had a higher proportion of benign indications and of hepatocellular carcinomas, patients affected by liver cirrhosis with portal hypertension and a lower proportion of major hepatectomies (all p < 0.001). After propensity-score matching, MILS showed better results in terms of surgery duration (p < 0.001), blood loss (p = 0.015), complication rate (p < 0.001), rate of Clavien-Dindo grade ≥ 3 complications (p = 0.012), comprehensive complication index (p < 0.001), length of stay (p < 0.001), readmissions (p = 0.016). Centers performing over 50 liver resections per year had a higher proportion of overall MILS cases (p < 0.001), a similar proportion of major resections (p = 0.362), but a higher prevalence of MILS major resections (p = 0.004), lower 90-day mortality rates (p < 0.001), lower overall complication rates (p < 0.001), and shorter hospital length of stay (p < 0.001).

Conclusion

MILS was the preferred technique in half of the cases, particularly in patients with cirrhosis and portal hypertension, and benign lesions. It provided superior short-term outcomes compared to the open approach for both minor and major liver resections in selected patients.