Surgical outcomes of laparoscopic and open resection of benign liver tumours in the Netherlands: a nationwide analysis

Arthur K E Elfrink; Martijn P D Haring; Vincent E de Meijer; Jan N M Ijzermans; Rutger-Jan Swijnenburg; Andries E Braat; Joris I Erdmann; Türkan Terkivatan; Wouter W Te Riele; Peter B van den Boezem; Marielle M E Coolsen; Wouter K G Leclercq; Daan J Lips; Roeland F de Wilde; Niels F M Kok; Dirk J Grünhagen; Joost M Klaase; Dutch Hepato Biliary Audit Group

doi:10.1016/j.hpb.2020.12.003

Surgical outcomes of laparoscopic and open resection of benign liver tumours in the Netherlands: a nationwide analysis

HPB (Oxford). 2021 Aug;23(8):1230-1243. doi: 10.1016/j.hpb.2020.12.003. Epub 2020 Dec 29.

Authors

Arthur K E Elfrink¹, Martijn P D Haring², Vincent E de Meijer², Jan N M Ijzermans³, Rutger-Jan Swijnenburg⁴, Andries E Braat⁵, Joris I Erdmann⁶, Türkan Terkivatan⁷, Wouter W Te Riele⁸, Peter B van den Boezem⁹, Marielle M E Coolsen¹⁰, Wouter K G Leclercq¹¹, Daan J Lips¹², Roeland F de Wilde⁷, Niels F M Kok¹³, Dirk J Grünhagen⁷, Joost M Klaase¹⁴; Dutch Hepato Biliary Audit Group

Collaborators

Dutch Hepato Biliary Audit Group:
Marcel den Dulk¹⁵, Marieke T de Boer¹⁶, Marc G H Besselink¹⁷, Cees H C Dejong¹⁵, Jeroen Hagendoorn¹⁸, Frederik J H Hoogwater¹⁶, Mike S L Liem¹⁹, I Quintus Molenaar¹⁸, Carlijn I Buis¹⁶, Cornelis Verhoef²⁰, Gijs A Patijn²¹, Ninos Ayez²², Koop Bosscha²³, Eric J T Belt²⁴, Maarten Vermaas²⁵, Colin Sietses²⁶, Steven J Oosterling²⁷, Hans Torrenga²⁸, Hasan Eker²⁹, Esther C J Consten³⁰, Hendrik A Marsman³¹

Affiliations

¹ Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden; Department of Surgery, University of Groningen and University Medical Center Groningen, Groningen. Electronic address: a.elfrink@dica.nl.
² Department of Surgery, University of Groningen and University Medical Center Groningen, Groningen; Dutch Benign Liver Tumour Group.
³ Department of Surgery, Erasmus MC Cancer Institute, Rotterdam; Dutch Benign Liver Tumour Group.
⁴ Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam.
⁵ Department of Surgery, Leiden University Medical Center, Leiden; Dutch Benign Liver Tumour Group.
⁶ Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam; Dutch Benign Liver Tumour Group.
⁷ Department of Surgery, Erasmus MC Cancer Institute, Rotterdam.
⁸ Department of Surgery, University Medical Center Utrecht, Utrecht; Department of Surgery, Isala, Zwolle; St. Antonius Hospital, Nieuwegein, the Netherlands.
⁹ Department of Surgery, Radboud Medical Center, Nijmegen.
¹⁰ Department of Surgery, Maastricht University Medical Center, Maastricht; Dutch Benign Liver Tumour Group.
¹¹ Department of Surgery, Máxima Medical Center, Veldhoven.
¹² Department of Surgery, Medisch Spectrum Twente, Enschede.
¹³ Department of Surgery, Antoni van Leeuwenhoek - Dutch Cancer Institute, Amsterdam.
¹⁴ Department of Surgery, University of Groningen and University Medical Center Groningen, Groningen.
¹⁵ Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
¹⁶ Department of Surgery, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands.
¹⁷ Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
¹⁸ Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
¹⁹ Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands.
²⁰ Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
²¹ Department of Surgery, Isala, Zwolle, the Netherlands.
²² Department of Surgery, Amphia Hospital, Breda, the Netherlands.
²³ Department of Surgery, Jeroen Bosch Ziekenhuis, Hertogenbosch, the Netherlands.
²⁴ Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
²⁵ Department of Surgery, Ijsselland Hospital, Capelle a/d Ijssel, the Netherlands.
²⁶ Department of Surgery, Gelderse Vallei, Ede, the Netherlands.
²⁷ Department of Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands.
²⁸ Department of Surgery, Deventer Hospital, Deventer, the Netherlands.
²⁹ Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
³⁰ Department of Surgery, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands; Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands.
³¹ Department of Surgery, OLVG, Amsterdam, the Netherlands.

PMID: 33478819
DOI: 10.1016/j.hpb.2020.12.003

Abstract

Background: Data on surgical outcomes of laparoscopic liver resection (LLR) versus open liver resection (OLR) of benign liver tumour (BLT) are scarce. This study aimed to provide a nationwide overview of postoperative outcomes after LLR and OLR of BLT.

Methods: This was a nationwide retrospective study including all patients who underwent liver resection for hepatocellular adenoma, haemangioma and focal nodular hyperplasia in the Netherlands from 2014 to 2019. Propensity score matching (PSM) was applied to compare 30-day overall and major morbidity and 30-day mortality after OLR and LLR.

Results: In total, 415 patients underwent BLT resection of whom 230 (55.4%) underwent LLR. PSM for OLR and LLR resulted in 250 matched patients. Median (IQR) length of stay was shorter after LLR than OLR (4 versus 6 days, 5.0-8.0, p < 0.001). Postoperative 30-day overall morbidity was lower after LLR than OLR (12.0% vs. 22.4%, p = 0.043). LLR was associated with reduced 30-day overall morbidity in multivariable analysis (aOR:0.46, CI:0.22-0.95, p = 0.043). Both 30-day major morbidity and 30-day mortality were not different.

Conclusions: LLR for BLT is associated with shorter hospital stay and reduced overall morbidity and is preferred if technically feasible.

MeSH terms

Carcinoma, Hepatocellular* / surgery
Hepatectomy / adverse effects
Humans
Laparoscopy* / adverse effects
Length of Stay
Liver Neoplasms* / surgery
Netherlands
Postoperative Complications / etiology
Retrospective Studies
Treatment Outcome