Short-term outcomes of laparoscopic central hepatectomy: a comparison with open surgery.

Purpose: Laparoscopic liver resection has advantages over open liver resection, including reduced blood loss and shorter hospital stays. Laparoscopic central hepatectomy (CH) is a highly challenging procedure, and such outcomes can only be achieved with a high level of expertise in laparoscopic liver surgery. Laparoscopic CH remains challenging, with safety and efficacy unclear. This study retrospectively evaluated the intra- and short-term outcomes of laparoscopic versus open CH and assessed safety and efficacy of laparoscopic surgery.

Methods: CH included anterior sectionectomy (AS) and central bisectionectomy (CBS) (excluding cases with biliary reconstruction). The study comprised 38 patients receiving CH in our department from January 2010 to November 2023.

Results: The laparoscopic group included 14 cases and the open group 24. AS/CBS was performed in 14/10 open group cases and 6/8 laparoscopic group cases. Short-term surgical outcomes showed no significant between-group difference in operative time, but the laparoscopic group lost significantly less blood (250 vs. 985 mL; p = 0.001) and the transfusion rate was lower (14% vs. 46%; p = 0.004). Among postoperative outcomes, incidence of bile leakage was not significantly different (33% vs. 42%; p = 0.42), but the laparoscopic group had significantly less postoperative ascites (0% vs. 17%; p = 0.047), fewer surgical site infections (SSI) (0% vs. 21%; p = 0.02), and shorter postoperative hospital stay (14 vs. 30 days; p = 0.005). The risk factor for bile leakage in CH by univariate and multivariate analysis was tumor proximity to the right anterior Glissonean pedicle (OR = 6.84; 95% CI = 1.67-32.7; p = 0.01).

Conclusion: Laparoscopic CH could be performed safely. Compared to open surgery, laparoscopic CH was effective in reducing blood loss, postoperative ascites, SSIs, and shortening postoperative hospital stay. However, tumors close to the root of the right anterior Glissonean pedicle were considered a risk factor for postoperative bile leakage and require caution.