Postoperative outcomes with minimally invasive minor hepatectomy based on ECOG performance status - analysis of multi-institutional database.

Objective: Minimally invasive liver resection (MILR) is associated with fewer postoperative complications compared to open liver resection. Eastern Cooperative Oncology Group (ECOG) performance status (PS) is a fast, reproducible patient selection tool used to guide therapy. We compared patient outcomes after MILR by ECOG PS.

Methods: Non-cirrhotic patients undergoing MILR resection at one of 14 North American healthcare centers were identified from the Americas Minimally Invasive Liver Surgery (AMILES) database (2010-2024). Perioperative outcomes were compared between ECOG1 and ECOG2 patients. Multivariable analysis (MVA) was used to identify factors independently associated with postoperative complications.

Results: Of 4,181 patients, 486 met our inclusion criteria. Median patient age was 62 years. Four-hundred twenty-eight patients (88.1%) were ECOG1. Overall postoperative complication rate was not lower in ECOG 1 patients compared to ECOG 2 patients on univariate (20.3 vs. 29.1%, p = 0.17), and MVA (aOR 0.60, p = 0.14). Robotic versus laparoscopic approach (aOR 0.52, p = 0.03) and use of intraoperative ablation versus no ablation (aOR 0.38, p = 0.03) were associated with decreased odds of postoperative complications. Intraoperative conversion from MILR to open was associated with increased odds of postoperative complications (aOR 2.22, p = 0.04).

Conclusion: In non-cirrhotic patients with ECOG2 performance status, minimally invasive minor liver resection may be considered with an acceptable complication rate similar to ECOG1 patients.