I. Sucandy1, J. Spence1, S. Schlosser1, T. J. Bourdeau1, S. B. Ross1, A. S. Rosemurgy1 1Florida Hospital Tampa,Surgery,Tampa, FLORIDA, USA
Introduction: Minimally invasive hepatectomy for benign and malignant liver lesions has gained popularity over the past decade due to superior perioperative outcomes when compared to conventional ‘open’ hepatectomy. Patients undergoing hepatectomy present with varying degrees of liver dysfunction, which may affect their postoperative outcomes. The Model for End Stage Liver Disease (MELD) score is objective, is reproducible, and has been shown to predict mortality related to cirrhosis. This study was undertaken to investigate the impact of preoperative MELD scores on outcomes after minimally invasive robotic hepatectomy.
Methods: With IRB approval, patients undergoing robotic hepatectomy were followed prospectively. Demographic data, MELD score, and outcomes, such as operative time, estimated blood loss, complications, and length of stay, were collected. Regression analysis was used to compare preoperative MELD scores with outcome variables; significance was accepted with 95% probability. For illustrative purposes, data are presented as median (mean ± SD).
Results: 75 patients underwent robotic hepatectomy. Patients age was 64 (62 ± 14.2) years and BMI was 28 (29 ± 7.0) kg/m2; 56% were women. 55 (73%) of the hepatectomies were undertaken for malignancy (36% hepatocellular carcinoma, 24% colorectal metastasis, 9% intrahepatic cholangiocarcinoma, 7% gallbladder cancer, and 6% metastatic neuroendocrine tumor). On regression analysis, MELD score did not correlate with operative time [227 (262 ± 107.5) minutes, p=0.518] or estimated blood loss [125 (266 ± 324.4) mL, p=0.583]. MELD score did correlate with length of stay [3 (5 ± 4.7) days, p=0.002]. 7 patients (9%) experienced complications (i.e., acute respiratory failure, bile leak requiring ERCP, intra-abdominal fluid collection, pleural effusion, surgical site infection, enterocutaneous fistula, and atrial fibrillation); their MELD score was 7 (8 ± 2.5). 68 patients (91%) did not experience any complications; their MELD score was 7 (8 ± 2.8) and was not different than patients experiencing complications (p=0.803). 1 (1%) patient died as a consequence of an enterocutaneous fistula.
Conclusion: Robotic hepatectomy can be undertaken with few complications, a short length of stay, and low mortality. Preoperative MELD score does not predict operative blood loss, operative duration, the occurrence of postoperative complications, or postoperative mortality; preoperative MELD score does predict hospital length of stay following robotic hepatectomy. For patients being considered for hepatectomy, an elevated MELD score should not deter surgeons from utilizing minimally invasive robotic hepatectomy.
