N. G. Berger1, R. Rajeev1, S. Tsai1, K. K. Christians1, F. M. Johnston1, T. C. Gamblin1, K. K. Turaga1 1Medical College Of Wisconsin,Department Of Surgery, Division Of Surgical Oncology,Milwaukee, WI, USA
Introduction: Oncologic equivalence for laparoscopic (LA) vs. open ablation (OA) of malignant liver tumors has been previously demonstrated in a large multi-institutional study. The aim of this project was to compare peri-procedural outcomes of LA vs. OA for malignant primary liver tumors.
Methods: Patients with primary hepatic malignancies undergoing ablation of their primary tumors were queried from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Database (2008-2013) using CPT codes. Multivariable logistic regression analyses were used to determine the association of technique of ablation with 30-day morbidity and mortality.
Results: Of 5,747 cases with primary hepatic malignancies, 11.4% (n=656) underwent ablation, 3.1% (n=177) had OA and 8.3% (n=479) had LA. Patients undergoing LA had a lower mortality (1.9% vs. 5.1%, p=0.03), lower minor morbidity (2.3% vs. 5.7%, p=0.03), and lower major morbidity (4.2% vs. 17.0%, p<0.001). Patients undergoing LA had marginally lower median platelet count (115 vs. 140, p=0.001), and higher INR (1.16 vs. 1.13, p=0.03). After adjusting for demographic characteristics (including BMI), and sequelae of liver failure (ascites, albumin, INR, platelet count), the mortality and minor morbidity were similar in both groups, while major morbidity was lower in LA (OR 1.13 95% CI (1.05-1.22) p=0.001). OA was associated with increased length of stay (5 vs. 2 days, p<0.001), and longer operative time (152 vs. 112 minutes, p<0.001).
Conclusion: Laparoscopic and open ablations have similar peri-procedural mortality and minor morbidity, while laparoscopic technique shows improved major morbidity and reduced peri-operative resource utilization. When technically feasible, LA should be preferred to OA.