title: Clinical and economic comparison of laparoscopic to open liver resections using a 2-to-1 matched pair analysis: an institutional experience.
abstract: BACKGROUND
  Surgical resection of hepatic lesions is associated with intraoperative and postoperative morbidity and mortality. Our center has introduced a laparoscopic liver resection (LLR) program over the past 3 years. Our objective is to describe the initial clinical experience with LLR, including a detailed cost analysis.
  
  
  METHODS
  We evaluated all LLRs from 2006 to 2010. Each was matched to 2 open cases for number of segments removed, patient age, and background liver histology. Model for End-Stage Liver Disease (MELD) and the Charlson comorbidity index were calculated retrospectively. Nonparametric statistical analysis was used to compare surgical and economic outcomes. Analyses were performed including and excluding converted cases.
  
  
  RESULTS
  Fifty-seven patients underwent attempted LLR. Demographic characteristics were similar between groups. Estimated blood loss was lower in the LLR vs the open liver resection (OLR) group, at 250 mL and 500 mL, respectively (p < 0.001). Median operating room times were 240 minutes and 270 minutes in the LLR and OLR groups, respectively (p = 0.14). Eight cases were converted to open (14%): 2 for bleeding, 2 for anatomic uncertainty, 1 for tumor size, 1 for margins, 1 for inability to localize the tumor, and 1 for adhesions. Median length of stay was lower for LLR at 5 days vs 6 days for OLR (p < 0.001). There was no difference in frequency of ICU admission, reoperation, 30-day emergency room visit, or 30-day readmission rates. Median overall cost for LLR was lower at $11,376 vs $12,523 for OLR (p = 0.077).
  
  
  CONCLUSIONS
  Our experience suggests that LLR confers the clinical advantages of reduced operating room time, estimated blood loss, and length of stay while decreasing overall cost. LLR, therefore, appears to be a clinically and fiscally advantageous approach in properly selected patients.
authors.affiliation: Division of General Surgery, University Health Network, 200 Elizabeth Street, Toronto, Ontario, Canada.
authors.forename: Faizal D
authors.initials: FD
authors.lastname: Bhojani
authors.forename: Adrian
authors.initials: A
authors.lastname: Fox
authors.forename: Kristen
authors.initials: K
authors.lastname: Pitzul
authors.forename: Steven
authors.initials: S
authors.lastname: Gallinger
authors.forename: Alice
authors.initials: A
authors.lastname: Wei
authors.forename: Carol-Anne
authors.initials: CA
authors.lastname: Moulton
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.forename: Sean P
authors.initials: SP
authors.lastname: Cleary
mesh_terms: D016063:Blood Loss, Surgical; D003365:Costs and Cost Analysis; D006498:Hepatectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D017721:Hospital Costs; D006801:Humans; D057194:Intention to Treat Analysis; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay; D016555:Matched-Pair Analysis; D009864:Ontario; D009873:Operating Rooms / Q000191:economics; D011183:Postoperative Complications / Q000453:epidemiology