title: Laparoscopy Decreases Pulmonary Complications in Patients Undergoing Major Liver Resection: A Propensity Score Analysis.
abstract: OBJECTIVE
  To compare both incidence and types of postoperative pulmonary complications (PPCs) between laparoscopic major hepatectomy (LMH) and open major hepatectomy (OMH).
  
  
  BACKGROUND
  LMHs are increasingly performed. Yet, the benefits of laparoscopy over laparotomy regarding PPCs remain unknown.
  
  
  METHODS
  In this multi-institutional study, all patients undergoing OMH or LMH between 1998 and 2013 were retrospectively reviewed. Risk factors for PPCs were analyzed on multivariate analysis. Comparison of both overall rate and types of PPCs between OMH and LMH patients was performed after propensity score adjustment on factors influencing the choice of the approach.
  
  
  RESULTS
  LMH was performed in 226 (18.6%) of the 1214 included patients. PPCs occurred in 480 (39.5%) patients including symptomatic pleural effusion in 366 (30.1%) patients, respiratory insufficiency in 141 (11.6%), acute respiratory distress syndrome in 84 (6.9%), pulmonary infection in 80 (6.5%), and pulmonary embolism in 47 (3.8%) patients. On multivariate analysis, preoperative hypoprotidemia [hazard ratio (HR): 1.341, 95% confidence interval (CI): 1.001-1.795; P = 0.049], open approach (HR: 2.481, 95% CI: 1.141-6.024; P = 0.024), right-sided hepatectomy (HR: 2.143, 95% CI: 1.544-2.975; P < 0.001), concomitant extrahepatic procedures (HR: 1.742, 95% CI: 1.103-2.750; P = 0.017), transfusion (HR: 2.851, 95% CI: 2.067-3.935; P < 0.001), and operative time more than 6 hours (HR: 1.510, 95% CI: 1.127-2.022; P = 0.006) were independently associated with PPCs. After propensity score matching, the overall incidence of PPCs (13.2% vs 40.5%, P < 0.001), symptomatic pleural effusion (11.6% vs 26.4%, P = 0.003), pleural effusion requiring drainage (1.7% vs 9.9%, P = 0.006), and acute respiratory distress syndrome (1.7% vs 9.9%, P = 0.006) were significantly lower in the laparoscopy group than in the open group.
  
  
  CONCLUSIONS
  Pure laparoscopy allows reducing PPCs in patients requiring major liver resection.
authors.affiliation: *Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France †Université Paris Descartes, Paris, France ‡Department of Hepatobiliary and Liver Transplantation, Hôpitaux de Paris Hôpital Saint Antoine, Paris, France §Université Pierre et Marie Curie Paris 6, Paris, France ¶Department of Hepatobiliary and Liver Transplantation, Hôpitaux de Paris Hôpital Beaujon, Beaujon, Clichy, France ||Université Paris 7 Diderot, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.forename: François
authors.initials: F
authors.lastname: Cauchy
authors.forename: Samir
authors.initials: S
authors.lastname: Ftériche
authors.forename: Takeo
authors.initials: T
authors.lastname: Nomi
authors.forename: Lilian
authors.initials: L
authors.lastname: Schwarz
authors.forename: Safi
authors.initials: S
authors.lastname: Dokmak
authors.forename: Olivier
authors.initials: O
authors.lastname: Scatton
authors.forename: Grazia
authors.initials: G
authors.lastname: Fusco
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Brice
authors.initials: B
authors.lastname: Gayet
authors.forename: Olivier
authors.initials: O
authors.lastname: Soubrane
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D016015:Logistic Models; D008171:Lung Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult