Comparison of laparoscopic major hepatectomy with propensity score matched open cases from the National Clinical Database in Japan.
BACKGROUND
The National Clinical Database (NCD) in Japan is a nationwide registry that collects the data of more than 1,200,000 surgical cases annually from over 3,500 hospitals. Based on the NCD data, this study compared the perioperative outcomes of major laparoscopic liver resection (LLR) with those of major open liver resection (OLR) using the propensity score matching method.


METHODS
We collected data on 15,191 major hepatectomy cases (929 major LLR cases and 14,262 major OLR cases), and investigated the short-term outcomes in well-matched groups.


RESULTS
In the LLR group, 30-day mortality, in-hospital mortality, and operative mortality were 0.9%, 1.7%, and 1.7% respectively. The mean blood loss in the LLR group (865.4 ± 1,148.2 ml) was significantly less than in the OLR group (1,053.8 ± 1,176.6 ml), and the median postoperative hospital stay for the LLR patients (21.37 ± 19.71 days) was significantly shorter than for the OLR patients (26.25 ± 24.53 days). The complication rate in the LLR group (16.4%) was significantly lower than that in the OLR group (23.5%).


CONCLUSIONS
LLR in selected patients is currently safely performed as well as OLR even in patients requiring major hepatectomy, associated with less blood loss, shorter hospital stays, and fewer complications.
Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
Takeshi
T
Takahara
Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.|Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
Go
G
Wakabayashi
Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
Hiroyuki
H
Konno
Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
Mitsukazu
M
Gotoh
Database Committee, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
Hiroki
H
Yamaue
Database Committee, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
Katsuhiko
K
Yanaga
Database Committee, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
Jirou
J
Fujimoto
Database Committee, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
Hironori
H
Kaneko
Database Committee, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
Michiaki
M
Unno
Database Committee, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
Itaru
I
Endo
The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
Yasuyuki
Y
Seto
Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
Hiroaki
H
Miyata
Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
Masaru
M
Miyazaki
Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.|Database Committee, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
Masakazu
M
Yamamoto
D000328:Adult; D000367:Age Factors; D000368:Aged; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007813:Laparotomy / Q000379:methods* / Q000401:mortality; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome
Laparoscopic liver resection; Major hepatectomy; National Clinical Database; Open liver resection; Propensity score matching