title: Outcome after laparoscopic and open resections of posterosuperior segments of the liver.
abstract: BACKGROUND
  Laparoscopic resection of posterosuperior (PS) segments of the liver is hindered by limited visualization and curvilinear resection planes. The aim of this study was to compare outcomes after open and laparoscopic liver resections of PS segments.
  
  
  METHODS
  Patients who underwent minor open liver resection (OLR) and laparoscopic liver resection (LLR) between 2006 and 2014 were identified from the institutional databases of seven tertiary referral European hepatobiliary surgical units. Propensity score-matched analysis was used to match groups for known confounders. Perioperative outcomes including complications were assessed using the Dindo-Clavien classification, and the comprehensive complication index was calculated. Survival was analysed with the Kaplan-Meier method.
  
  
  RESULTS
  Some 170 patients underwent OLR and 148 had LLR. After propensity score-matched analysis, 86 patients remained in both groups. Overall postoperative complication rates were significantly higher after OLR compared with LLR: 28 versus 14 per cent respectively (P = 0·039). The mean(s.d.) comprehensive complication index was higher in the OLR group, although the difference was not statistically significant (26·7(16·6) versus 18·3(8·0) in the LLR group; P = 0·108). The mean(s.d.) duration of required analgesia and the median (range) duration of postoperative hospital stay were significantly shorter in the LLR group: 3·0(1·1) days versus 1·6(0·8) days in the OLR group (P < 0·001), and 6 (3-44) versus 4 (1-11) days (P < 0·001), respectively. The 3-year recurrence-free survival rates for patients with hepatocellular carcinoma (37 per cent for OLR versus 30 per cent for LLR; P = 0·534) and those with colorectal liver metastases (36 versus 36 per cent respectively; P = 0·440) were not significantly different between the groups.
  
  
  CONCLUSIONS
  LLR of tumours in PS segments is feasible in selected patients. LLR is associated with fewer complications and does not compromise survival compared with OLR.
authors.affiliation: Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital and Medical School, Ghent, Belgium.
authors.forename: V
authors.initials: V
authors.lastname: Scuderi
authors.affiliation: The Intervention Centre, Department of Hepatic, Pancreatic and Biliary Surgery, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway.
authors.forename: L
authors.initials: L
authors.lastname: Barkhatov
authors.affiliation: Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Montalti
authors.affiliation: Hepatobiliary Surgery, Department of Surgery, San Raffaele Hospital Milan, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Ratti
authors.affiliation: Hepatobiliary and Pancreatic Surgical Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: F
authors.initials: F
authors.lastname: Cipriani
authors.affiliation: Hepatic, Pancreatic and Biliary Surgery and Liver Transplant Unit, General and Digestive Surgery, University Clinic of Navarra, Pamplona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Pardo
authors.affiliation: Department of Digestive Minimally Invasive Surgery, Antoine Béclère Hospital, Paris-Saclay University, Clamart, France.
authors.forename: H
authors.initials: H
authors.lastname: Tranchart
authors.affiliation: Department of Digestive Minimally Invasive Surgery, Antoine Béclère Hospital, Paris-Saclay University, Clamart, France.
authors.forename: I
authors.initials: I
authors.lastname: Dagher
authors.affiliation: Hepatic, Pancreatic and Biliary Surgery and Liver Transplant Unit, General and Digestive Surgery, University Clinic of Navarra, Pamplona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Rotellar
authors.affiliation: Hepatobiliary and Pancreatic Surgical Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: M
authors.initials: M
authors.lastname: Abu Hilal
authors.affiliation: The Intervention Centre, Department of Hepatic, Pancreatic and Biliary Surgery, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway.
authors.forename: B
authors.initials: B
authors.lastname: Edwin
authors.affiliation: Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Vivarelli
authors.affiliation: Hepatobiliary Surgery, Department of Surgery, San Raffaele Hospital Milan, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Aldrighetti
authors.affiliation: Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital and Medical School, Ghent, Belgium.
authors.forename: R I
authors.initials: RI
authors.lastname: Troisi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D057216:Propensity Score; D012189:Retrospective Studies; D055815:Young Adult