title: Short-term outcomes of laparoscopic vs. open liver resection for hepatocellular adenoma: a multicenter propensity score adjustment analysis by the AFC-HCA-2013 study group.
abstract: Patients with hepatocellular adenomas are, in selected cases, candidates for liver resection, which can be approached via laparoscopy or laparotomy. The present study aimed to investigate the effects of the surgical approach on the postoperative morbidities of both minor and major liver resections.
  
  
  
  In this multi-institutional study, all patients who underwent open or laparoscopic hepatectomies for hepatocellular adenomas between 1989 and 2013 in 27 European centers were retrospectively reviewed. A multiple imputation model was constructed to manage missing variables. Comparisons of both the overall rate and the types of complications between open and laparoscopic hepatectomy were performed after propensity score adjustment (via the standardized mortality ratio weighting method) on the factors that influenced the choice of the surgical approach.
  
  
  
  The laparoscopic approach was selected in 208 (38%) of the 533 included patients. There were 194 (93%) women. The median age was 38.9 years. After the application of multiple imputation, 208 patients who underwent laparoscopic operations were compared with 216 patients who underwent laparotomic operations. After adjustment, there were 20 (9.6%) major liver resections in the laparoscopy group and 17 (7.9%) in the open group. The conversion rate was 6.3%. The two surgical approaches exhibited similar postoperative morbidity rates and severities. Laparoscopic resection was associated with significantly less blood loss (93 vs. 196 ml, p < 0.001), a less frequent need for pedicle clamping (21 vs. 40%, p = 0.002), a reduced need for transfusion (8 vs. 24 red blood cells units, p < 0.001), and a shorter hospital stay (5 vs. 7 days, p < 0.001). The mortality was nil.
  
  
  
  Laparoscopy can achieve short-term outcomes similar to those of open surgery for hepatocellular adenomas and has the additional benefits of a reduced blood loss, need for transfusion, and a shorter hospital stay.
authors.affiliation: Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Paris Est University, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France.
authors.forename: Filippo
authors.identifier: 0000-0002-8836-6466
authors.initials: F
authors.lastname: Landi
authors.affiliation: Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Paris Est University, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France.
authors.forename: Nicola
authors.initials: N
authors.lastname: De' Angelis
authors.affiliation: Department of Liver Transplantation and HPB Surgery, Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Scatton
authors.affiliation: Department of Clinical Pharmacology, Vall d'Hebron University Hospital, Universidad Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Vidal
authors.affiliation: Department of Digestive, Hepato-Biliary, Endocrine Surgery, and Surgical Oncology, Nancy University Hospital, Lorraine University, Lorraine, France.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ayav
authors.affiliation: Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Muscari
authors.affiliation: Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
authors.forename: Safi
authors.initials: S
authors.lastname: Dokmak
authors.affiliation: Department of General Surgery, Humanitas University and Research Hospital, Milan, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Torzilli
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.affiliation: Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Soubrane
authors.affiliation: Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
authors.affiliation: Department of Surgery, la Timone Hospital, Aix-Marseille University, Marseille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Hardwigsen
authors.affiliation: Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Paris Est University, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France. alexis.laurent@aphp.fr.|INSERM, UMR 955, Créteil, France. alexis.laurent@aphp.fr.
authors.forename: Alexis
authors.initials: A
authors.lastname: Laurent
mesh_terms: D018248:Adenoma, Liver Cell / Q000601:surgery*; D000328:Adult; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000379:methods; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D007902:Length of Stay / Q000706:statistics & numerical data*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Hepatocellular adenoma; Laparoscopic liver resection; Open liver resection; Postoperative morbidity; Propensity score adjustment