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%). Conclusion: 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.