Comparison of outcomes between open and minimally invasive hepatic resections for hepatocellular carcinoma: A retrospective analysis.

Abstract

4110 Background: Recent data from the United States indicate that the incidence of hepatocellular carcinoma (HCC) has tripled over the past 40 years, with risk factors like obesity-related fatty liver disease and chronic hepatitis C on the rise. Despite advances in treatment, the five-year survival rate remains low at 14%. Minimally Invasive Surgery (MIS) has garnered popularity in hepato-pancreato-biliary (HPB) procedures, comprising 1 in 13 cases. MIS offers advantages such as shorter hospital stays and reduced morbidity, with better outcomes. However, the safety and efficacy of MIS, specifically for HCC resection, remain underexplored. To address this gap, we conducted this study to evaluate and compare the outcomes of MIS vs. open surgical approaches for HCC resection. Methods: The 2016–2022 National Inpatient Sample (NIS) was utilized for this study. Patients with a primary procedural code for hepatic resection, categorized as either open or minimally invasive approaches, were identified. This cohort was further narrowed to include only patients diagnosed with hepatocellular carcinoma (HCC). Differences in common postoperative complications between open and minimally invasive approaches were analyzed. Results: We studied 3,595 hepatic resections for HCC, with 87.5% performed as open procedures and 12.5% as minimally invasive surgeries. Both approaches were predominantly conducted in males (70.9% vs. 75.6%, p = 0.041), with open resection patients being younger (mean age 63.94 vs. 66.67, p < 0.01). Open resections were associated with higher complication rates, including critical care needs (aOR 6.428, 95% CI 2.606–15.858, p < 0.001), sepsis (aOR 3.728, 95% CI 1.508–9.215, p = 0.004), acute kidney injury(AKI) (aOR 2.406, 95% CI 1.714–3.337, p < 0.001), bleeding (aOR 2.314, 95% CI 1.838–2.914, p < 0.001), and blood transfusion requirements (aOR 4.514, 95% CI 2.661–7.658, p < 0.001). Open procedures also resulted in higher mean hospital charges ($180,561 vs. $131,566, p < 0.01) and more extended hospital stays (8.5 vs. 5.3 days, p < 0.01). Despite these differences, mortality rates between open and minimally invasive approaches were similar (aOR 1.486, 95% CI 0.85–2.595, p = 0.164). Conclusions: Our study found that open hepatic resection for HCC is associated with a higher rate of complications, including bleeding, AKI , increased critical care needs, and blood transfusion requirements, compared to minimally invasive surgery. However, mortality rates between the two approaches remain comparable. With the rising incidence of HCC, transitioning toward MIS may provide notable benefits in reducing postoperative morbidity. Since most hepatic resections are still performed using open techniques, further research is necessary to enhance surgical outcomes and explore alternative strategies.