Short-term outcomes of laparoscopic central hepatectomy: A comparison with open surgery

Purpose Laparoscopic central hepatectomy (CH) remains challenging, with safety and efficacy unclear. This study retrospectively evaluated short-term outcomes of laparoscopic versus open CH and assessed safety and efficacy of laparoscopic surgery. Methods CH included anterior sectionectomy (AS) and central bisectionectomy (CBS) (excluding cases with biliary reconstruction). The study comprised 38 patients receiving CH in our department from January 2010 to November 2023. Results The laparoscopic group included 14 cases and the open group 24. AS/CBS was performed in 14/10 open group cases and 6/8 laparoscopic group cases. Short-term surgical outcomes showed no significant between-group difference in operative time, but the laparoscopic group lost significantly less blood (250 vs. 985 mL; p=0.001) and the transfusion rate was lower (14% vs. 46%; p=0.004). Among postoperative outcomes, incidence of bile leakage was not significantly different (33% vs. 42%; p=0.42), but the laparoscopic group had significantly less postoperative ascites (0% vs. 17%; p=0.047), fewer surgical site infections (SSI) (0% vs. 21%; p=0.02), and shorter postoperative hospital stay (14 vs. 30 days; p=0.03). The risk factor for bile leakage in CH by univariate and multivariate analysis was tumor proximity to the right anterior Glissonean pedicle (OR=6.84; 95% CI=1.67-32.7; p=0.01). Conclusion Laparoscopic CH could be performed safely. Compared to open surgery, laparoscopic CH was effective in reducing blood loss, postoperative ascites, SSIs, and shortening postoperative hospital stay. However, tumors close to the root of the right anterior Glissonean pedicle were considered a risk factor for postoperative bile leakage and require caution.