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Incidence and Clinical Impact of Bile Leakage after Laparoscopic and Open Liver Resection: An International Multicenter Propensity Score-Matched Study of 13,379 Patients

Incidence and Clinical Impact of Bile Leakage after Laparoscopic and Open Liver Resection: An International Multicenter Propensity Score-Matched Study of 13,379 Patients
Incidence and Clinical Impact of Bile Leakage after Laparoscopic and Open Liver Resection: An International Multicenter Propensity Score-Matched Study of 13,379 Patients

BACKGROUND: Despite many developments, postoperative bile leakage (POBL) remains a relatively common postoperative complication after laparoscopic liver resection (LLR) and open liver resection (OLR). This study aimed to assess the incidence and clinical impact of POBL in patients undergoing LLR and OLR in a large international multicenter cohort using a propensity score-matched analysis.

STUDY DESIGN: Patients undergoing LLR or OLR for all indications between January 2000 and October 2019 were retrospectively analyzed using a large, international, multicenter liver database including data from 15 tertiary referral centers. Primary outcome was clinically relevant POBL (CR-POBL), defined as Grade B/C POBL.

RESULTS: Overall, 13,379 patients met the inclusion criteria and were included in the analysis (6,369 LLR and 7,010 OLR), with 6.0% POBL. After propensity score matching, a total of 3,563 LLR patients were matched to 3,563 OLR patients. In both groups, propensity score matching accounted for similar extent and types of resections. The incidence of CR-POBL was significantly lower in patients after LLR as compared with patients after OLR (2.6% vs 6.0%; p < 0.001). Among the subgroup of patients with CR-POBL, patients after LLR experienced less severe (non-POBL) postoperative complications (10.1% vs 20.9%; p = 0.028), a shorter hospital stay (12.5 vs 17 days; p = 0.001), and a lower 90-day/in-hospital mortality (0% vs 5.4%; p = 0.027) as compared with patients after OLR with CR-POBL.

CONCLUSION: Patients after LLR seem to experience a lower rate of CR-POBL as compared with the open approach. Our findings suggest that in patients after LLR, the clinical impact of CR-POBL is less than after OLR.

99-112
Görgec, Burak
57ac6eda-4ee2-474e-8369-a74ec4f6ca35
Cacciaguerra, Andrea Benedetti
42ca93f3-8bc6-4814-84a4-89f48dd8a37d
Aldrighetti, Luca A
a4b19d20-4a6e-4b98-9267-f76edcd689a0
Ferrero, Alessandro
0cb0b38c-30c5-44f9-996c-27e9ef37b62f
Cillo, Umberto
3b5d8132-098f-4e0c-8507-51f35311d119
Edwin, Bjørn
b04994d3-928a-49ad-8bdf-183c7e7a08d2
Vivarelli, Marco
2882acf3-3bbd-4c3c-979b-2dd6abc27850
Lopez-Ben, Santiago
b38b54a3-d823-44f9-9b0e-96e330237341
Besselink, Marc G
45b5ed26-b8ed-4706-902f-b36907ed0994
Abu Hilal, Mohammed
2b7464e5-6a59-4bd8-bfe4-27a1918a5c5a
Primrose, John
d85f3b28-24c6-475f-955b-ec457a3f9185
International Study Group of Bile Leakage after Liver Surgery
Görgec, Burak
57ac6eda-4ee2-474e-8369-a74ec4f6ca35
Cacciaguerra, Andrea Benedetti
42ca93f3-8bc6-4814-84a4-89f48dd8a37d
Aldrighetti, Luca A
a4b19d20-4a6e-4b98-9267-f76edcd689a0
Ferrero, Alessandro
0cb0b38c-30c5-44f9-996c-27e9ef37b62f
Cillo, Umberto
3b5d8132-098f-4e0c-8507-51f35311d119
Edwin, Bjørn
b04994d3-928a-49ad-8bdf-183c7e7a08d2
Vivarelli, Marco
2882acf3-3bbd-4c3c-979b-2dd6abc27850
Lopez-Ben, Santiago
b38b54a3-d823-44f9-9b0e-96e330237341
Besselink, Marc G
45b5ed26-b8ed-4706-902f-b36907ed0994
Abu Hilal, Mohammed
2b7464e5-6a59-4bd8-bfe4-27a1918a5c5a
Primrose, John
d85f3b28-24c6-475f-955b-ec457a3f9185

Primrose, John , International Study Group of Bile Leakage after Liver Surgery (2022) Incidence and Clinical Impact of Bile Leakage after Laparoscopic and Open Liver Resection: An International Multicenter Propensity Score-Matched Study of 13,379 Patients. Journal of the American College of Surgeons, 234 (2), 99-112. (doi:10.1097/XCS.0000000000000039).

Record type: Article

Abstract

BACKGROUND: Despite many developments, postoperative bile leakage (POBL) remains a relatively common postoperative complication after laparoscopic liver resection (LLR) and open liver resection (OLR). This study aimed to assess the incidence and clinical impact of POBL in patients undergoing LLR and OLR in a large international multicenter cohort using a propensity score-matched analysis.

STUDY DESIGN: Patients undergoing LLR or OLR for all indications between January 2000 and October 2019 were retrospectively analyzed using a large, international, multicenter liver database including data from 15 tertiary referral centers. Primary outcome was clinically relevant POBL (CR-POBL), defined as Grade B/C POBL.

RESULTS: Overall, 13,379 patients met the inclusion criteria and were included in the analysis (6,369 LLR and 7,010 OLR), with 6.0% POBL. After propensity score matching, a total of 3,563 LLR patients were matched to 3,563 OLR patients. In both groups, propensity score matching accounted for similar extent and types of resections. The incidence of CR-POBL was significantly lower in patients after LLR as compared with patients after OLR (2.6% vs 6.0%; p < 0.001). Among the subgroup of patients with CR-POBL, patients after LLR experienced less severe (non-POBL) postoperative complications (10.1% vs 20.9%; p = 0.028), a shorter hospital stay (12.5 vs 17 days; p = 0.001), and a lower 90-day/in-hospital mortality (0% vs 5.4%; p = 0.027) as compared with patients after OLR with CR-POBL.

CONCLUSION: Patients after LLR seem to experience a lower rate of CR-POBL as compared with the open approach. Our findings suggest that in patients after LLR, the clinical impact of CR-POBL is less than after OLR.

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Accepted/In Press date: 19 October 2021
Published date: 1 February 2022

Identifiers

Local EPrints ID: 455651
URI: http://eprints.soton.ac.uk/id/eprint/455651
PURE UUID: 59b42c54-737b-4beb-bee7-ecdd6dcb0e10
ORCID for John Primrose: ORCID iD orcid.org/0000-0002-2069-7605

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Date deposited: 30 Mar 2022 16:33
Last modified: 28 Apr 2022 01:38

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Contributors

Author: Burak Görgec
Author: Andrea Benedetti Cacciaguerra
Author: Luca A Aldrighetti
Author: Alessandro Ferrero
Author: Umberto Cillo
Author: Bjørn Edwin
Author: Marco Vivarelli
Author: Santiago Lopez-Ben
Author: Marc G Besselink
Author: Mohammed Abu Hilal
Author: John Primrose ORCID iD
Corporate Author: International Study Group of Bile Leakage after Liver Surgery

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