Impact of laparoscopic approach on volumetric and functional liver recovery in advanced hepatectomy

This study aimed to assess the impact of the laparoscopic approach on volumetric and functional liver recovery after laparoscopic advanced hepatectomy compared to the open approach. The data of consecutive patients who underwent open and laparoscopic advanced hepatectomy between 2014 and 2022 were retrospectively analyzed. The period from 2014 to 2016 was assigned to the open hepatectomy (OH) group, while the period from 2017 to 2022 was assigned to the laparoscopic hepatectomy (LH) group. Liver regeneration rate was defined as the rate of increase in the planned remnant liver volume. Functional analysis was performed by comparing the laboratory recovery rate, which was calculated as the postoperative value divided by the preoperative value. A total of 86 patients were enrolled in this study; of these, 39 underwent OH and 47 underwent LH. There were no significant differences in preoperative variables between the two groups. The liver regeneration rate at one week was higher in the LH group than in the OH group (25.2 vs. 34.2 %, OH vs. LH groups, respectively, p = 0.081) with a trend toward significance. Subgroup analysis for major hepatectomy showed that the LH group had a higher liver regeneration rate than the OH group (22.1 vs. 32.6 %; p = 0.016), and the prothrombin activity rates in the LH group were maintained at the preoperative level compared to the OH group (83.9 vs. 88.0 %; p = 0.061). In advanced hepatectomy, especially in major hepatectomy, laparoscopic approach may allow early liver recovery.