Laparoscopic approaches for hepatic total caudate lobe resection: A multi-institutional real-world retrospective cohort study

Laparoscopic total caudate lobe resection (LHCLR) presents a challenge because of its specific location and anatomical characteristics. Most existing studies on LHCLR are single-case or case series reports, and standardization research on the combined left–right approach (LRA) and the anterior hepatic transection approach (AHA) is still lacking. This retrospective cohort study collected data from eight referral institutions that patients underwent LHCLR. All surgical approaches were divided into two types and compared. Comparison was conducted on the postoperative efficacy and oncological outcomes between the two approaches. We used 1:1 propensity score matching (PSM) to control confounding factors and calculate propensity using a binary logistic model. For repeated-measurement data, such as biochemical indicators, this study used a generalized estimation equation model to estimate the differences between groups. KM survival curve analysis and log-rank test were used to compare the differences between the overall survival and progression-free survival of various groups at different time points. A total of 77 patients (34 males [44.2 %] and 43 females [55.8 %]), including 57 (74.03 %) who underwent the LRA and 20 (25.97 %) who underwent the AHA, were included in the analysis. The lesion size, amount of blood loss and blood transfusions, operative time, complication rate, and postoperative hospital stay of all patients in the AHA group were significantly higher than those in the LRA group before and after inverse probability of treatment weighting. After PSM was used for 1:1 matching, 14 pairs were matched. No significant differences in appeal variables were observed after matching, and no statistically significant differences were detected in the oncological outcomes between the two groups. An appropriate surgical approach should be selected based on the lesion size, location, and pathology for LHCLR. The AHA is suitable for large tumors but may result in a high incidence of complications, especially ascites and the degree of complications.