Safety of laparoscopic hepatectomy in patients with severe comorbidities - A propensity score matched analysis

D. Heise*, J. Bednarsch, A. Kroh, R. Eickhoff, M.M.E. Coolsen, R. van Dam, S.A. Lang, U.P. Neumann, F. Ulmer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background Laparoscopic hepatectomy (LH) is nowadays considered as the standard of care for various liver malignancies. However, studies focusing on perioperative outcome after LH in patients with severe comorbidities are still sparse. Methods 247 patients, who underwent LH between January 2016 and March 2020 at European surgical center Aachen Maastricht (ESCAM) were retrospectively analyzed regarding surgical outcome. All patients were categorized according to the ASA guidelines and a propensity score matched (PSM) analysis was performed to compare patients with severe comorbidities with patients with minor or no comorbidities. Results After PSM, no statistically significant differences regarding clinical characteristics were observed. We performed major resections in 26.4% of h-ASA (ASA > 2) patients and 19.4% of l-ASA (ASA <= 2) patients, respectively (P = .322). Overall morbidity (Clavien-Dindo >= 1) was observed more frequently in the h-ASA group (h-ASA: 25.0% vs. l-ASA: 8.3%; P = .007) while analysis of major morbidity (Clavien-Dindo >= 3b) showed a non-significant tendency for more complications in h-ASA patients (h-ASA: 8.3% vs. l-ASA: 1.4%; P = .053). A subgroup analysis identified major resection (HR = 5.05; P = .006) as an independent risk factor for the occurrence of any postoperative complication and chronic kidney disease (HR = 22.59; P = .030) and liver fibrosis (HR = 30.16; P = .031) as risk factors for the occurrence of major complications in h-ASA patients. Conclusion LH in patients with severe systemic comorbidities shows a strong tendency towards an increased rate of major complications. Careful patient selection with respect to the planned extent of resection and the presence of chronic kidney disease and liver fibrosis should be performed to improve perioperative results.
Original languageEnglish
Pages (from-to)609-617
Number of pages9
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Issue number6
Early online date22 Jul 2021
Publication statusPublished - Jun 2022


  • ASA
  • comorbidity
  • complications
  • laparoscopic hepatectomy
  • postoperative outcome

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