Ablation approach for primary liver tumors: Peri‐operative outcomes. Issue 7 (26th February 2018) - Berger, Nicholas G.
Abstract : Background and Objectives: Ablation is a common treatment modality for malignant primary liver tumors(PLTs), outcomes following laparoscopic (LA) versus open ablation (OA) are ill‐defined. This project compares peri‐procedural outcomes of LA versus OA for PLTs. Materials and Methods: Patients with PLTs undergoing radiofrequency ablation were queried from ACS NSQIP Database (2005‐2013) using CPT codes. Patients undergoing percutaneous ablation or hepatic resection were excluded. Multivariable logistic regression analyses determined the association of ablation approach with 30‐day morbidity and mortality. Results: Of 5747 with PLTs, 655 (11.4%) ablations were identified: 177 (27.0%) underwent OA, 478 (73.0%) underwent LA. Patients undergoing LA had lower mortality (1.9% vs 5.1%, P = 0.026), lower minor morbidity (2.3% vs 5.7%, P = 0.031), and lower major morbidity (4.2% vs 17.0%, P < 0.001). Adjusting for demographics, disease‐specific variables (preoperative ascites, total bilirubin, platelet count, albumin, and INR), 30‐day mortality (OR 3.85, 95%CI: 1.38‐10.80, P = 0.010), minor morbidity (OR 2.98, 95%CI: 1.16‐7.67, P = 0.024), and major morbidity (OR 4.59 95%CI: 2.41‐8.76, P < 0.001) were statistically lower in LA. OA demonstrated increased length of stay(LOS) (5 vs 2 days, P < 0.001), and longer operative time (152 vs 112 min, P < 0.001). Conclusion: LA offers decreased peri‐procedural morbidity, mortality, and reduced LOS. LA should be the preferred method for hepatic ablation.