| Clinical and Economic Comparison of Laparoscopic to Open Liver Resections Using a 2-to-1 Matched Pair Analysis: An Institutional Experience. | |
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MedLine Citation:
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PMID: 22192894 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: Surgical resection of hepatic lesions is associated with intraoperative and postoperative morbidity and mortality. Our center has introduced a laparoscopic liver resection (LLR) program over the past 3 years. Our objective is to describe the initial clinical experience with LLR, including a detailed cost analysis. STUDY DESIGN: We evaluated all LLRs from 2006 to 2010. Each was matched to 2 open cases for number of segments removed, patient age, and background liver histology. Model for End-Stage Liver Disease (MELD) and the Charlson comorbidity index were calculated retrospectively. Nonparametric statistical analysis was used to compare surgical and economic outcomes. Analyses were performed including and excluding converted cases. RESULTS: Fifty-seven patients underwent attempted LLR. Demographic characteristics were similar between groups. Estimated blood loss was lower in the LLR vs the open liver resection (OLR) group, at 250 mL and 500 mL, respectively (p < 0.001). Median operating room times were 240 minutes and 270 minutes in the LLR and OLR groups, respectively (p = 0.14). Eight cases were converted to open (14%): 2 for bleeding, 2 for anatomic uncertainty, 1 for tumor size, 1 for margins, 1 for inability to localize the tumor, and 1 for adhesions. Median length of stay was lower for LLR at 5 days vs 6 days for OLR (p < 0.001). There was no difference in frequency of ICU admission, reoperation, 30-day emergency room visit, or 30-day readmission rates. Median overall cost for LLR was lower at $11,376 vs $12,523 for OLR (p = 0.077). CONCLUSIONS: Our experience suggests that LLR confers the clinical advantages of reduced operating room time, estimated blood loss, and length of stay while decreasing overall cost. LLR, therefore, appears to be a clinically and fiscally advantageous approach in properly selected patients. |
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Authors:
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Faizal D Bhojani; Adrian Fox; Kristen Pitzul; Steven Gallinger; Alice Wei; Carol-Anne Moulton; Allan Okrainec; Sean P Cleary |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-12-20 |
Journal Detail:
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Title: Journal of the American College of Surgeons Volume: - ISSN: 1879-1190 ISO Abbreviation: - Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2011-12-23 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9431305 Medline TA: J Am Coll Surg Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Division of General Surgery, University Health Network, Toronto, ON, Canada. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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