Significance of a Minimally Invasive Approach in Reducing Surgical Risks Throughout the Clinical Course of Patients Undergoing Hepatectomy.

Abstract

Although minimally invasive surgery (MIS) is thought to reduce the surgical risks in both initial and repeat hepatectomy patients, the actual clinical impact of the MIS-oriented surgical approach on their clinical course is not fully understood. The clinical records of 1138 consecutive patients who had undergone hepatectomy were retrospectively reviewed, and the clinical significance of an MIS-oriented approach was analyzed. The analysis of the records of the 752 patients who had undergone an initial hepatectomy showed that MIS was associated with a lower risk of postoperative morbidity and that it was also correlated with a milder grade of adhesions observed during the next surgery. The severity of adhesions was scored according to the TORAD v2.0, and an analysis of the records of 386 repeat hepatectomy patients revealed that both the grade of adhesion and MIS were associated with a risk of postoperative morbidity at the time of the repeat hepatectomy (odds ratio, 1.60 per +1 point of the TORAD v2.0; and odds ratio, 0.09 for MIS). MIS is associated with a lower surgical risk in both initial and repeat hepatectomy patients because of its less invasiveness and lower probability of being followed by severe adhesion formation.