• Ye Xin Koh, Yun Zhao, Ivan En-Howe Tan, Hwee Leong Tan, Darren Weiquan Chua, Ek Khoon Tan, Jin Yao Teo, Kwok Ann Ang, Marianne Kit Har Au, and Brian Kim Poh Goh.
• Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, 20 College Road, Singapore 169856.
• J. Am. Coll. Surg. 2024 Dec 2.

BackgroundThis study compared the clinical and economic outcomes of laparoscopic (LLR) and open liver resection (OLR) for all hepatectomies, including minor and major hepatectomies.Study DesignThis retrospective study included 920 consecutive elective patients undergoing liver resection from 2017 to 2023. Patient demographics, postoperative surgical outcomes, postoperative length of stay (LOS), and costs were compared between LLR and OLR before and after propensity score matching (PSM). A decision model was developed to assess the cost-effectiveness of LLR versus OLR.ResultsAfter PSM, LLR was associated with significantly fewer postoperative transfusions for all hepatectomies (P < 0.001) and major hepatectomy (P = 0.001). LLR was associated with a shorter postoperative median LOS (P < 0.001), lower 30-day readmission (P = 0.022) and reoperation (P = 0.044) rates, and significantly reduced postoperative pneumonia (P = 0.038), unplanned intubation (P = 0.020), sepsis (P = 0.041), and major complications (P < 0.001) for all hepatectomies. This clinical superiority was complemented by a significant reduction in total costs for all (P < 0.001), minor (P = 0.001), and major (P < 0.001) hepatectomies. Cost-effectiveness analysis revealed that LLR was dominant over OLR, with a negative incremental cost-effectiveness ratio (-$2120.72) and an increased net monetary benefit ($75,015.92) at the willingness-to-pay (WTP) threshold of $25,000. The probability of LLR being cost-effective was 99.8% across various WTP thresholds.ConclusionsLLR is a safe and cost-effective alternative to OLR. While LLR has higher initial procedural costs, these are offset by significant reductions in postoperative major complications, LOS, and total costs.Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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