Short-term outcomes of laparoscopic versus open major hepatectomy for benign liver disease: an international bicentric study

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PURPOSE: Laparoscopic hepatectomy is well established for minor resections in benign liver disease; however, evidence for its reproducibility in major hepatectomy remains limited. Therefore, the purpose of this international bicentric study was to compare perioperative outcomes of laparoscopic versus open major hepatectomy for benign liver disease in two high-volume hepatobiliary centers. METHODS: This retrospective international bicentric study analyzed prospectively maintained databases from two high-volume hepatobiliary centers in São Paulo, Brazil, and Paris, France, between 2000 and 2024. Adult patients undergoing right or left major hepatectomy for benign liver disease were included. Perioperative outcomes were compared between laparoscopic and open approaches using standardized definitions. Multivariate analysis identified independent predictors of intraoperative transfusion and early hospital discharge. RESULTS: A total of 126 patients were included (78 open; 48 laparoscopic). Laparoscopic major hepatectomy was associated with lower blood loss (150 vs. 400 mL, p < 0.001), reduced transfusion rates (8.3% vs. 38.5%, p = 0.001), shorter hospital stay (5 vs. 7 days, p < 0.001), and fewer biliary leakage (4.2% vs. 20.5%, p = 0.016). On multivariate analysis, the laparoscopic approach independently predicted lower transfusion risk (OR 0.096, 95% CI 0.011–0.862; p = 0.036) and early hospital discharge (OR 0.083, 95% CI 0.008–0.847; p = 0.036). Operative time, ICU admission, overall morbidity, and mortality were comparable between approaches, with no postoperative deaths. CONCLUSION: Laparoscopic major hepatectomy for benign liver disease is safe and feasible in experienced centers and is associated with improved short-term perioperative outcomes compared with the open approach.

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