Does minimally invasive anatomical hepatectomy reduce surgical site infections?

Aim: This study aims to clarify the effectiveness of laparoscopic anatomical liver resections (ALRs) in surgical site infections (SSIs). Methods: We included 95 cases (44.0%) of laparoscopic ALRs (LALRs) and 121 (56.0%) of open ALRs (OALRs). Retrospective comparisons were performed between the two groups. Results: In preoperative factors, tumor size was significantly smaller in LALRs than in OALRs (34.4 f 23.0 mm vs. 45.9 f 35.7 mm, P = 0.007). The operative duration was longer in LALRs than in OALRs (523.0 f 186.5 min vs. 356.3 f 100.5 min, P < 0.001). However, the blood loss and the blood transfusion were fewer in LALRs than in OALRs (592.1 f 911.7 mL vs. 1,240.6 f 1,131.8 mL, P < 0.001, 26.3% vs. 48.8%, P = 0.001, respectively). Postoperative complications above the Clavien-Dindo grade IIIb were one case (1.1%) in LALRs and two in OALRs (P = 1.000). The postoperative hospital stay was shorter in LALRs than in OALRs (14.8 f 16.5 days vs. 20.7 f 18.9 days, P = 0.017). There was one (0.8%) postoperative death within 90 days in OALRs and none (0.0%) in LALRs (P = 1.000). Incisional SSIs (ISSIs) were significantly reduced in LALRs than in OALRs (1.1% vs. 7.4%, P = 0.045). Organ/space SSIs (OSSIs) were observed in five cases (5.3%) in LALRs and seven cases (5.8%) in OALRs (P = 1.000). A strong correlation between bile leakage and OSSIs was found. Although OSSIs (Odds ratio 31.200, P = 0.009) were the significant predictive factors for developing ISSIs in OALRs, no risk factors predicting ISSIs were found in LALRs using Multivariate logistic regression analyses. Conclusion: Although this is a limited study at a single institution, minimally invasive anatomical hepatectomy can reduce ISSIs.