The Minimally Invasive Approach Confers Improved Outcomes in Frail Cancer Patients Undergoing Hepatectomy: An ACS NSQIP Analysis.

BACKGROUND: Morbidity for liver resection has decreased and frail patients are undergoing surgery. The impact of the minimally invasive approach (MILR) is unknown. This study aims to evaluate the impact of approach on outcomes in frail patients.

METHODS: Elective hepatectomies from the 2014-2020 ACS-NSQIP Hepatectomy-specific PUF were reviewed. The five-factor modified frailty index (mFI-5) was used. It includes diabetes, hypertension, functional status, heart failure and dyspnea. Patients were considered frail if their mFI-5 was >2.

RESULTS: 3,116 patients were included: 2117 (67.9%) minor and 999 (32%) major. There were 2, 254 open cases and 862 MILR. Postoperatively (minor) MILR conferred lower risk of prolonged LOS, discharge not-to-home, transfusion, major complications, and minor complications (P<0.05). Postoperatively (major) MILR had lower incidence of prolonged LOS and any complication (P<0.05). In the minor group, MILR remained independently predictive of lower rates of prolonged LOS (OR: 0.34, 95% CI: 0.28-0.42), discharge not-to-home (0.58, 0.41-0.84), transfusion (0.72, 0.54-0.96), major complication (0.78, 0.62-1) and any complication (0.73, 0.58-0.92). In the major group, MILR remained independently predictive of prolonged LOS (0.60, 0.40-0.89).

CONCLUSION: MILR conferred lower rates of complications in minor as well as shorter LOS in major hepatectomy. The minimally invasive approach to hepatectomy may benefit frail cancer patients.