BReLLS, Belgian Prospective Registry on consecutive laparoscopic and open liver surgery: Results of the first 18 months enrollment

Objectives. The BReLLS (Belgian Registry on Laparoscopic Liver Surgery) project is a prospective, non-compulsory, online registry of laparoscopic (LLS) and open (OLS) liver procedures, endorsed by the Belgian Section of Hepato-Biliary and Pancreatic Surgery in 2016. The primary aim is to monitor the evolution and spreading of LLS in Belgium. The secondary aim is to evaluate the cost/benefit ratio of LLS in order to allow appropriate reimbursement.
Methods. The BReLLS is accessible through a secured SSL server (www.brells.org). Participating centers prospectively record pre-operative, intra-operative and postoperative (90-day morbidity and follow-up) data of all consecutive LLS and OLS. Statistics are generated real-time and are available to each participating center. An audit is planned after the first 2-years of patients enrollment with early oncological follow-up.
Results. From February 2017 to October 2018, 12 centers have joint the BReLLS reporting data of 630 procedures (390 LLS and 240 OLS). Indication for LLS were colorectal metastases (46.4%), hepatocellular-carcinoma (17.2%), benign diseases (17%), other metastases (14.1%) and mixed various pathologies (5.3%). LLS encompassed major hepatectomies (16.5%), sectionectomies (14.1%), mono or bi-segmentectomies (20.3%) and sub-segmentectomies (49.1%). LLS were converted to OLS in 4.1% of cases. Overall morbidity was 9.7% for LLS and 29.7% for OLS (p=.0001). Major morbidity (Clavien-Dindo ≥ IIIb) occurred in 1.5% and 5.8% of LLS and OLS (p=.004). 90-days mortality following LLS was nihil vs 1.6% (n=4) for OLS (p=.027).
Conclusions. LLS are wide spreading in Belgium. In selected patients, LLS are safe, advantageous and reproducible in major HPB centers. A low morbidity has been prospectively confirmed. Further (ongoing) evaluation will focus on the selection criteria for patients undergoing LLS eventually defining the limits of the minimally invasive approach for malignant diseases.