Belgian prospective registry on laparoscopic liver surgery compared to open procedures: 3-year snapshot of multi centric activity

The Belgian Registry on Laparoscopic Liver Surgery is a prospective, non-compulsory, online registry of laparoscopic (LLS) and open (OLS) liver procedures, endorsed in 2016 by the Belgian Section of Hepato-Biliary and Pancreatic Surgery. The primary aim is to assess the evolution of laparoscopic liver surgery compared to the standard open approach in Belgium. Methods: Participating centers included, through a secured SSL server (www.brells.org), all consecutive liver surgeries from 2017 to 2019. Demographic, pre- intra- and postoperative data of all consecutive LLS and OLS were recorded. Results: In total 13 centers participated to the study. 1531 procedures were recorded (841 LLS and 690 OLS) in 1408 patients. Demographics of patients were similar between LLS and OLS. Indication for surgery were 57% liver metastases (49% LLS, 51% OLS), 29% primary liver tumors (57% LLS, 43% OLS) and 16% benign diseases (73%LLS, 27% OLS). Exclusive local thermal ablation (LA) accounted for 118 procedures. Excluding LA from analysis, rate of major hepatectomies was 18,2% (n=258) and median Ghent difficulty score was 5,6 (4,8 LLS vs 6,5 OLS). LLS were converted to OLS
in 3,3% of cases. Overall morbidity and mortality were significantly lower in LLS compared to OLS respectively 27% vs 53% and 0,6% vs 2,9%. Length of hospital stay was significantly shorter in LLS (Median 4 vs 7 days). Conclusions: LLS are wide spreading in Belgium accounting globally to 55% of all liver surgeries. In selected patients, LLS are safe, advantageous and reproducible in major HPB centers. A low morbidity has been prospectively confirmed.