OBJECTIVES : Hepatocellular carcinoma (HCC) is a common indication for hepatectomy that is often complicated by postoperative complication. We sought to investigate the relationship between open with laparoscopic approach of hepatectomy and incidences of postoperative infectious complications.

METHODS : Using a multicenter database, HCC patients who underwent laparoscopic hepatectomy (LH) or open hepatectomy (OH) were reviewed and analyzed. Propensity score matching (PSM), inverse probability of treatment weight (IPTW), and multivariate logistic regression analyses were utilized to assess the association of operative approach with postoperative infectious complications including incisional surgical site infection (SSI), organ/space SSI, and remote infection (RI).

RESULTS : Among 3,876 patients, 845 (21.8%) and 3,031 (78.2%) patients underwent LH and OH, respectively. The overall incidence of infection was 6.9% versus 14.6% among patients who underwent LH versus OH, respectively (P<0.001). Of note, the incidences of incisional SSI (1.8% vs. 6.3%, P<0.001), organ/space SSI (1.8% vs. 4.6%, P<0.001), and RI (3.8% vs. 9.8%, P<0.001) were all significantly lower among patients who underwent LH versus OH. After PSM (6.9%, 1.8%, 1.8% and 3.8% vs. 18.5%, 8.4%, 5.2% and 12.8%, respectively) and IPTW (9.5%, 2.3%, 2.1% and 5.5% vs. 14.3%, 6.3%, 4.5% and 9.8%, respectively), LH remained associated with statistically lower incidences of all types of infectious complications. After adjustment for other confounding factors on multivariate analyses, LH remained independently associated with lower incidences of overall infection, incisional SSI, organ/space SSI, and RI in the overall, PSM, and IPTW cohorts, respectively.

CONCLUSION : Compared with open approach, laparoscopic approach was independently associated with lower incidences of postoperative infectious complications following hepatectomy for HCC.