Does laparoscopic hepatectomy offer benefits for patients with COPD? A propensity score analysis

Background: To date, it remains unclear whether laparoscopic hepatectomy (LH) is safe and feasible for patients with chronic obstructive pulmonary disease (COPD). Thus, we compared the perioperative outcomes of LH versus open hepatectomy (OH) in this special cohort of patients. Methods: Between February 2014 and October 2020, 162 patients who underwent hepatectomy met the inclusion and exclusion criteria of this study. Perioperative data were compared between the two groups by propensity score matching (PSM) analysis. Results: After PSM, 55 patients with well-balanced baseline data were included in each group. Intra-operative blood loss, overall postoperative complications, and postoperative pulmonary complications (PPCs) were significantly lower in the LH group than in the OH group (P < 0.001, P = 0.047, and P = 0.020 after PSM, respectively). However, major complications, early readmission, and early mortality were comparable between the two groups. According to multivariate analysis, high stage of COPD, preop-erative tobacco use, and long operative time were independent risk factors for PPCs, whereas treatment with LH was a protective factor. Conclusion: LH is safe and feasible for selected patients with COPD when performed by experienced surgeons, and it has superior perioperative outcomes (especially regarding PPCs) when compared to OH.