Protective Effect of Minimally Invasive Approach on Postoperative Peak Transaminase Following Liver Resection: A Single-Center Propensity Score-Based Analysis.

Simple Summary: The degree of liver damage after liver resection is generally assessed by serum ALT levels. Postoperative ALT levels may have a multifactorial cause correlated with the extent of resection, duration of surgery and of vascular clamping. Extensive and prolonged manipulation of the liver during open hepatectomy could also be correlated with hepatocyte injury. The aim of our study was to assess if a minimally invasive approach for liver resection, with less manipulation of the liver, may be associated with less transient hepatic damage and with consequent lower postoperative ALT levels than those detected after open hepatectomy. The results showed that liver resections performed using a minimally invasive approach were associated with significantly lower postoperative ALT values when compared with those performed by open approach. Moreover, the duration of hepatic pedicle clamping and multiple liver resections were independent predictors for high postoperative peak ALT levels on POD 1 and the minimally invasive approach showed a protective effect. Background: Postoperative serum ALT levels are one of the most frequently used marker to detect liver tissue damage following liver resection. The aim of this study was to evaluate if minimally invasive liver surgery (MILS) may result in less hepatic injury than open hepatectomy by assessing the differences of postoperative ALT levels. Methods: Patients who underwent MILS between 2009 and 2019 at our unit were included and compared with open liver resections. Median ALT levels was measured on postoperative day (POD) 1, 3 and 5. Postoperative peak transaminase (PPT) of ALT was determined on POD 1. The stabilized inverse probability treatment weighing (SIPTW) process was used to balance the two groups. A multivariable logistic regression analysis was used to analyze factors associated with high PPT. Results: After SIPTW, 292 MILS were compared with 159 open resections. Median ALT levels on POD 1, 3 and 5 were significantly higher in the open group than in the MILS group (301 vs. 187, p = 0.002; 180 vs. 121, p < 0.0001; 104 vs. 60, p < 0.0001; respectively). At the multivariable logistic regression analysis, MILS showed a protective effect for high PPT. Conclusions: MILS was associated with significantly lower postoperative ALT levels compared with open liver resections. MILS showed a protective effect for high PPT. [ABSTRACT FROM AUTHOR]