29 - MINIMALLY INVASIVE APPROACH MAY MITIGATE THE NEGATIVE IMPACT OF SMOKING IN PATIENTS UNDERGOING LIVER RESECTION HISTORY. ANALYSIS OF CLINICAL OUTCOMES FROM A TERTIARY HEPATOBILIARY CENTER

Objectives: The detrimental effects of tobacco use in patients after major open abdominal operations are well documented especially during the postoperative recovery period. Many surgeons even refuse to offer an operation to such patients. Published literature on the impact smoking has on robotic surgery, specifically in liver resection, is scarce. This study was undertaken to investigate whether tobacco use impacts the postoperative course of patients undergoing robotic hepatectomy.

Methods: We prospectively followed 353 patients that underwent robotic hepatectomy. 125 patients were classified as smokers and 228 patients were classified as nonsmokers. The hepatectomies were categorized into four levels of technical complexity (low, intermediate, advanced, or expert) using IWATE scores. Significance was assigned at a p-value≤0.05 and data are presented as median (mean±SD). Patients were then propensity-score matched based on patient preoperative variables and IWATE representing liver tumor characteristics.

Results: Prior to matching, differences were found in age, MELD score, and cirrhosis status between the two cohorts. Perioperative variables such as estimated blood loss, pulmonary complications (pneumonia and chronic obstructive pulmonary disease exacerbation), and length of stay were statistically different. The patients who smoked had higher respiratory complications (6% vs 1%; p=0.02) and longer hospital stay (4 (5±4.2) vs 4 (4±3.6) days; p=0.02).
After the propensity score matching, 71 patients were assigned to each cohort. The perioperative variables specifically postoperative complications, length of hospital stay, 30-day hospital readmissions, and mortality were similar (Table).

Conclusion: The minimally invasive robotic approach to liver resection appears to mitigate the adverse effects of smoking history in patients’ perioperative course. Future larger multi-institutional studies are needed.