Impact of tumor size on the difficulty of laparoscopic left lateral sectionectomies

Giada Arizza, Nadia Russolillo, Alessandro Ferrero, Nicholas L. Syn, Federica Cipriani, Davit Aghayan, Marco V. Marino, Riccardo Memeo, Vincenzo Mazzaferro, Adrian K. H. Chiow, Iswanto Sucandy, Arpad Ivanecz, Marco Vivarelli, Fabrizio Di Benedetto, Sung-Hoon Choi, Jae Hoon Lee, James O. Park, Mikel Gastaca, Constantino Fondevila, Mikhail EfanovFernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P. Sutcliffe, Johann Pratschke, Chung Ngai Tang, Charing C. Chong, Mathieu D'Hondt, Chee Chien Yong, Andrea Ruzzenente, Paolo Herman, T. Peter Kingham, Olivier Scatton, Rong Liu, Giovanni Battista Levi Sandri, Olivier Soubrane, Alejandro Mejia, Santiago Lopez-Ben, Kazateru Monden, Go Wakabayashi, Daniel Cherqui, Roberto I. Troisi, Mengqiu Yin, Felice Giuliante, David Geller, Atsushi Sugioka, Bjorn Edwin, Tan-To Cheung, Tran Cong Duy Long, Mohammad Abu Hilal, David Fuks, Kuo-Hsin Chen, Luca Aldrighetti, Ho-Seong Han, Brian K. P. Goh, Chung-Yip Chan, Mikel Prieto, Juul Meurs, Celine De Meyere, Felix Krenzien, Moritz Schmelzle, Kit-Fai Lee, Kelvin K. Ng, Diana Salimgereeva, Ruslan Alikhanov, Lip-Seng Lee, Jae Young Jang, Kevin P. Labadie, Yutaro Kato, Masayuki Kojima, Asmund Avdem Fretland, Jacob Ghotbi, Fabricio Ferreira Coelho, Jaime Arthur Pirola Kruger, Victor Lopez-Lopez, Paolo Magistri, Margarida Casellas I Robert, Kohei Mishima, Roberto Montalti, Mariano Giglio, Alessandro Mazzotta, Boram Lee, Mizelle D’Silva, Hao-Ping Wang, Mansour Saleh, Franco Pascual, Amal Suhool, Phan Phuoc Nghia, Chetana Lim, Qiu Liu, Prashant Kadam, Bernardo Dalla Valle, Eric C. Lai, Maria Conticchio, Ugo Giustizieri, Davide Citterio, Zewei Chen, Shian Yu, Francesco Ardito, Simone Vani, Epameinondas Dogeas, Tiing Foon Siow, Federico Mocchegianni, Giuseppe Maria Ettorre, Marco Colasanti, Yoelimar Guzmán

Risultato della ricerca: Contributo in rivistaArticolo in rivistapeer review

Abstract

Background: Tumor size (TS) represents a critical parameter in the risk assessment of laparoscopic liver resections (LLR). Moreover, TS has been rarely related to the extent of liver resection. The aim of this study was to study the relationship between tumor size and difficulty of laparoscopic left lateral sectionectomy (L-LLS). Methods: The impact of TS cutoffs was investigated by stratifying tumor size at each 10 mm-interval. The optimal cutoffs were chosen taking into consideration the number of endpoints which show a statistically significant split around the cut-points of interest and the magnitude of relative risk after correction for multiple risk factors. Results: A total of 1910 L-LLS were included. Overall, open conversion and intraoperative blood transfusion were 3.1 and 3.3%, respectively. The major morbidity rate was 2.7% and 90-days mortality 0.6%. Three optimal TS cutoffs were identified: 40-, 70-, and 100-mm. All the selected cutoffs showed a significant discriminative power for the prediction of open conversion, operative time, blood transfusion and need of Pringle maneuver. Moreover, 70- and 100-mm cutoffs were both discriminative for estimated blood loss and major complications. A stepwise increase in rates of open conversion rate (Z = 3.90, P <.001), operative time (Z = 3.84, P <.001), blood loss (Z = 6.50, P <.001), intraoperative blood transfusion rate (Z = 5.15, P <.001), Pringle maneuver use (Z = 6.48, P <.001), major morbidity(Z = 2.17, P =.030) and 30-days readmission (Z = 1.99, P =.047) was registered as the size increased. Conclusion: L-LLS for tumors of increasing size was associated with poorer intraoperative and early postoperative outcomes suggesting increasing difficulty of the procedure. We determined three optimal TS cutoffs (40-, 70- and 100-mm) to accurately stratify surgical difficulty after L-LLS.
Lingua originaleEnglish
pagine (da-a)N/A-N/A
RivistaJournal of Hepato-Biliary-Pancreatic Sciences
Volume2023
DOI
Stato di pubblicazionePubblicato - 2022

Keywords

  • difficulty
  • laparoscopic hepatectomy
  • size
  • left lateral sectionectomy
  • laparoscopic liver

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