Background: The aim of this multicentric study was to investigate the impact of tumor location and size on the difficulty of Laparoscopic-Left Hepatectomy (L-LH). Methods: Patients who underwent L-LH performed across 46 centers from 2004 to 2020 were analyzed. Of 1236 L-LH, 770 patients met the study criteria. Baseline clinical and surgical characteristics with a potential impact on LLR were included in a multi-label conditional interference tree. Tumor size cut-off was algorithmically determined. Results: Patients were stratified into 3 groups based on tumor location and dimension: 457 in antero-lateral location (Group 1), 144 in postero-superior segment (4a) with tumor size ≤40 mm (Group 2), and 169 in postero-superior segment (4a) with tumor size >40 mm (Group 3). Patients in the Group 3 had higher conversion rate (7.0% vs. 7.6% vs. 13.0%, p-value.048), longer operating time (median, 240 min vs. 285 min vs. 286 min, p-value <.001), greater blood loss (median, 150 mL vs. 200 mL vs. 250 mL, p-value <.001) and higher intraoperative blood transfusion rate (5.7% vs. 5.6% vs. 11.3%, p-value.039). Pringle's maneuver was also utilized more frequently in Group 3 (66.7%), compared to Group 1 (53.2%) and Group 2 (51.8%) (p =.006). There were no significant differences in postoperative stay, major morbidity, and mortality between the three groups. Conclusion: L-LH for tumors that are >40 mm in diameter and located in PS Segment 4a are associated with the highest degree of technical difficulty. However, post-operative outcomes were not different from L-LH of smaller tumors located in PS segments, or tumors located in the antero-lateral segments.
Sub-classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes / Ruzzenente, A.; Valle, B. D.; Poletto, E.; Syn, N. L.; Kabir, T.; Sugioka, A.; Cipriani, F.; Cherqui, D.; Han, H. -S.; Armstrong, T.; Long, T. C. D.; Scatton, O.; Herman, P.; Pratschke, J.; Aghayan, D. L.; Liu, R.; Marino, M. V.; Chiow, A. K. H.; Sucandy, I.; Ivanecz, A.; Vivarelli, M.; Dibenedetto, F.; Choi, S. -H.; Lee, J. H.; Prieto, M.; Fondevila, C.; Efanov, M.; Rotellar, F.; Choi, G. -H.; Robles-Campos, R.; Wang, X.; Sutcliffe, R. P.; Lai, E. C. H.; Chong, C. C.; D'Hondt, M.; Yong, C. C.; Troisi, R. I.; Kingham, T. P.; Ferrero, A.; Levisandri, G. B.; Soubrane, O.; Yin, M.; Lopez-Ben, S.; Mazzaferro, V.; Giuliante, F.; Monden, K.; Mishima, K.; Wakabayashi, G.; Cheung, T. -T.; Fuks, D.; Abuhilal, M.; Chen, K. -H.; Aldrighetti, L.; Edwin, B.; Goh, B. K. P.. - In: JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES. - ISSN 1868-6974. - 30:9(2023), pp. 1098-1110. [10.1002/jhbp.1323]
Sub-classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes
Cipriani F.;Aldrighetti L.;
2023-01-01
Abstract
Background: The aim of this multicentric study was to investigate the impact of tumor location and size on the difficulty of Laparoscopic-Left Hepatectomy (L-LH). Methods: Patients who underwent L-LH performed across 46 centers from 2004 to 2020 were analyzed. Of 1236 L-LH, 770 patients met the study criteria. Baseline clinical and surgical characteristics with a potential impact on LLR were included in a multi-label conditional interference tree. Tumor size cut-off was algorithmically determined. Results: Patients were stratified into 3 groups based on tumor location and dimension: 457 in antero-lateral location (Group 1), 144 in postero-superior segment (4a) with tumor size ≤40 mm (Group 2), and 169 in postero-superior segment (4a) with tumor size >40 mm (Group 3). Patients in the Group 3 had higher conversion rate (7.0% vs. 7.6% vs. 13.0%, p-value.048), longer operating time (median, 240 min vs. 285 min vs. 286 min, p-value <.001), greater blood loss (median, 150 mL vs. 200 mL vs. 250 mL, p-value <.001) and higher intraoperative blood transfusion rate (5.7% vs. 5.6% vs. 11.3%, p-value.039). Pringle's maneuver was also utilized more frequently in Group 3 (66.7%), compared to Group 1 (53.2%) and Group 2 (51.8%) (p =.006). There were no significant differences in postoperative stay, major morbidity, and mortality between the three groups. Conclusion: L-LH for tumors that are >40 mm in diameter and located in PS Segment 4a are associated with the highest degree of technical difficulty. However, post-operative outcomes were not different from L-LH of smaller tumors located in PS segments, or tumors located in the antero-lateral segments.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
