Introduction: Although tumor size (TS) is known to affect surgical outcomes in laparoscopic liver resection (LLR), its impact on laparoscopic major hepatectomy (L-MH) is not well studied. The objectives of this study were to investigate the impact of TS on the perioperative outcomes of L-MH and to elucidate the optimal TS cutoff for stratifying the difficulty of L-MH. Methods: This was a post-hoc analysis of 3008 patients who underwent L-MH at 48 international centers. A total 1396 patients met study criteria and were included. The impact of TS cutoffs was investigated by stratifying TS at each 10-mm interval. The optimal cutoffs were determined taking into consideration the number of endpoints which showed a statistically significant split around the cut-points of interest and the magnitude of relative risk after correction for multiple risk factors. Results: We identified 2 optimal TS cutoffs, 50 mm and 100 mm, which segregated L-MH into 3 groups. An increasing TS across these 3 groups (≤ 50 mm, 51–100 mm, > 100 mm), was significantly associated with a higher open conversion rate (11.2%, 14.7%, 23.0%, P < 0.001), longer operating time (median, 340 min, 346 min, 365 min, P = 0.025), increased blood loss (median, 300 ml, ml, 400 ml, P = 0.002) and higher rate of intraoperative blood transfusion (13.1%, 15.9%, 27.6%, P < 0.001). Postoperative outcomes such as overall morbidity, major morbidity, and length of stay were comparable across the three groups. Conclusion: Increasing TS was associated with poorer intraoperative but not postoperative outcomes after L-MH. We determined 2 TS cutoffs (50 mm and 10 mm) which could optimally stratify the surgical difficulty of L-MH.
Impact of Tumor Size on the Difficulty of Laparoscopic Major Hepatectomies: An International Multicenter Study / Kato, Y.; Sugioka, A.; Kojima, M.; Syn, N. L.; Zhongkai, W.; Liu, R.; Cipriani, F.; Armstrong, T.; Aghayan, D. L.; Siow, T. -F.; Lim, C.; Scatton, O.; Herman, P.; Coelho, F. F.; Marino, M. V.; Mazzaferro, V.; Chiow, A. K. H.; Sucandy, I.; Ivanecz, A.; Choi, S. H.; Lee, J. H.; Gastaca, M.; Vivarelli, M.; Giuliante, F.; Dalla Valle, B.; Ruzzenente, A.; Yong, C. -C.; Fondevila, C.; Efanov, M.; Di Benedetto, F.; Belli, A.; Park, J. O.; Rotellar, F.; Choi, G. -H.; Robles-Campos, R.; Wang, X.; Sutcliffe, R. P.; Schmelzle, M.; Pratschke, J.; Lai, E. C. H.; Chong, C. C. N.; D'Hondt, M.; Monden, K.; Lopez-Ben, S.; Kingham, T. P.; Forchino, F.; Ferrero, A.; Ettorre, G. M.; Levi Sandri, G. B.; Pascual, F.; Cherqui, D.; Soubrane, O.; Wakabayashi, G.; Troisi, R. I.; Cheung, T. -T.; Chen, Z.; Yin, M.; D'Silva, M.; Han, H. -S.; Nghia, P. P.; Long, T. C.; Edwin, B.; Fuks, D.; Chen, K. -H.; Abu Hilal, M.; Aldrighetti, L.; Goh, B. K. P.. - In: ANNALS OF SURGICAL ONCOLOGY. - ISSN 1068-9265. - 30:11(2023), pp. 6628-6636. [10.1245/s10434-023-13863-z]
Impact of Tumor Size on the Difficulty of Laparoscopic Major Hepatectomies: An International Multicenter Study
Cipriani F.;Belli A.;Aldrighetti L.;
2023-01-01
Abstract
Introduction: Although tumor size (TS) is known to affect surgical outcomes in laparoscopic liver resection (LLR), its impact on laparoscopic major hepatectomy (L-MH) is not well studied. The objectives of this study were to investigate the impact of TS on the perioperative outcomes of L-MH and to elucidate the optimal TS cutoff for stratifying the difficulty of L-MH. Methods: This was a post-hoc analysis of 3008 patients who underwent L-MH at 48 international centers. A total 1396 patients met study criteria and were included. The impact of TS cutoffs was investigated by stratifying TS at each 10-mm interval. The optimal cutoffs were determined taking into consideration the number of endpoints which showed a statistically significant split around the cut-points of interest and the magnitude of relative risk after correction for multiple risk factors. Results: We identified 2 optimal TS cutoffs, 50 mm and 100 mm, which segregated L-MH into 3 groups. An increasing TS across these 3 groups (≤ 50 mm, 51–100 mm, > 100 mm), was significantly associated with a higher open conversion rate (11.2%, 14.7%, 23.0%, P < 0.001), longer operating time (median, 340 min, 346 min, 365 min, P = 0.025), increased blood loss (median, 300 ml, ml, 400 ml, P = 0.002) and higher rate of intraoperative blood transfusion (13.1%, 15.9%, 27.6%, P < 0.001). Postoperative outcomes such as overall morbidity, major morbidity, and length of stay were comparable across the three groups. Conclusion: Increasing TS was associated with poorer intraoperative but not postoperative outcomes after L-MH. We determined 2 TS cutoffs (50 mm and 10 mm) which could optimally stratify the surgical difficulty of L-MH.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
