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 / A. Ruzzenente, B.D. Valle, E. Poletto, N.L. Syn, T. Kabir, A. Sugioka, F. Cipriani, D. Cherqui, H.-. Han, T. Armstrong, T.C.D. Long, O. Scatton, P. Herman, J. Pratschke, D.L. Aghayan, R. Liu, M.V. Marino, A.K.H. Chiow, I. Sucandy, A. Ivanecz, M. Vivarelli, F. Dibenedetto, S.-. Choi, J.H. Lee, M. Prieto, C. Fondevila, M. Efanov, F. Rotellar, G.-. Choi, R. Robles-Campos, X. Wang, R.P. Sutcliffe, E.C.H. Lai, C.C. Chong, M. D'Hondt, C.C. Yong, R.I. Troisi, T.P. Kingham, A. Ferrero, G.B. Levisandri, O. Soubrane, M. Yin, S. Lopez-Ben, V. Mazzaferro, F. Giuliante, K. Monden, K. Mishima, G. Wakabayashi, T.-. Cheung, D. Fuks, M. Abuhilal, K.-. Chen, L. Aldrighetti, B. Edwin, B.K.P. Goh, M. Gastaca, H. Schotte, C. De Meyere, F. Krenzien, M. Schmelzle, K.-. Lee, D. Salimgereeva, R. Alikhanov, L.-. Lee, J.Y. Jang, Y. Kato, M. Kojima, A.A. Fretland, J. Ghotbi, F.F. Coelho, J.A.P. Kruger, V. Lopez-Lopez, P. Magistri, M.C.I. Robert, R. Montalti, M. Giglio, A. Mazzotta, B. Lee, M. D'Silva, H.-. Wang, M. Saleh, F. Pascual, P.P. Nghia, C. Lim, Q. Liu, P. Kadam, C.-. Tang, Z. Chen, S. Yu, U. Giustizieri, D. Citterio, F. Ardito, S. Vani, T.F. Siow, F. Mocchegianni, G.M. Ettorre, M. Colasanti. - In: JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES. - ISSN 1868-6974. - (2023). [Epub ahead of print] [10.1002/jhbp.1323]

Sub-classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes

V. Mazzaferro;
2023

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.
difficulty; laparoscopy; left hepatectomy; location; tumor size
Settore MED/18 - Chirurgia Generale
2023
5-mar-2023
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/988531
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