Impact of Tumor Size on the Difficulty of Laparoscopic Major Hepatectomies: An International Multicenter Study.
Kato, Yutaro Sugioka, Atsushi Kojima, Masayuki Syn, Nicholas L Zhongkai, Wang Liu, Rong Cipriani, Federica Armstrong, Thomas Aghayan, Davit L Siow, Tiing-Foong
Kato, Yutaro
Sugioka, Atsushi
Kojima, Masayuki
Syn, Nicholas L
Zhongkai, Wang
Liu, Rong
Cipriani, Federica
Armstrong, Thomas
Aghayan, Davit L
Siow, Tiing-Foong
Citations
Altmetric:
Affiliation
Other Contributors
Publication date
2023-10-30
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
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.
Keywords: Difficulty; Laparoscopic liver resection; Major hepatectomy; Minimally invasive liver; Size.
Citation
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., … International Robotic and Laparoscopic Liver Resection Study Group Investigators (2023). Impact of Tumor Size on the Difficulty of Laparoscopic Major Hepatectomies: An International Multicenter Study. Annals of surgical oncology, 30(11), 6628–6636. https://doi.org/10.1245/s10434-023-13863-z
Type
Article