Impact of tumor size on the difficulty of laparoscopic left lateral sectionectomies.
Aizza, Giada Russolillo, Nadia Ferrero, Alessandro Syn, Nicholas L Cipriani, Federica Aghayan, Davit L Marino, Marco V Memeo, Riccardo Mazzaferro, Vincenzo Chiow, Adrian K H
Aizza, Giada
Russolillo, Nadia
Ferrero, Alessandro
Syn, Nicholas L
Cipriani, Federica
Aghayan, Davit L
Marino, Marco V
Memeo, Riccardo
Mazzaferro, Vincenzo
Chiow, Adrian K H
Citations
Altmetric:
Affiliation
Other Contributors
Publication date
2022-12-05
Collections
Research Projects
Organizational Units
Journal Issue
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.
Citation
Aizza G, Russolillo N, Ferrero A, Syn NL, Cipriani F, Aghayan D, Marino MV, Memeo R, Mazzaferro V, Chiow AKH, Sucandy I, Ivanecz A, Vivarelli M, Di Benedetto F, Choi SH, Lee JH, Park JO, Gastaca M, Fondevila C, Efanov M, Rotellar F, Choi GH, Robles-Campos R, Wang X, Sutcliffe RP, Pratschke J, Tang CN, Chong CC, D'Hondt M, Yong CC, Ruzzenente A, Herman P, Kingham TP, Scatton O, Liu R, Levi Sandri GB, Soubrane O, Mejia A, Lopez-Ben S, Monden K, Wakabayashi G, Cherqui D, Troisi RI, Yin M, Giuliante F, Geller D, Sugioka A, Edwin B, Cheung TT, Long TCD, Hilal MA, Fuks D, Chen KH, Aldrighetti L, Han HS, Goh BKP; International Robotic and Laparoscopic Liver Resection study group investigators. Impact of tumor size on the difficulty of laparoscopic left lateral sectionectomies. J Hepatobiliary Pancreat Sci. 2023 May;30(5):558-569. doi: 10.1002/jhbp.1279. Epub 2022 Dec 5.
Type
Article