Impact of liver cirrhosis, the severity of cirrhosis, and portal hypertension on the outcomes of minimally invasive left lateral sectionectomies for primary liver malignancies.

Coelho, Fabricio Ferreira; Herman, Paulo; Chin, Ken-Min; Hasegawa, Kiyoshi; Zhang, Wanguang; Alzoubi, Mohammed; Siow, Tiing-Foong; Scatton, Olivier; Mazzaferro, Vincenzo; Sucandy, Iswanto; Ivanecz, Arpad; Choi, Sung Hoon; Lee, Jae Hoon; Gastaca, Mikel; Vivarelli, Marco; Giuliante, Felice; Ruzzenente, Andrea; Yong, Chee-Chien; Dokmak, Safi; Fondevila, Constantino; Efanov, Mikhail; Morise, Zenichi; Di Benedetto, Fabrizio; Brustia, Raffaele; Valle, Raffaele Dalla; Boggi, Ugo; Geller, David; Belli, Andrea; Memeo, Riccardo; Gruttadauria, Salvatore; Mejia, Alejandro; Rotellar, Fernando; Choi, Gi Hong; Robles-Campos, Ricardo; Wang, Xiaoying; Pratschke, Johann; D'Hondt, Mathieu; Monden, Kazuteru; Lopez-Ben, Santiago; Liu, Rong; Ferrero, Alessandro; Ettorre, Giuseppe Maria; Cipriani, Federica; Cherqui, Daniel; Liang, Xiao; Soubrane, Olivier; Wakabayashi, Go; Yin, Mengqiu; Cheung, Tan-To; Sugioka, Atsushi; Han, Ho-Seong; Long, Tran Cong Duy; Fuks, David; Abu Hilal, Mohammad; Chen, Kuo-Hsin; Aldrighetti, Luca; Edwin, Bjørn; Kruger, Jaime A. P.; Wu, Andrew G. R.; Aghayan, Davit L.; Kingham, T. Peter; Marino, Marco V.; Chiow, Adrian K. H.; Park, James O.; Lai, Eric C. H.; Chong, Charing C. N.; Troisi, Roberto I.; Goh, Brian K. P.

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Coelho, Fabricio Ferreira
Herman, Paulo
Chin, Ken-Min
Hasegawa, Kiyoshi
Zhang, Wanguang
Alzoubi, Mohammed
Siow, Tiing-Foong
Scatton, Olivier
Mazzaferro, Vincenzo
Sucandy, Iswanto

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Publication date

2023-06-08

Subject

Gastroenterology

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Abstract

Background: The impact of cirrhosis and portal hypertension on perioperative outcomes of minimally invasive left lateral sectionectomies remains unclear. We aimed to compare the perioperative outcomes between patients with preserved and compromised liver function (noncirrhotics versus Child-Pugh A) when undergoing minimally invasive left lateral sectionectomies. In addition, we aimed to determine if the extent of cirrhosis (Child-Pugh A versus B) and the presence of portal hypertension had a significant impact on perioperative outcomes. Methods: This was an international multicenter retrospective analysis of 1,526 patients who underwent minimally invasive left lateral sectionectomies for primary liver malignancies at 60 centers worldwide between 2004 and 2021. In the study, 1,370 patients met the inclusion criteria and formed the final study group. Baseline clinicopathological characteristics and perioperative outcomes of these patients were compared. To minimize confounding factors, 1:1 propensity score matching and coarsened exact matching were performed. Results: The study group comprised 559, 753, and 58 patients who did not have cirrhosis, Child-Pugh A, and Child-Pugh B cirrhosis, respectively. Six-hundred and thirty patients with cirrhosis had portal hypertension, and 170 did not. After propensity score matching and coarsened exact matching, Child-Pugh A patients with cirrhosis undergoing minimally invasive left lateral sectionectomies had longer operative time, higher intraoperative blood loss, higher transfusion rate, and longer hospital stay than patients without cirrhosis. The extent of cirrhosis did not significantly impact perioperative outcomes except for a longer duration of hospital stay. Conclusion: Liver cirrhosis adversely affected the intraoperative technical difficulty and perioperative outcomes of minimally invasive left lateral sectionectomies.

Citation

Coelho FF, Herman P, Kruger JAP, Wu AGR, Chin KM, Hasegawa K, Zhang W, Alzoubi M, Aghayan DL, Siow TF, Scatton O, Kingham TP, Marino MV, Mazzaferro V, Chiow AKH, Sucandy I, Ivanecz A, Choi SH, Lee JH, Gastaca M, Vivarelli M, Giuliante F, Ruzzenente A, Yong CC, Dokmak S, Fondevila C, Efanov M, Morise Z, Di Benedetto F, Brustia R, Valle RD, Boggi U, Geller D, Belli A, Memeo R, Gruttadauria S, Mejia A, Park JO, Rotellar F, Choi GH, Robles-Campos R, Wang X, Sutcliffe RP, Pratschke J, Lai ECH, Chong CCN, D'Hondt M, Monden K, Lopez-Ben S, Liu R, Ferrero A, Ettorre GM, Cipriani F, Cherqui D, Liang X, Soubrane O, Wakabayashi G, Troisi RI, Yin M, Cheung TT, Sugioka A, Han HS, Long TCD, Fuks D, Abu Hilal M, Chen KH, Aldrighetti L, Edwin B, Goh BKP; International Robotic and Laparoscopic Liver Resection study group investigators are coauthors of this study. Impact of liver cirrhosis, the severity of cirrhosis, and portal hypertension on the outcomes of minimally invasive left lateral sectionectomies for primary liver malignancies. Surgery. 2023 Jun 8:S0039-6060(23)00263-5. doi: 10.1016/j.surg.2023.04.057. Epub ahead of print. PMID: 37301612.

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Article