Impact of tumor size on the difficulty of laparoscopic major hepatectomies: an international multicenter study
Author
Kato, YutaroSugioka, Atsushi
Kojima, Masayuki
Syn, Nicholas L
Zhongkai, Wang
Liu, Rong
Cipriani, Federica
Armstrong, Thomas
Aghayan, Davit L
Siow, Tiing-Foong
Lim, Chetana
Scatton, Olivier
Herman, Paulo
Coelho, Fabricio Ferreira
Marino, Marco V
Mazzaferro, Vincenzo
Chiow, Adrian K H
Sucandy, Iswanto
Ivanecz, Arpad
Choi, Sung Hoon
Lee, Jae Hoon
Gastaca, Mikel
Vivarelli, Marco
Giuliante, Felice
Dalla Valle, Bernardo
Ruzzenente, Andrea
Yong, Chee-Chien
Fondevila, Constantino
Efanov, Mikhail
Di Benedetto, Fabrizio
Belli, Andrea
Park, James O
Rotellar, Fernando
Choi, Gi-Hong
Robles-Campos, Ricardo
Wang, Xiaoying
Sutcliffe, Robert P
Schmelzle, Moritz
Pratschke, Johann
Lai, Eric C H
Chong, Charing C N
D'Hondt, Mathieu
Monden, Kazuteru
Lopez-Ben, Santiago
Kingham, T Peter
Forchino, Fabio
Ferrero, Alessandro
Ettorre, Giuseppe Maria
Levi Sandri, Giovanni Battista
Pascual, Franco
Cherqui, Daniel
Soubrane, Olivier
Wakabayashi, Go
Troisi, Roberto I
Cheung, Tan-To
Chen, Zewei
Yin, Mengqiu
D'Silva, Mizelle
Han, Ho-Seong
Nghia, Phan Phuoc
Long, Tran Cong Duy
Edwin, Bjørn
Fuks, David
Chen, Kuo-Hsin
Abu Hilal, Mohammad
Aldrighetti, Luca
Goh, Brian K P
Publication date
2023-07-28Subject
Surgery
Metadata
Show full item recordAbstract
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.Citation
Kato Y, Sugioka A, Kojima M, Syn NL, Zhongkai W, Liu R, Cipriani F, Armstrong T, Aghayan DL, Siow TF, Lim C, Scatton O, Herman P, Coelho FF, Marino MV, Mazzaferro V, Chiow AKH, Sucandy I, Ivanecz A, Choi SH, Lee JH, Gastaca M, Vivarelli M, Giuliante F, Dalla Valle B, Ruzzenente A, Yong CC, Fondevila C, Efanov M, Di Benedetto F, Belli A, Park JO, Rotellar F, Choi GH, Robles-Campos R, Wang X, Sutcliffe RP, Schmelzle M, Pratschke J, Lai ECH, Chong CCN, D'Hondt M, Monden K, Lopez-Ben S, Kingham TP, Forchino F, Ferrero A, Ettorre GM, Levi Sandri GB, Pascual F, Cherqui D, Soubrane O, Wakabayashi G, Troisi RI, Cheung TT, Chen Z, Yin M, D'Silva M, Han HS, Nghia PP, Long TCD, Edwin B, Fuks D, Chen KH, Abu Hilal M, Aldrighetti L, Goh BKP; International Robotic and Laparoscopic Liver Resection Study Group Investigators. Impact of Tumor Size on the Difficulty of Laparoscopic Major Hepatectomies: An International Multicenter Study. Ann Surg Oncol. 2023 Jul 28. doi: 10.1245/s10434-023-13863-z. Epub ahead of print. PMID: 37505351.Type
ArticlePMID
37505351Journal
Annals of Surgical OncologyPublisher
Springerae974a485f413a2113503eed53cd6c53
10.1245/s10434-023-13863-z