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. 2022 Dec;36(12):9054-9063.
doi: 10.1007/s00464-022-09372-x. Epub 2022 Jul 13.

Resection type is a predictor of postoperative complications in laparoscopic partial liver resection

Akihiro Tanemura  1 , Shugo Mizuno  2 , Koki Maeda  2 , Toru Shinkai  2 , Takahiro Ito  2 , Aoi Hayasaki  2 , Kazuyuki Gyoten  2 , Takehiro Fujii  2 , Yusuke Iizawa  2 , Yasuhiro Murata  2 , Naohisa Kuriyama  2 , Masashi Kishiwada  2 , Hiroyuki Sakurai  2
Affiliations

Resection type is a predictor of postoperative complications in laparoscopic partial liver resection

Akihiro Tanemura et al. Surg Endosc. 2022 Dec.

Abstract

Background: Partial laparoscopic liver resection (LLR) is a procedure that can have varying levels of surgical difficulty depending on the tumor status and procedure. Therefore, we aimed to evaluate the surgical outcomes of partial LLR using a new resection classification system.

Methods: From January 2009 to May 2021, 156 patients underwent LLR; of them, 87 patients who underwent pure partial LLR were included in this study. They were classified according to the IWATE criteria as the low (n = 56) and intermediate (n = 31) difficulty groups and reclassified according to the resection type as the edge (ER, n = 45), bowl-shaped (BSR, n = 27), and dome-shaped resection (DSR, n = 15) groups. The following surgical outcomes were comparatively analyzed among the groups: intraoperative blood loss, the operation time, and complication rates. Preoperative risk factors for intraoperative blood transfusion and complications were evaluated.

Results: In the IWATE criteria-based analysis, the intermediate-difficulty group had significantly higher intraoperative blood loss (p = 0.005), operation time (p = 0.005), and Clavien-Dindo (CD) grade-based complication rates (CD grade 2 or higher, p = 0.03) than the low-difficulty group. When analyzing the resection type, the CD grade-based complication rate (p = 0.013) and surgical site infection (SSI, p = 0.005) were significantly higher and the postoperative hospitalization was significantly longer (p = 0.028) in the bowl-shaped resection (BSR) group than in the edge- (ER) and dome-shaped resection (DSR) groups. The tumor size (p = 0.011) and IWATE criteria score (p = 0.006) were independent risk factors for intraoperative blood transfusion in the multivariate analysis. The tumor depth (p = 0.011) and BSR (p = 0.002) were independent risk factors for complications of CD grade 2 or higher in the multivariate analysis. BSR was an independent risk factor for SSI in the multivariate analysis (p = 0.017).

Conclusions: Resection type could predict the rate of postoperative complications, while the IWATE criteria could predict the intraoperative surgical difficulty.

Keywords: Difficulty score; IWATE criteria; Laparoscopic liver resection; Partial liver resection; Resection type; Tumor depth.

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