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. 2023 May;30(5):558-569.
doi: 10.1002/jhbp.1279. Epub 2022 Dec 5.

Impact of tumor size on the difficulty of laparoscopic left lateral sectionectomies

Giada Aizza  1 , Nadia Russolillo  1 , Alessandro Ferrero  1 , Nicholas L Syn  2 , Federica Cipriani  3 , Davit Aghayan  4 , Marco V Marino  5   6 , Riccardo Memeo  7 , Vincenzo Mazzaferro  8 , Adrian K H Chiow  9 , Iswanto Sucandy  10 , Arpad Ivanecz  11 , Marco Vivarelli  12 , Fabrizio Di Benedetto  13 , Sung-Hoon Choi  14 , Jae Hoon Lee  15 , James O Park  16 , Mikel Gastaca  17 , Constantino Fondevila  18 , Mikhail Efanov  19 , Fernando Rotellar  20   21 , Gi-Hong Choi  22 , Ricardo Robles-Campos  23 , Xiaoying Wang  24 , Robert P Sutcliffe  25 , Johann Pratschke  26 , Chung Ngai Tang  27 , Charing C Chong  28 , Mathieu D'Hondt  29 , Chee Chien Yong  30 , Andrea Ruzzenente  31 , Paolo Herman  32 , T Peter Kingham  33 , Olivier Scatton  34 , Rong Liu  35 , Giovanni Battista Levi Sandri  36 , Olivier Soubrane  37 , Alejandro Mejia  38 , Santiago Lopez-Ben  39 , Kazateru Monden  40 , Go Wakabayashi  41 , Daniel Cherqui  42 , Roberto I Troisi  43 , Mengqiu Yin  44 , Felice Giuliante  45 , David Geller  46 , Atsushi Sugioka  47 , Bjorn Edwin  4 , Tan-To Cheung  48 , Tran Cong Duy Long  49 , Mohammad Abu Hilal  50   51 , David Fuks  37 , Kuo-Hsin Chen  52 , Luca Aldrighetti  3 , Ho-Seong Han  53 , Brian K P Goh  54   55   56 ; International Robotic and Laparoscopic Liver Resection study group investigators
Collaborators, Affiliations

Impact of tumor size on the difficulty of laparoscopic left lateral sectionectomies

Giada Aizza et al. J Hepatobiliary Pancreat Sci. 2023 May.

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.

Keywords: difficulty; laparoscopic hepatectomy; laparoscopic liver; left lateral sectionectomy; size.

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Conflict of interest statement

  1. Dr Goh BK has received travel grants and honorarium from Johnson and Johnson, Olympus and Transmedic the local distributor for the Da Vinci Robot.

  2. Dr Marino MV is a consultant for CAVA robotics LLC.

  3. Johann Pratschke reports a research grant from Intuitive Surgical Deutschland GmbH and personal fees or non-financial support from Johnson & Johnson, Medtronic, AFS Medical, Astellas, CHG Meridian, Chiesi, Falk Foundation, La Fource Group, Merck, Neovii, NOGGO, pharma- consult Peterson, and Promedicis.

  4. Moritz Schmelzle reports personal fees or other support outside of the submitted work from Merck, Bayer, ERBE, Amgen, Johnson & Johnson, Takeda, Olympus, Medtronic, Intuitive.

  5. Asmund Fretland reports receiving speaker fees from Bayer.

  6. Fernando Rotellar reports speaker fees and support outside the submitted work from Integra, Medtronic, Olympus, Corza, Sirtex and Johnson & Johnson.

Figures

Figure 1.
Figure 1.
Cutoff analysis
See this image and copyright information in PMC

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