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Multicenter Study
. 2023 Sep;30(9):1098-1110.
doi: 10.1002/jhbp.1323. Epub 2023 Mar 29.

Sub-classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes

Andrea Ruzzenente  1 , Bernardo Dalla Valle  1 , Edoardo Poletto  1 , Nicholas L Syn  2 , Tousif Kabir  3 , Atsushi Sugioka  4 , Federica Cipriani  5 , Daniel Cherqui  6 , Ho-Seong Han  7 , Thomas Armstrong  8 , Tran Cong Duy Long  9 , Olivier Scatton  10 , Paolo Herman  11 , Johann Pratschke  12 , Davit L Aghayan  13 , Rong Liu  14 , Marco V Marino  15 , Adrian K H Chiow  16 , Iswanto Sucandy  17 , Arpad Ivanecz  18 , Marco Vivarelli  19 , Fabrizio Di Benedetto  20 , Sung-Hoon Choi  21 , Jae Hoon Lee  22 , Mikel Prieto  23 , Constantino Fondevila  24   25 , Mikhail Efanov  26 , Fernando Rotellar  27 , Gi-Hong Choi  28 , Ricardo Robles-Campos  29 , Xiaoying Wang  30 , Robert P Sutcliffe  31 , Eric C H Lai  32 , Charing C Chong  33 , Mathieu D'Hondt  34 , Chee Chien Yong  35 , Roberto I Troisi  36 , T Peter Kingham  37 , Alessandro Ferrero  38 , Giovanni Battista Levi Sandri  39 , Olivier Soubrane  40 , Mengqiu Yin  41 , Santiago Lopez-Ben  42 , Vincenzo Mazzaferro  43 , Felice Giuliante  44 , Kazateru Monden  45 , Kohei Mishima  46 , Go Wakabayashi  46 , Tan-To Cheung  47 , David Fuks  40 , Mohammad Abu Hilal  48 , Kuo-Hsin Chen  49 , Luca Aldrighetti  5 , Bjorn Edwin  13 , Brian K P Goh  50 ; International robotic and laparoscopic liver resection study group investigators are co-authors of this study
Collaborators, Affiliations
Multicenter Study

Sub-classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes

Andrea Ruzzenente et al. J Hepatobiliary Pancreat Sci. 2023 Sep.

Abstract

Background: The aim of this multicentric study was to investigate the impact of tumor location and size on the difficulty of Laparoscopic-Left Hepatectomy (L-LH).

Methods: Patients who underwent L-LH performed across 46 centers from 2004 to 2020 were analyzed. Of 1236 L-LH, 770 patients met the study criteria. Baseline clinical and surgical characteristics with a potential impact on LLR were included in a multi-label conditional interference tree. Tumor size cut-off was algorithmically determined.

Results: Patients were stratified into 3 groups based on tumor location and dimension: 457 in antero-lateral location (Group 1), 144 in postero-superior segment (4a) with tumor size ≤40 mm (Group 2), and 169 in postero-superior segment (4a) with tumor size >40 mm (Group 3). Patients in the Group 3 had higher conversion rate (7.0% vs. 7.6% vs. 13.0%, p-value .048), longer operating time (median, 240 min vs. 285 min vs. 286 min, p-value <.001), greater blood loss (median, 150 mL vs. 200 mL vs. 250 mL, p-value <.001) and higher intraoperative blood transfusion rate (5.7% vs. 5.6% vs. 11.3%, p-value .039). Pringle's maneuver was also utilized more frequently in Group 3 (66.7%), compared to Group 1 (53.2%) and Group 2 (51.8%) (p = .006). There were no significant differences in postoperative stay, major morbidity, and mortality between the three groups.

Conclusion: L-LH for tumors that are >40 mm in diameter and located in PS Segment 4a are associated with the highest degree of technical difficulty. However, post-operative outcomes were not different from L-LH of smaller tumors located in PS segments, or tumors located in the antero-lateral segments.

Keywords: difficulty; laparoscopy; left hepatectomy; location; tumor size.

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Conflict of interest statement

Conflicts of interest

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

ii) Dr Marino MV is a consultant for CAVA robotics LLC.

iii) 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 and Promedicis.

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

v) Asmund Fretland reports receiving speaker fees from Bayer.

vi) 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.
Multi-label Conditional Inference Tree Depicting Hierarchic Interaction of Tumor Size and Location in Determining Surgical Outcomes
Figure 2:
Figure 2:
Cutoff analysis for anterolateral tumors. The impact of tumor size cutoffs on surgical outcomes was systematically investigated by iteratively dichotomizing the tumor size at each 10mm-interval and computing treatment effect sizes local to that cutoff.
See this image and copyright information in PMC

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