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Multicenter Study
. 2023 Sep;174(3):581-592.
doi: 10.1016/j.surg.2023.04.057. Epub 2023 Jun 9.

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

Fabricio Ferreira Coelho  1 , Paulo Herman  1 , Jaime A P Kruger  1 , Andrew G R Wu  2 , Ken-Min Chin  3 , Kiyoshi Hasegawa  4 , Wanguang Zhang  5 , Mohammad Alzoubi  6 , Davit L Aghayan  7 , Tiing-Foong Siow  8 , Olivier Scatton  9 , T Peter Kingham  10 , Marco V Marino  11 , Vincenzo Mazzaferro  12 , Adrian K H Chiow  13 , Iswanto Sucandy  14 , Arpad Ivanecz  15 , Sung Hoon Choi  16 , Jae Hoon Lee  17 , Mikel Gastaca  18 , Marco Vivarelli  19 , Felice Giuliante  20 , Andrea Ruzzenente  21 , Chee-Chien Yong  22 , Safi Dokmak  23 , Constantino Fondevila  24 , Mikhail Efanov  25 , Zenichi Morise  26 , Fabrizio Di Benedetto  27 , Raffaele Brustia  28 , Raffaele Dalla Valle  29 , Ugo Boggi  30 , David Geller  31 , Andrea Belli  32 , Riccardo Memeo  33 , Salvatore Gruttadauria  34 , Alejandro Mejia  35 , James O Park  36 , Fernando Rotellar  37 , Gi Hong Choi  38 , Ricardo Robles-Campos  39 , Xiaoying Wang  40 , Robert P Sutcliffe  41 , Johann Pratschke  42 , Eric C H Lai  43 , Charing C N Chong  44 , Mathieu D'Hondt  45 , Kazuteru Monden  46 , Santiago Lopez-Ben  47 , Rong Liu  48 , Alessandro Ferrero  49 , Giuseppe Maria Ettorre  50 , Federica Cipriani  51 , Daniel Cherqui  52 , Xiao Liang  53 , Olivier Soubrane  54 , Go Wakabayashi  55 , Roberto I Troisi  56 , Mengqiu Yin  57 , Tan-To Cheung  58 , Atsushi Sugioka  59 , Ho-Seong Han  60 , Tran Cong Duy Long  61 , David Fuks  54 , Mohammad Abu Hilal  62 , Kuo-Hsin Chen  8 , Luca Aldrighetti  51 , Bjørn Edwin  7 , Brian K P Goh  63 ; International Robotic and Laparoscopic Liver Resection study group investigators are coauthors of this study
Collaborators, Affiliations
Multicenter 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

Fabricio Ferreira Coelho et al. Surgery. 2023 Sep.

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.

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