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Multicenter Study
. 2023 Oct;49(10):106997.
doi: 10.1016/j.ejso.2023.106997. Epub 2023 Aug 6.

Impact of liver cirrhosis and portal hypertension on minimally invasive limited liver resection for primary liver malignancies in the posterosuperior segments: An international multicenter study

Chetana Lim  1 , Olivier Scatton  1 , Andrew G R Wu  2 , Wanguang Zhang  3 , Kiyoshi Hasegawa  4 , Federica Cipriani  5 , Jasper Sijberden  6 , Davit L Aghayan  7 , Tiing-Foong Siow  8 , Safi Dokmak  9 , Paulo Herman  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 Prieto  18 , Marco Vivarelli  19 , Felice Giuliante  20 , Andrea Ruzzenente  21 , Chee-Chien Yong  22 , Mengqiu Yin  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 , T Peter Kingham  48 , Alessandro Ferrero  49 , Giuseppe Maria Ettorre  50 , Daniel Cherqui  51 , Xiao Liang  52 , Olivier Soubrane  53 , Go Wakabayashi  54 , Roberto I Troisi  55 , Tan-To Cheung  56 , Atsushi Sugioka  57 , Ho-Seong Han  58 , Tran Cong Duy Long  59 , Rong Liu  60 , Bjørn Edwin  7 , David Fuks  53 , Kuo-Hsin Chen  61 , Mohammad Abu Hilal  62 , Luca Aldrighetti  5 , Brian K P Goh  63 ; International robotic and laparoscopic liver resection study group investigators
Collaborators, Affiliations
Multicenter Study

Impact of liver cirrhosis and portal hypertension on minimally invasive limited liver resection for primary liver malignancies in the posterosuperior segments: An international multicenter study

Chetana Lim et al. Eur J Surg Oncol. 2023 Oct.

Abstract

Introduction: To assess the impact of cirrhosis and portal hypertension (PHT) on technical difficulty and outcomes of minimally invasive liver resection (MILR) in the posterosuperior segments.

Methods: This is a post-hoc analysis of patients with primary malignancy who underwent laparoscopic and robotic wedge resection and segmentectomy in the posterosuperior segments between 2004 and 2019 in 60 centers. Surrogates of difficulty (i.e, open conversion rate, operation time, blood loss, blood transfusion, and use of the Pringle maneuver) and outcomes were compared before and after propensity-score matching (PSM) and coarsened exact matching (CEM).

Results: Of the 1954 patients studied, 1290 (66%) had cirrhosis. Among the cirrhotic patients, 310 (24%) had PHT. After PSM, patients with cirrhosis had higher intraoperative blood transfusion (14% vs. 9.3%; p = 0.027) and overall morbidity rates (20% vs. 14.5%; p = 0.023) than those without cirrhosis. After coarsened exact matching (CEM), patients with cirrhosis tended to have higher intraoperative blood transfusion rate (12.1% vs. 6.7%; p = 0.059) and have higher overall morbidity rate (22.8% vs. 12.5%; p = 0.007) than those without cirrhosis. After PSM, Pringle maneuver was more frequently applied in cirrhotic patients with PHT (62.2% vs. 52.4%; p = 0.045) than those without PHT.

Conclusion: MILR in the posterosuperior segments in cirrhotic patients is associated with higher intraoperative blood transfusion and postoperative morbidity. This parameter should be utilized in the difficulty assessment of MILR.

Keywords: Cirrhosis; Difficulty score; Laparoscopic liver; Minimally invasive liver; Posterosuperior segments.

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References

    1. Han HS, Shehta A, Ahn S, et al. Laparoscopic versus open liver resection for hepatocellular carcinoma: Case-matched study with propensity score matching. J Hepatol 2015; 63(3):643–50. - PubMed
    1. Ciria R, Gomez-Luque I, Ocana S, et al. A Systematic Review and Meta-Analysis Comparing the Short- and Long-Term Outcomes for Laparoscopic and Open Liver Resections for Hepatocellular Carcinoma: Updated Results from the European Guidelines Meeting on Laparoscopic Liver Surgery, Southampton, UK, 2017. Ann Surg Oncol 2018; 26(1):252–263. - PubMed
    1. Sposito C, Battiston C, Facciorusso A, et al. Propensity score analysis of outcomes following laparoscopic or open liver resection for hepatocellular carcinoma. Br J Surg 2016; 103(7):871–80. - PubMed
    1. Nomi T, Hirokawa F, Kaibori M, et al. Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: a multi-centre propensity score-based analysis. Surg Endosc 2019; 34(2):658–666. - PubMed
    1. Troisi RI, Berardi G, Morise Z, et al. Laparoscopic and open liver resection for hepatocellular carcinoma with Child-Pugh B cirrhosis: multicentre propensity score-matched study. Br J Surg 2021; 108(2):196–204. - PubMed

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