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Multicenter Study
. 2024 Jan;50(1):107252.
doi: 10.1016/j.ejso.2023.107252. Epub 2023 Nov 8.

Impact of liver cirrhosis, severity of cirrhosis and portal hypertension on the difficulty of laparoscopic and robotic minor liver resections for primary liver malignancies in the anterolateral segments

Junhao Zheng  1 , Xiao Liang  2 , Andrew G R Wu  3 , Tousif Kabir  4 , Olivier Scatton  5 , Chetana Lim  5 , Kiyoshi Hasegawa  6 , Jasper P Sijberden  7 , Davit L Aghayan  8 , Tiing Foong Siow  9 , Safi Dokmak  10 , Paulo Herman  11 , Marco V Marino  12 , Vincenzo Mazzaferro  13 , Adrian K H Chiow  14 , Iswanto Sucandy  15 , Arpad Ivanecz  16 , Sung Hoon Choi  17 , Jae Hoon Lee  18 , Mikel Prieto  19 , Marco Vivarelli  20 , Felice Giuliante  21 , Andrea Ruzzenente  22 , Chee-Chien Yong  23 , Mengqiu Yin  24 , Zewei Chen  24 , Constantino Fondevila  25 , Mikhail Efanov  26 , Zenichi Morise  27 , Fabrizio Di Benedetto  28 , Raffaele Brustia  29 , Raffaele Dalla Valle  30 , Ugo Boggi  31 , David Geller  32 , Andrea Belli  33 , Riccardo Memeo  34 , Salvatore Gruttadauria  35 , Alejandro Mejia  36 , James O Park  37 , Fernando Rotellar  38 , Gi-Hong Choi  39 , Ricardo Robles-Campos  40 , Xiaoying Wang  41 , Robert P Sutcliffe  42 , Johann Pratschke  43 , Eric C H Lai  44 , Charing C N Chong  45 , Mathieu D'Hondt  46 , Kazuteru Monden  47 , Santiago Lopez-Ben  48 , T Peter Kingham  49 , Alessandro Ferrero  50 , Giuseppe Maria Ettorre  51 , Daniel Cherqui  52 , Federica Cipriani  53 , Olivier Soubrane  54 , Wanguang Zhang  55 , Go Wakabayashi  56 , Roberto I Troisi  57 , Tan-To Cheung  58 , Yutaro Kato  59 , Atsushi Sugioka  59 , Tran Cong Duy Long  60 , Rong Liu  61 , Bjørn Edwin  8 , David Fuks  54 , Mohammad Abu Hilal  62 , Kuo-Hsin Chen  9 , Luca Aldrighetti  53 , Ho-Seong Han  63 , Brian K P Goh  64 ; International robotic and laparoscopic liver resection study group investigators
Collaborators, Affiliations
Multicenter Study

Impact of liver cirrhosis, severity of cirrhosis and portal hypertension on the difficulty of laparoscopic and robotic minor liver resections for primary liver malignancies in the anterolateral segments

Junhao Zheng et al. Eur J Surg Oncol. 2024 Jan.

Abstract

Introduction: We performed this study in order to investigate the impact of liver cirrhosis (LC) on the difficulty of minimally invasive liver resection (MILR), focusing on minor resections in anterolateral (AL) segments for primary liver malignancies.

Methods: This was an international multicenter retrospective study of 3675 patients who underwent MILR across 60 centers from 2004 to 2021.

Results: 1312 (35.7%) patients had no cirrhosis, 2118 (57.9%) had Child A cirrhosis and 245 (6.7%) had Child B cirrhosis. After propensity score matching (PSM), patients in Child A cirrhosis group had higher rates of open conversion (p = 0.024), blood loss >500 mls (p = 0.001), blood transfusion (p < 0.001), postoperative morbidity (p = 0.004), and in-hospital mortality (p = 0.041). After coarsened exact matching (CEM), Child A cirrhotic patients had higher open conversion rate (p = 0.05), greater median blood loss (p = 0.014) and increased postoperative morbidity (p = 0.001). Compared to Child A cirrhosis, Child B cirrhosis group had longer postoperative stay (p = 0.001) and greater major morbidity (p = 0.012) after PSM, and higher blood transfusion rates (p = 0.002), longer postoperative stay (p < 0.001), and greater major morbidity (p = 0.006) after CEM. After PSM, patients with portal hypertension experienced higher rates of blood loss >500 mls (p = 0.003) and intraoperative blood transfusion (p = 0.025).

Conclusion: The presence and severity of LC affect and compound the difficulty of MILR for minor resections in the AL segments. These factors should be considered for inclusion into future difficulty scoring systems for MILR.

Keywords: Cirrhosis; Difficulty score; Laparoscopic hepatectomy; Laparoscopic liver; Minimally-invasive hepatectomy; Minimally-invasive liver.

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Conflict of interest statement

Declaration of competing interest

Figures

Figure 1.
Figure 1.
Selection of patients meeting study inclusion criteria.
See this image and copyright information in PMC

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