Introduction: 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 0.048), longer operating time (median, 240 min vs. 285 min vs. 286min, p-value <0.001), greater blood loss (median, 150ml vs. 200ml vs. 250 ml, p-value <0.001) and higher intraoperative blood transfusion rate (5.7% vs. 5.6% vs. 11.3%, p-value 0.039). 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=0.006). There were no significant differences in postoperative stay, major morbidity, and mortality between the 3 groups. Conclusion: L-LH for tumors that are >40mm 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 tumours located in PS segments, or tumors located in the antero-lateral segments.
Sub-classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes / Ruzzenente, Andrea; Dalla Valle, Bernardo; Poletto, Edoardo; L Syn, Nicholas; Kabir, Tousif; Sugioka, Atsushi; Cipriani, Federica; Cherqui, Daniel; Han, Ho-Seong; Armstrong, Thomas; Cong Duy Long, Tran; Scatton, Olivier; Herman, Paolo; Pratschke, Johann; L Aghayan, Davit; Liu, Rong; V Marino, Marco; H Chiow, Adrian K; Sucandy, Iswanto; Ivanecz, Arpad; Vivarelli, Marco; DI BENEDETTO, Fabrizio; Choi, Sung-Hoon; Hoon Lee, Jae; Prieto, Mikel; Fondevila, Constantino; Efanov, Mikhail; Rotellar, Fernando; Choi, Gi-Hong; Robles-Campos, Ricardo; Wang, Xiaoying; P Sutcliffe, Robert; H Lai, Eric C; C Chong, Charing; D'Hondt, Mathieu; Chien Yong, Chee; I Troisi, Roberto; Peter Kingham, T; Ferrero, Alessandro; Battista Levi Sandri, Giovanni; Soubrane, Olivier; Yin, Mengqiu; Lopez-Ben, Santiago; Mazzaferro, Vincenzo; Giuliante, Felice; Monden, Kazateru; Mishima, Kohei; Wakabayashi, Go; Cheung, Tan-To; Fuks, David; Abu Hilal, Mohammad; Chen, Kuo-Hsin; Aldrighetti, Luca; Edwin, Bjorn; P Goh, Brian K; robotic and laparoscopic liver resection study group investigators are co-authors of this study, International. - In: JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES. - ISSN 1868-6974. - 30:9(2023), pp. 1098-1110. [10.1002/jhbp.1323]
Sub-classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes
Fabrizio Di Benedetto;
2023
Abstract
Introduction: 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 0.048), longer operating time (median, 240 min vs. 285 min vs. 286min, p-value <0.001), greater blood loss (median, 150ml vs. 200ml vs. 250 ml, p-value <0.001) and higher intraoperative blood transfusion rate (5.7% vs. 5.6% vs. 11.3%, p-value 0.039). 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=0.006). There were no significant differences in postoperative stay, major morbidity, and mortality between the 3 groups. Conclusion: L-LH for tumors that are >40mm 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 tumours located in PS segments, or tumors located in the antero-lateral segments.
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