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 Journal Article
| Authors: | Lim, C.; Scatton, O.; Wu, A. G. R.; Zhang, W.; Hasegawa, K.; Cipriani, F.; Sijberden, J.; Aghayan, D. L.; Siow, T. F.; Dokmak, S.; Herman, P.; Marino, M. V.; Mazzaferro, V.; Chiow, A. K. H.; Sucandy, I.; Ivanecz, A.; Choi, S. H.; Lee, J. H.; Prieto, M.; Vivarelli, M.; Giuliante, F.; Ruzzenente, A.; Yong, C. C.; Yin, M.; Fondevila, C.; Efanov, M.; Morise, Z.; Di Benedetto, F.; Brustia, R.; Dalla Valle, R.; Boggi, U.; Geller, D.; Belli, A.; Memeo, R.; Gruttadauria, S.; Mejia, A.; Park, J. O.; Rotellar, F.; Choi, G. H.; Robles-Campos, R.; Wang, X.; Sutcliffe, R. P.; Pratschke, J.; Lai, E. C. H.; Chong, C. C. N.; D'Hondt, M.; Monden, K.; Lopez-Ben, S.; Kingham, T. P.; Ferrero, A.; Ettorre, G. M.; Cherqui, D.; Liang, X.; Soubrane, O.; Wakabayashi, G.; Troisi, R. I.; Cheung, T. T.; Sugioka, A.; Han, H. S.; Long, T. C. D.; Liu, R.; Edwin, B.; Fuks, D.; Chen, K. H.; Abu Hilal, M.; Aldrighetti, L.; Goh, B. K. P.; International robotic and laparoscopic liver resection study group investigators |
| Article Title: | 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 |
| 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. © 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology |
| Keywords: | adult; aged; cancer surgery; major clinical study; clinical feature; cirrhosis; liver cell carcinoma; liver cirrhosis; comparative study; lymph node dissection; laparoscopic surgery; tumor volume; morbidity; retrospective study; postoperative complication; multicenter study; operation duration; bile leakage; reoperation; surgical infection; blood transfusion; surgical mortality; minimally invasive surgery; hepatectomy; liver cancer; bile duct carcinoma; hospital readmission; portal hypertension; postoperative hemorrhage; ablation therapy; peroperative care; hernioplasty; decompensated liver cirrhosis; demographics; wedge resection; pringle maneuver; child pugh score; operative blood loss; human; male; female; article; segmentectomy; robot assisted surgery; difficulty score; posterosuperior segments; laparoscopic liver; american society of anaesthesiologists score; minimally invasive liver; hepatocholangiocarcinoma |
| Journal Title: | European Journal of Surgical Oncology |
| Volume: | 49 |
| Issue: | 10 |
| ISSN: | 0748-7983 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2023-10-01 |
| Start Page: | 106997 |
| Language: | English |
| DOI: | 10.1016/j.ejso.2023.106997 |
| PUBMED: | 37591027 |
| PROVIDER: | scopus |
| PMCID: | PMC10866151 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
