Scientific publications

Impact of Liver Cirrhosis, Severity of Cirrhosis, and Portal Hypertension on the Difficulty and Outcomes of Laparoscopic and Robotic Major Liver Resections for Primary Liver Malignancies. Scientific Publication

Nov 7, 2023 | Magazine: Annals of Surgical Oncology

Federica Cipriani #  1 , Luca Aldrighetti #  1 , Francesca Ratti  1 , Andrew G R Wu  2 , Tousif Kabir  3 , Olivier Scatton  4 , Chetana Lim  4 , Wanguang Zhang  5 , Jasper Sijberden  6 , Davit L Aghayan  7 , Tiing-Foong Siow  8 , Safi Dokmak  9 , Fabricio Ferreira Coelho  10 , Paulo Herman  10 , Marco V Marino  11   12 , Vincenzo Mazzaferro  13 , Adrian K H Chiow  14 , Iswanto Sucandy  15 , Arpad Ivanecz  16 , Sung-Hoon Choi  17 , Jae Hoon Lee  18 , Mikel Gastaca  19 , Marco Vivarelli  20 , Felice Giuliante  21 , Andrea Ruzzenente  22 , Chee-Chien Yong  23 , Mengqiu Yin  24 , Constantino Fondevila  25   26 , Mikhail Efanov  27 , Zenichi Morise  28 , Fabrizio Di Benedetto  29 , Raffaele Brustia  30 , Raffaele Dalla Valle  31 , Ugo Boggi  32 , David Geller  33 , Andrea Belli  34 , Riccardo Memeo  35 , Salvatore Gruttadauria  36   37 , Alejandro Mejia  38 , James O Park  39 , Fernando Rotellar  40   41 , Gi-Hong Choi  42 , Ricardo Robles-Campos  43 , Xiaoying Wang  44 , Robert P Sutcliffe  45 , Johann Pratschke  46 , Eric C H Lai  47 , Charing C N Chong  48 , Mathieu D'Hondt  49 , Kazuteru Monden  50 , Santiago Lopez-Ben  51 , T Peter Kingham  52 , Alessandro Ferrero  53 , Giuseppe Maria Ettorre  54 , Daniel Cherqui  55 , Xiao Liang  56 , Olivier Soubrane  57 , Go Wakabayashi  58 , Roberto I Troisi  59 , Tan-To Cheung  60 , Yutaro Kato  61 , Atsushi Sugioka  61 , Ho-Seong Han  62 , Tran Cong Duy Long  63 , Qu Liu  64 , Rong Liu  64 , Bjørn Edwin  7 , David Fuks  57 , Kuo-Hsin Chen  8 , Mohammad Abu Hilal  6   65 , Brian K P Goh  66   67 ; International Robotic and Laparoscopic Liver Resection Study Group Investigators


Background: Minimally invasive liver resections (MILR) offer potential benefits such as reduced blood loss and morbidity compared with open liver resections. Several studies have suggested that the impact of cirrhosis differs according to the extent and complexity of resection. Our aim was to investigate the impact of cirrhosis on the difficulty and outcomes of MILR, focusing on major hepatectomies.

Methods: A total of 2534 patients undergoing minimally invasive major hepatectomies (MIMH) for primary malignancies across 58 centers worldwide were retrospectively reviewed. Propensity score (PSM) and coarsened exact matching (CEM) were used to compare patients with and without cirrhosis.

Results: A total of 1353 patients (53%) had no cirrhosis, 1065 (42%) had Child-Pugh A and 116 (4%) had Child-Pugh B cirrhosis. Matched comparison between non-cirrhotics vs Child-Pugh A cirrhosis demonstrated comparable blood loss. However, after PSM, postoperative morbidity and length of hospitalization was significantly greater in Child-Pugh A cirrhosis, but these were not statistically significant with CEM. Comparison between Child-Pugh A and Child-Pugh B cirrhosis demonstrated the latter had significantly higher transfusion rates and longer hospitalization after PSM, but not after CEM. Comparison of patients with cirrhosis of all grades with and without portal hypertension demonstrated no significant difference in all major perioperative outcomes after PSM and CEM.

Conclusions: The presence and severity of cirrhosis affected the difficulty and impacted the outcomes of MIMH, resulting in higher blood transfusion rates, increased postoperative morbidity, and longer hospitalization in patients with more advanced cirrhosis. As such, future difficulty scoring systems for MIMH should incorporate liver cirrhosis and its severity as variables.

CITATION  Ann Surg Oncol. 2024 Jan;31(1):97-114. doi: 10.1245/s10434-023-14376-5. Epub 2023 Nov 7