Impact of tumor size on the difficulty of laparoscopic left lateral sectionectomies
Giada Arizza 1 , Nadia Russolillo 1 , Alessandro Ferrero 1 , Nicholas L Syn 2 , Federica Cipriani 3 , Davit Aghayan 4 , Marco V Marino 5 , Riccardo Memeo 6 , Vincenzo Mazzaferro 7 , Adrian K H Chiow 8 , Iswanto Sucandy 9 , Arpad Ivanecz 10 , Marco Vivarelli 11 , Fabrizio Di Benedetto 12 , Sung-Hoon Choi 13 , Jae Hoon Lee 14 , James O Park 15 , Mikel Gastaca 16 , Constantino Fondevila 17 , Mikhail Efanov 18 , Fernando Rotellar 19 , Gi-Hong Choi 20 , Ricardo Robles-Campos 21 , Xiaoying Wang 22 , Robert P Sutcliffe 23 , Johann Pratschke 24 , Chung Ngai Tang 25 , Charing C Chong 26 , Mathieu D'Hondt 27 , Chee Chien Yong 28 , Andrea Ruzzenente 29 , Paolo Herman 30 , T Peter Kingham 31 , Olivier Scatton 32 , Rong Liu 33 , Giovanni Battista Levi Sandri 34 , Olivier Soubrane 35 , Alejandro Mejia 36 , Santiago Lopez-Ben 37 , Kazateru Monden 38 , Go Wakabayashi 39 , Daniel Cherqui 40 , Roberto I Troisi 41 , Mengqiu Yin 42 , Felice Giuliante 43 , David Geller 44 , Atsushi Sugioka 45 , Bjorn Edwin 4 , Tan-To Cheung 46 , Tran Cong Duy Long 47 , Mohammad Abu Hilal 48 , David Fuks 35 , Kuo-Hsin Chen 49 , Luca Aldrighetti 3 , Ho-Seong Han 50 , Brian K P Goh 51 52 , International robotic and laparoscopic liver resection study group investigators
Introduction: Tumor size(TS) represents a critical parameter in the risk assessment of laparoscopic liver resections(LLR). Moreover, TS has been rarely related to the extent of liver resection. The aim of this study was to study the relationship between tumor size and difficulty of laparoscopic left lateral sectionectomy( L-LLS).
Methods: The impact of TS cutoffs was investigated by stratifying tumor size at each 10mm-interval. The optimal cut-offs were chosen taking into consideration the number of endpoints which show a statistically significant split around the cut-points of interest and the magnitude of relative risk after correction for multiple risk factors.
Results: 1910 L-LLS were included. Overall, open conversion and intraoperative blood transfusion were 3.1% and 3.3%, respectively. The major morbidity rate was 2.7% and 90-days mortality 0.6%. Three optimal TS cut-offs were identified: 40-mm, 70-mm, and 100-mm. All the selected cut-offs showed a significant discriminative power for the prediction of open conversion, operative time, blood transfusion and need of Pringle manoeuvre. Moreover, 70-mm and 100-mm cut-offs were both discriminative for estimated blood loss and major complications. A stepwise increase in rates of open conversion rate (Z=3.90,p<0.001), operative time (Z=3.84,p<0.001), blood loss (Z=6.50,p<0.001), intraoperative blood transfusion rate (Z=5.15,p<0.001), Pringle manoeuvre use (Z=6.48,p<0.001), major morbidity(Z=2.17,p=0.030) and 30-days readmission (Z=1.99, p=0.047) was registered as the size increased.
Conclusions: L-LLS for tumours of increasing size was associated with poorer intraoperative and early postoperative outcomes suggesting increasing difficulty of the procedure. We determined 3 optimal TS cutoffs(40-mm, 70-mm and 100-mm) to accurately stratify surgical difficulty after L-LLS.
CITATION J Hepatobiliary Pancreat Sci. 2023 May;30(5):558-569. doi: 10.1002/jhbp.1279. Epub 2022 Dec 5.