Sub-classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes
Andrea Ruzzenente 1 , Bernardo Dalla Valle 1 , Edoardo Poletto 1 , Nicholas L Syn 2 , Tousif Kabir 3 , Atsushi Sugioka 4 , Federica Cipriani 5 , Daniel Cherqui 6 , Ho-Seong Han 7 , Thomas Armstrong 8 , Tran Cong Duy Long 9 , Olivier Scatton 10 , Paolo Herman 11 , Johann Pratschke 12 , Davit L Aghayan 13 , Rong Liu 14 , Marco V Marino 15 , Adrian K H Chiow 16 , Iswanto Sucandy 17 , Arpad Ivanecz 18 , Marco Vivarelli 19 , Fabrizio Di Benedetto 20 , Sung-Hoon Choi 21 , Jae Hoon Lee 22 , Mikel Prieto 23 , Constantino Fondevila 24 , Mikhail Efanov 25 , Fernando Rotellar 26 , Gi-Hong Choi 27 , Ricardo Robles-Campos 28 , Xiaoying Wang 29 , Robert P Sutcliffe 30 , Eric C H Lai 31 , Charing C Chong 32 , Mathieu D'Hondt 33 , Chee Chien Yong 34 , Roberto I Troisi 35 , T Peter Kingham 36 , Alessandro Ferrero 37 , Giovanni Battista Levi Sandri 38 , Olivier Soubrane 39 , Mengqiu Yin 40 , Santiago Lopez-Ben 41 , Vincenzo Mazzaferro 42 , Felice Giuliante 43 , Kazateru Monden 44 , Kohei Mishima 45 , Go Wakabayashi 45 , Tan-To Cheung 46 , David Fuks 39 , Mohammad Abu Hilal 47 , Kuo-Hsin Chen 48 , Luca Aldrighetti 5 , Bjorn Edwin 13 , Brian K P Goh 49 ; International robotic and laparoscopic liver resection study group investigators are co-authors of this study
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.
CITATION J Hepatobiliary Pancreat Sci. 2023 Sep;30(9):1098-1110. doi: 10.1002/jhbp.1323. Epub 2023 Mar 29.