Comparison between the difficulty of laparoscopic limited liver resections of tumors located in Segment 7 vs. Segment 8: an international multicenter propensity-score matched study
Mikhail Efanov 1 , Diana Salimgereeva 1 , Ruslan Alikhanov 1 , Andrew G R Wu 2 , David Geller 3 , Federica Cipriani 4 , Davit L Aghayan 5 , Asmund Avdem Fretland 5 , Jasper Sijberden 6 , Andrea Belli 7 , Marco V Marino 8 , Vincenzo Mazzaferro 9 , Adrian K H Chiow 10 , Iswanto Sucandy 11 , Arpad Ivanecz 12 , Sung-Hoon Choi 13 , Jae Hoon Lee 14 , Mikel Prieto 15 , Marco Vivarelli 16 , Felice Giuliante 17 , Andrea Ruzzenente 18 , Chee-Chine Yong 19 , Constantino Fondevila 20 , Fernando Rotellar 21 , Gi-Hong Choi 22 , Ricardo Robless Campos 23 , Xiaoying Wang 24 , Robert P Sutcliffe 25 , Johann Pratschke 26 , Eric Lai 27 , Charing C Chong 28 , Mathieu D'Hondt 29 , Kazuteru Monden 30 , Santiago Lopez-Ben 31 , Paulo Herman 32 , Fabrizio Di Benedetto 33 , T Peter Kingham 34 , Rong Liu 35 , Tran Cong Duy Long 36 , Alessandro Ferrero 37 , Giovanni Battista Levi Sandri 38 , Daniel Cherqui 39 , Olivier Scatton 40 , Go Wakabayashi 41 , Roberto I Troisi 42 , Tan-To Cheung 43 , Atsushi Sugioka 44 , Ho-Seong Han 45 , Mohamed Abu Hilal 46 , Olivier Soubrane 47 , David Fuks 47 , Luca Aldrighetti 4 , Bjorn Edwin 5 , Brian K P Goh 48 , International robotic and laparoscopic liver resection study group investigators
Background: Presently, according to different difficulty scoring systems, there is no difference in complexity estimation of laparoscopic liver resection (LLR) of segments 7 and 8. However, there is no published data supporting this assumption. To date, no studies are comparing the outcomes of laparoscopic parenchyma-sparing resection of the liver segments 7 and 8.
Methods: A posthoc analysis of patients undergoing LLR of segments 7 and 8 in 46 centers between 2004 and 2020 was performed. 1:1 Propensity score matching (PSM) was used to compare isolated LLR of segments 7 and 8. Subset analyses were also performed to compare atypical resections and segmentectomies of 7 and 8.
Results: 2411 patients were identified, and 1691 patients met the inclusion criteria. Comparison after PSM between the entire cohort of segment 7 and segment 8 resections revealed inferior results for segment 7 resection in terms of increased blood loss, blood transfusions, and conversions to open surgery. Subset analyses of only atypical resections similarly demonstrated poorer outcomes for segment 7 in terms of increased blood loss, operation time, blood transfusions, and conversions to open surgery. Conversely, a subgroup analysis of segmentectomies after PSM found better outcomes for segment 7 in terms of a shorter operation time and hospital stay.
Conclusion: Differences in the outcomes of segments 7 and 8 resections suggest a greater difficulty of laparoscopic atypical resection of segment 7 compared to segment 8, and greater difficulty of segmentectomy 8 compared to segmentectomy 7.
CITA DEL ARTÍCULO J Hepatobiliary Pancreat Sci. 2023 Feb;30(2):177-191. doi: 10.1002/jhbp.1210. Epub 2022 Jul 20.