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Impact of tumor size on the difficulty of laparoscopic left lateral sectionectomies

Authors
 Giada Aizza  ;  Nadia Russolillo  ;  Alessandro Ferrero  ;  Nicholas L Syn  ;  Federica Cipriani  ;  Davit Aghayan  ;  Marco V Marino  ;  Riccardo Memeo  ;  Vincenzo Mazzaferro  ;  Adrian K H Chiow  ;  Iswanto Sucandy  ;  Arpad Ivanecz  ;  Marco Vivarelli  ;  Fabrizio Di Benedetto  ;  Sung-Hoon Choi  ;  Jae Hoon Lee  ;  James O Park  ;  Mikel Gastaca  ;  Constantino Fondevila  ;  Mikhail Efanov  ;  Fernando Rotellar  ;  Gi-Hong Choi  ;  Ricardo Robles-Campos  ;  Xiaoying Wang  ;  Robert P Sutcliffe  ;  Johann Pratschke  ;  Chung Ngai Tang  ;  Charing C Chong  ;  Mathieu D'Hondt  ;  Chee Chien Yong  ;  Andrea Ruzzenente  ;  Paolo Herman  ;  T Peter Kingham  ;  Olivier Scatton  ;  Rong Liu  ;  Giovanni Battista Levi Sandri  ;  Olivier Soubrane  ;  Alejandro Mejia  ;  Santiago Lopez-Ben  ;  Kazateru Monden  ;  Go Wakabayashi  ;  Daniel Cherqui  ;  Roberto I Troisi  ;  Mengqiu Yin  ;  Felice Giuliante  ;  David Geller  ;  Atsushi Sugioka  ;  Bjorn Edwin  ;  Tan-To Cheung  ;  Tran Cong Duy Long  ;  Mohammad Abu Hilal  ;  David Fuks  ;  Kuo-Hsin Chen  ;  Luca Aldrighetti  ;  Ho-Seong Han  ;  Brian K P Goh 
Citation
 JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES, Vol.30(5) : 558-569, 2023-05 
Journal Title
JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES
ISSN
 1868-6974 
Issue Date
2023-05
MeSH
Hepatectomy / methods ; Humans ; Laparoscopy* / methods ; Length of Stay ; Liver Neoplasms* / surgery ; Operative Time ; Postoperative Complications / surgery ; Retrospective Studies
Keywords
difficulty ; laparoscopic hepatectomy ; laparoscopic liver ; left lateral sectionectomy ; size
Abstract
Background: 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 10 mm-interval. The optimal cutoffs 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: A total of 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 cutoffs were identified: 40-, 70-, and 100-mm. All the selected cutoffs showed a significant discriminative power for the prediction of open conversion, operative time, blood transfusion and need of Pringle maneuver. Moreover, 70- and 100-mm cutoffs were both discriminative for estimated blood loss and major complications. A stepwise increase in rates of open conversion rate (Z = 3.90, P < .001), operative time (Z = 3.84, P < .001), blood loss (Z = 6.50, P < .001), intraoperative blood transfusion rate (Z = 5.15, P < .001), Pringle maneuver use (Z = 6.48, P < .001), major morbidity(Z = 2.17, P = .030) and 30-days readmission (Z = 1.99, P = .047) was registered as the size increased.

Conclusion: L-LLS for tumors of increasing size was associated with poorer intraoperative and early postoperative outcomes suggesting increasing difficulty of the procedure. We determined three optimal TS cutoffs (40-, 70- and 100-mm) to accurately stratify surgical difficulty after L-LLS.
Full Text
https://onlinelibrary.wiley.com/doi/10.1002/jhbp.1279
DOI
10.1002/jhbp.1279
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Choi, Gi Hong(최기홍) ORCID logo https://orcid.org/0000-0002-1593-3773
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/196030
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