Impact of Tumor Size on the Difficulty of Laparoscopic Major Hepatectomies: An International Multicenter Study
Authors
Yutaro Kato ; Atsushi Sugioka ; Masayuki Kojima ; Nicholas L Syn ; Wang Zhongkai ; Rong Liu ; Federica Cipriani ; Thomas Armstrong ; Davit L Aghayan ; Tiing-Foong Siow ; Chetana Lim ; Olivier Scatton ; Paulo Herman ; Fabricio Ferreira Coelho ; Marco V Marino ; Vincenzo Mazzaferro ; Adrian K H Chiow ; Iswanto Sucandy ; Arpad Ivanecz ; Sung Hoon Choi ; Jae Hoon Lee ; Mikel Gastaca ; Marco Vivarelli ; Felice Giuliante ; Bernardo Dalla Valle ; Andrea Ruzzenente ; Chee-Chien Yong ; Constantino Fondevila ; Mikhail Efanov ; Fabrizio Di Benedetto ; Andrea Belli ; James O Park ; Fernando Rotellar ; Gi-Hong Choi ; Ricardo Robles-Campos ; Xiaoying Wang ; Robert P Sutcliffe ; Moritz Schmelzle ; Johann Pratschke ; Eric C H Lai ; Charing C N Chong ; Mathieu D'Hondt ; Kazuteru Monden ; Santiago Lopez-Ben ; T Peter Kingham ; Fabio Forchino ; Alessandro Ferrero ; Giuseppe Maria Ettorre ; Giovanni Battista Levi Sandri ; Franco Pascual ; Daniel Cherqui ; Olivier Soubrane ; Go Wakabayashi ; Roberto I Troisi ; Tan-To Cheung ; Zewei Chen ; Mengqiu Yin ; Mizelle D'Silva ; Ho-Seong Han ; Phan Phuoc Nghia ; Tran Cong Duy Long ; Bjørn Edwin ; David Fuks ; Kuo-Hsin Chen ; Mohammad Abu Hilal ; Luca Aldrighetti ; Brian K P Goh ; International Robotic and Laparoscopic Liver Resection Study Group Investigators
Citation
ANNALS OF SURGICAL ONCOLOGY, Vol.30(11) : 6628-6636, 2023-10
IntroductionAlthough tumor size (TS) is known to affect surgical outcomes in laparoscopic liver resection (LLR), its impact on laparoscopic major hepatectomy (L-MH) is not well studied. The objectives of this study were to investigate the impact of TS on the perioperative outcomes of L-MH and to elucidate the optimal TS cutoff for stratifying the difficulty of L-MH.MethodsThis was a post-hoc analysis of 3008 patients who underwent L-MH at 48 international centers. A total 1396 patients met study criteria and were included. The impact of TS cutoffs was investigated by stratifying TS at each 10-mm interval. The optimal cutoffs were determined taking into consideration the number of endpoints which showed a statistically significant split around the cut-points of interest and the magnitude of relative risk after correction for multiple risk factors.ResultsWe identified 2 optimal TS cutoffs, 50 mm and 100 mm, which segregated L-MH into 3 groups. An increasing TS across these 3 groups (& LE; 50 mm, 51-100 mm, > 100 mm), was significantly associated with a higher open conversion rate (11.2%, 14.7%, 23.0%, P < 0.001), longer operating time (median, 340 min, 346 min, 365 min, P = 0.025), increased blood loss (median, 300 ml, ml, 400 ml, P = 0.002) and higher rate of intraoperative blood transfusion (13.1%, 15.9%, 27.6%, P < 0.001). Postoperative outcomes such as overall morbidity, major morbidity, and length of stay were comparable across the three groups.ConclusionIncreasing TS was associated with poorer intraoperative but not postoperative outcomes after L-MH. We determined 2 TS cutoffs (50 mm and 10 mm) which could optimally stratify the surgical difficulty of L-MH.