Sub-classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes
© 2023 Japanese Society of Hepato-Biliary-Pancreatic Surgery..
BACKGROUND: 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 .048), longer operating time (median, 240 min vs. 285 min vs. 286 min, p-value <.001), greater blood loss (median, 150 mL vs. 200 mL vs. 250 mL, p-value <.001) and higher intraoperative blood transfusion rate (5.7% vs. 5.6% vs. 11.3%, p-value .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 = .006). There were no significant differences in postoperative stay, major morbidity, and mortality between the three groups.
CONCLUSION: L-LH for tumors that are >40 mm 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 tumors located in PS segments, or tumors located in the antero-lateral segments.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:30 |
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| Enthalten in: |
Journal of hepato-biliary-pancreatic sciences - 30(2023), 9 vom: 21. Sept., Seite 1098-1110 |
| Sprache: |
Englisch |
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| Links: |
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| Themen: |
Difficulty |
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| Anmerkungen: |
Date Completed 14.09.2023 Date Revised 28.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1002/jhbp.1323 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Sub-classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 14.09.2023 | ||
| 500 | |a Date Revised 28.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 Japanese Society of Hepato-Biliary-Pancreatic Surgery. | ||
| 520 | |a BACKGROUND: 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) | ||
| 520 | |a 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 | ||
| 520 | |a 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 .048), longer operating time (median, 240 min vs. 285 min vs. 286 min, p-value <.001), greater blood loss (median, 150 mL vs. 200 mL vs. 250 mL, p-value <.001) and higher intraoperative blood transfusion rate (5.7% vs. 5.6% vs. 11.3%, p-value .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 = .006). There were no significant differences in postoperative stay, major morbidity, and mortality between the three groups | ||
| 520 | |a CONCLUSION: L-LH for tumors that are >40 mm 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 tumors located in PS segments, or tumors located in the antero-lateral segments | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a difficulty | |
| 650 | 4 | |a laparoscopy | |
| 650 | 4 | |a left hepatectomy | |
| 650 | 4 | |a location | |
| 650 | 4 | |a tumor size | |
| 700 | 1 | |a Valle, Bernardo Dalla |e verfasserin |4 aut | |
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| 700 | 1 | |a Syn, Nicholas L |e verfasserin |4 aut | |
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| 700 | 1 | |a Aghayan, Davit L |e verfasserin |4 aut | |
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| 700 | 1 | |a Marino, Marco V |e verfasserin |4 aut | |
| 700 | 1 | |a Chiow, Adrian K H |e verfasserin |4 aut | |
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| 700 | 1 | |a Di Benedetto, Fabrizio |e verfasserin |4 aut | |
| 700 | 1 | |a Choi, Sung-Hoon |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Jae Hoon |e verfasserin |4 aut | |
| 700 | 1 | |a Prieto, Mikel |e verfasserin |4 aut | |
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| 700 | 1 | |a Sutcliffe, Robert P |e verfasserin |4 aut | |
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| 700 | 1 | |a Chong, Charing C |e verfasserin |4 aut | |
| 700 | 1 | |a D'Hondt, Mathieu |e verfasserin |4 aut | |
| 700 | 1 | |a Yong, Chee Chien |e verfasserin |4 aut | |
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| 700 | 1 | |a Ferrero, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Levi Sandri, Giovanni Battista |e verfasserin |4 aut | |
| 700 | 1 | |a Soubrane, Olivier |e verfasserin |4 aut | |
| 700 | 1 | |a Yin, Mengqiu |e verfasserin |4 aut | |
| 700 | 1 | |a Lopez-Ben, Santiago |e verfasserin |4 aut | |
| 700 | 1 | |a Mazzaferro, Vincenzo |e verfasserin |4 aut | |
| 700 | 1 | |a Giuliante, Felice |e verfasserin |4 aut | |
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| 700 | 1 | |a Gastaca, Mikel |e investigator |4 oth | |
| 700 | 1 | |a Schotte, Henri |e investigator |4 oth | |
| 700 | 1 | |a De Meyere, Celine |e investigator |4 oth | |
| 700 | 1 | |a Krenzien, Felix |e investigator |4 oth | |
| 700 | 1 | |a Schmelzle, Moritz |e investigator |4 oth | |
| 700 | 1 | |a Lee, Kit-Fai |e investigator |4 oth | |
| 700 | 1 | |a Salimgereeva, Diana |e investigator |4 oth | |
| 700 | 1 | |a Alikhanov, Ruslan |e investigator |4 oth | |
| 700 | 1 | |a Lee, Lip-Seng |e investigator |4 oth | |
| 700 | 1 | |a Jang, Jae Young |e investigator |4 oth | |
| 700 | 1 | |a Kato, Yutaro |e investigator |4 oth | |
| 700 | 1 | |a Kojima, Masayuki |e investigator |4 oth | |
| 700 | 1 | |a Fretland, Asmund Avdem |e investigator |4 oth | |
| 700 | 1 | |a Ghotbi, Jacob |e investigator |4 oth | |
| 700 | 1 | |a Coelho, Fabricio Ferreira |e investigator |4 oth | |
| 700 | 1 | |a Kruger, Jaime Arthur Pirola |e investigator |4 oth | |
| 700 | 1 | |a Lopez-Lopez, Victor |e investigator |4 oth | |
| 700 | 1 | |a Magistri, Paolo |e investigator |4 oth | |
| 700 | 1 | |a Robert, Margarida Casellas I |e investigator |4 oth | |
| 700 | 1 | |a Montalti, Roberto |e investigator |4 oth | |
| 700 | 1 | |a Giglio, Mariano |e investigator |4 oth | |
| 700 | 1 | |a Mazzotta, Alessandro |e investigator |4 oth | |
| 700 | 1 | |a Lee, Boram |e investigator |4 oth | |
| 700 | 1 | |a D'Silva, Mizelle |e investigator |4 oth | |
| 700 | 1 | |a Wang, Hao-Ping |e investigator |4 oth | |
| 700 | 1 | |a Saleh, Mansour |e investigator |4 oth | |
| 700 | 1 | |a Pascual, Franco |e investigator |4 oth | |
| 700 | 1 | |a Nghia, Phan Phuoc |e investigator |4 oth | |
| 700 | 1 | |a Lim, Chetana |e investigator |4 oth | |
| 700 | 1 | |a Liu, Qiu |e investigator |4 oth | |
| 700 | 1 | |a Kadam, Prashant |e investigator |4 oth | |
| 700 | 1 | |a Tang, Chung-Ngai |e investigator |4 oth | |
| 700 | 1 | |a Chen, Zewei |e investigator |4 oth | |
| 700 | 1 | |a Yu, Shian |e investigator |4 oth | |
| 700 | 1 | |a Giustizieri, Ugo |e investigator |4 oth | |
| 700 | 1 | |a Citterio, Davide |e investigator |4 oth | |
| 700 | 1 | |a Ardito, Francesco |e investigator |4 oth | |
| 700 | 1 | |a Vani, Simone |e investigator |4 oth | |
| 700 | 1 | |a Siow, Tiing Foong |e investigator |4 oth | |
| 700 | 1 | |a Mocchegianni, Federico |e investigator |4 oth | |
| 700 | 1 | |a Ettorre, Giuseppe Maria |e investigator |4 oth | |
| 700 | 1 | |a Colasanti, Marco |e investigator |4 oth | |
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