Impact of tumor size on the difficulty of laparoscopic left lateral sectionectomies.
difficulty
laparoscopic hepatectomy
laparoscopic liver
left lateral sectionectomy
size
Journal
Journal of hepato-biliary-pancreatic sciences
ISSN: 1868-6982
Titre abrégé: J Hepatobiliary Pancreat Sci
Pays: Japan
ID NLM: 101528587
Informations de publication
Date de publication:
May 2023
May 2023
Historique:
revised:
04
10
2022
received:
06
08
2022
accepted:
13
10
2022
pmc-release:
01
05
2024
medline:
26
5
2023
pubmed:
20
11
2022
entrez:
19
11
2022
Statut:
ppublish
Résumé
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). 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 36401813
doi: 10.1002/jhbp.1279
pmc: PMC10195918
mid: NIHMS1851951
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
558-569Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Organisme : US National Cancer Institute MSKCC Core Grant
ID : P30 CA008747
Investigateurs
Chung-Yip Chan
(CY)
Mikel Prieto
(M)
Juul Meurs
(J)
Celine De Meyere
(C)
Felix Krenzien
(F)
Moritz Schmelzle
(M)
Kit-Fai Lee
(KF)
Kelvin K Ng
(KK)
Diana Salimgereeva
(D)
Ruslan Alikhanov
(R)
Lip-Seng Lee
(LS)
Jae Young Jang
(JY)
Kevin P Labadie
(KP)
Yutaro Kato
(Y)
Masayuki Kojima
(M)
Asmund Avdem Fretland
(AA)
Jacob Ghotbi
(J)
Fabricio Ferreira Coelho
(FF)
Jaime Arthur Pirola Kruger
(JAP)
Victor Lopez-Lopez
(V)
Paolo Magistri
(P)
Margarida Casellas I Robert
(MCI)
Kohei Mishima
(K)
Roberto Montalti
(R)
Mariano Giglio
(M)
Alessandro Mazzotta
(A)
Boram Lee
(B)
Mizelle D'Silva
(M)
Hao-Ping Wang
(HP)
Mansour Saleh
(M)
Franco Pascual
(F)
Amal Suhool
(A)
Phan Phuoc Nghia
(PP)
Chetana Lim
(C)
Qiu Liu
(Q)
Prashant Kadam
(P)
Bernardo Dalla Valle
(B)
Eric C Lai
(EC)
Maria Conticchio
(M)
Ugo Giustizieri
(U)
Davide Citterio
(D)
Zewei Chen
(Z)
Shian Yu
(S)
Francesco Ardito
(F)
Simone Vani
(S)
Epameinondas Dogeas
(E)
Tiing Foon Siow
(TF)
Federico Mocchegianni
(F)
Giuseppe Maria Ettorre
(GM)
Marco Colasanti
(M)
Yoelimar Guzmán
(Y)
Informations de copyright
© 2022 Japanese Society of Hepato-Biliary-Pancreatic Surgery.
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