Impact of Tumor Size on the Difficulty of Laparoscopic Major Hepatectomies: An International Multicenter Study.
Difficulty
Laparoscopic liver resection
Major hepatectomy
Minimally invasive liver
Size
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
17
11
2022
accepted:
19
06
2023
medline:
20
9
2023
pubmed:
28
7
2023
entrez:
28
7
2023
Statut:
ppublish
Résumé
Although 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. This 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. We identified 2 optimal TS cutoffs, 50 mm and 100 mm, which segregated L-MH into 3 groups. An increasing TS across these 3 groups (≤ 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. Increasing 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.
Identifiants
pubmed: 37505351
doi: 10.1245/s10434-023-13863-z
pii: 10.1245/s10434-023-13863-z
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
6628-6636Subventions
Organisme : US National Cancer Institute MSKCC Core Grant
ID : P30 CA008747
Organisme : Research Project of Zhejiang Provincial Public Welfare Fund project in the Field of Social development
ID : LGF20H160028
Investigateurs
Mikel Prieto
(M)
Celine De Meyere
(C)
Juul Meurs
(J)
Kit-Fai Lee
(KF)
Diana Salimgereeva
(D)
Ruslan Alikhanov
(R)
Lip-Seng Lee
(LS)
Jae Young Jang
(JY)
Jaime Arthur Pirola Kruger
(JAP)
Victor Lopez-Lopez
(V)
Margarida Casellas I Robert
(M)
Roberto Montalti
(R)
Boram Lee
(B)
Hao-Ping Wang
(HP)
Mansour Saleh
(M)
Simone Vani
(S)
Francesco Ardito
(F)
Ugo Giustizieri
(U)
Davide Citterio
(D)
Federico Mocchegiani
(F)
Marco Colasanti
(M)
Yoelimar Guzmán
(Y)
Kevin P Labadie
(KP)
Paolo Magistri
(P)
Kohei Mishima
(K)
Felix Krenzien
(F)
Prashant Kadam
(P)
Chung Ngai Tang
(CN)
Jacob Ghotbi
(J)
Åsmund Avdem Fretland
(ÅA)
Mariano Giglio
(M)
Alessandro Mazzotta
(A)
Qu Liu
(Q)
Shian Yu
(S)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2023. Society of Surgical Oncology.
Références
Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, et al. Recommendations for laparoscopic liver resection. A report from the Second International Consensus Conference held in Morioka. Ann Surg. 2015;261:619–29.
pubmed: 25742461
Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G. Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg. 2016;263:761–77.
doi: 10.1097/SLA.0000000000001413
pubmed: 26700223
Kasai M, Cipriani F, Gayet B, Aldrighetti L, Ratti F, Sarmiento JM, et al. Laparoscopic versus open major hepatectomy: a systematic review and meta-analysis of individual patient data. Surgery. 2018;163:985–95.
doi: 10.1016/j.surg.2018.01.020
pubmed: 29555197
Goh BKP, Lee SY, Teo JY, Kam JH, Jeyaraj PR, Chew PC, et al. Changing trends and outcomes associated with the adoption of minimally invasive hepatectomy: a contemporary single-institution experience with 400 consecutive resections. Surg Endosc. 2018;32(11):4658–65.
doi: 10.1007/s00464-018-6310-1
pubmed: 29967997
Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, et al. A novel difficulty scoring system for laparoscopic liver resection. J Hepato-Biliary-Pancreat Sci. 2014;21(10):745–53. https://doi.org/10.1002/jhbp.166 .
doi: 10.1002/jhbp.166
Wakabayshi G. What has changed after the Morioka consensus conference 2014 on laparoscopic liver resection? HepatoBiliary Surg Nutr. 2016;5(4):281–9.
doi: 10.21037/hbsn.2016.03.03
Halls MC, Beraldi G, Cipriani F, Barkhatov L, Lainas P, Harris S, et al. Development and validation of a difficulty score to predict intraoperative complications during laparoscopic liver resection. Br J Surg. 2018;105(9):1182–91.
doi: 10.1002/bjs.10821
pubmed: 29737513
Kawaguchi Y, Fuks D, Kokudo N, Gayet B. Difficulty of laparoscopic liver resection: proposal for a new classification. Ann Surg. 2018;267(1):13–7.
doi: 10.1097/SLA.0000000000002176
pubmed: 28187043
Hasegawa Y, Wakabayashi G, Nitta H, Takahara T, Katagiri H, Umemura A, et al. A novel model for prediction of pure laparoscopic liver resection surgical difficulty. Surg Endosc. 2017;31(12):5356–63.
doi: 10.1007/s00464-017-5616-8
pubmed: 28593408
Goh BKP, Prieto M, Syn N, Koh YX, Teo JY, Lee SY, et al. Validation and comparison of the Iwate, IMM, Southampton and Hasegawa difficulty scoring systems for primary laparoscopic hepatectomies. HPB (Oxford). 2021;23(5):770–6.
doi: 10.1016/j.hpb.2020.09.015
pubmed: 33023824
Linn YL, Wu AG, Han HS, Liu R, Chen KH, Fuks D, et al. Systematic review and meta-analysis of difficulty scoring systems for laparoscopic and robotic liver resections. J Hepatopancreat J Hepatobiliary Pancreat Sci. 2022;30:36–59.
doi: 10.1002/jhbp.1211
pubmed: 35780493
Kabir T, Syn N, Koh YX, Chung AY, Chan CY, Goh BKP. Impact of tumors size on the difficulty of minimally invasive liver resection. Eur J Surg Oncol. 2021;48:169–76.
doi: 10.1016/j.ejso.2021.08.019
pubmed: 34420824
Goh BK, Kabir T, Syn N. RE: new simple three-level liver resection classification without compromising the performance to predict surgical and postoperative outcomes. Eur J Surg Oncol. 2022;46:303–4.
doi: 10.1016/j.ejso.2021.11.129
Strasberg SM, Belghiti J, Clavien PA, Gadzijev E, Garden JO, Lau WY, et al. The Brisbane 2000 terminology of liver anatomy and resections. HPB. 2000;2(3):333–9.
doi: 10.1016/S1365-182X(17)30755-4
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
doi: 10.1097/01.sla.0000133083.54934.ae
pubmed: 15273542
pmcid: 1360123
Budczies J, Klauschen F, Sinn BV, Gyorffy B, Schmitt WD, Darb-Esfahani S, et al. Cutoff finder: a comprehensive and straightforward web application enabling rapid biomarker cutoff optimization. PloS One. 2012;7(12):e51862.
doi: 10.1371/journal.pone.0051862
pubmed: 23251644
pmcid: 3522617
Hothorn T, Hornik K, Zeileis A. Party: a laboratory for recursive partitioning. https://cran.r-project.org/web/packages/party/vignettes/party.pdf
Levi Sandri GB, Spoletini G, Vennarecci G, Francone E, Abu Hilal M, Ettorre GM. Laparoscopic liver resection for large HCC: short- and long-term outcomes in relation to tumor size. Surg Endosc. 2018;32(12):4772–9.
doi: 10.1007/s00464-018-6225-x
pubmed: 29770883
Shelat VG, Cipriani F, Basseres T, Armstrong TH, Takhar AS, Pearce NW, et al. Pure laparoscopic liver resection for large malignant tumors: Does size matter? Ann Surg Oncol. 2015;22(4):1288–93. https://doi.org/10.1245/s10434-014-4107-6 .
doi: 10.1245/s10434-014-4107-6
pubmed: 25256130
Kabir T, Syn NL, Guo Y, Lim KI, Goh BKP. Laparoscopic liver resection for huge (> 10 cm) HCC: a coarsened exact-matched single-surgeon study. Surg Oncol. 2021;37:101569.
doi: 10.1016/j.suronc.2021.101569
pubmed: 33839442