Impact of Liver Cirrhosis, Severity of Cirrhosis, and Portal Hypertension on the Difficulty and Outcomes of Laparoscopic and Robotic Major Liver Resections for Primary Liver Malignancies.
Cirrhosis
Difficulty score
Laparoscopic hepatectomy
Laparoscopic liver
Minimally invasive hepatectomy
Minimally invasive liver
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:
Jan 2024
Jan 2024
Historique:
received:
14
07
2023
accepted:
17
09
2023
medline:
7
12
2023
pubmed:
8
11
2023
entrez:
7
11
2023
Statut:
ppublish
Résumé
Minimally invasive liver resections (MILR) offer potential benefits such as reduced blood loss and morbidity compared with open liver resections. Several studies have suggested that the impact of cirrhosis differs according to the extent and complexity of resection. Our aim was to investigate the impact of cirrhosis on the difficulty and outcomes of MILR, focusing on major hepatectomies. A total of 2534 patients undergoing minimally invasive major hepatectomies (MIMH) for primary malignancies across 58 centers worldwide were retrospectively reviewed. Propensity score (PSM) and coarsened exact matching (CEM) were used to compare patients with and without cirrhosis. A total of 1353 patients (53%) had no cirrhosis, 1065 (42%) had Child-Pugh A and 116 (4%) had Child-Pugh B cirrhosis. Matched comparison between non-cirrhotics vs Child-Pugh A cirrhosis demonstrated comparable blood loss. However, after PSM, postoperative morbidity and length of hospitalization was significantly greater in Child-Pugh A cirrhosis, but these were not statistically significant with CEM. Comparison between Child-Pugh A and Child-Pugh B cirrhosis demonstrated the latter had significantly higher transfusion rates and longer hospitalization after PSM, but not after CEM. Comparison of patients with cirrhosis of all grades with and without portal hypertension demonstrated no significant difference in all major perioperative outcomes after PSM and CEM. The presence and severity of cirrhosis affected the difficulty and impacted the outcomes of MIMH, resulting in higher blood transfusion rates, increased postoperative morbidity, and longer hospitalization in patients with more advanced cirrhosis. As such, future difficulty scoring systems for MIMH should incorporate liver cirrhosis and its severity as variables.
Sections du résumé
BACKGROUND
BACKGROUND
Minimally invasive liver resections (MILR) offer potential benefits such as reduced blood loss and morbidity compared with open liver resections. Several studies have suggested that the impact of cirrhosis differs according to the extent and complexity of resection. Our aim was to investigate the impact of cirrhosis on the difficulty and outcomes of MILR, focusing on major hepatectomies.
METHODS
METHODS
A total of 2534 patients undergoing minimally invasive major hepatectomies (MIMH) for primary malignancies across 58 centers worldwide were retrospectively reviewed. Propensity score (PSM) and coarsened exact matching (CEM) were used to compare patients with and without cirrhosis.
RESULTS
RESULTS
A total of 1353 patients (53%) had no cirrhosis, 1065 (42%) had Child-Pugh A and 116 (4%) had Child-Pugh B cirrhosis. Matched comparison between non-cirrhotics vs Child-Pugh A cirrhosis demonstrated comparable blood loss. However, after PSM, postoperative morbidity and length of hospitalization was significantly greater in Child-Pugh A cirrhosis, but these were not statistically significant with CEM. Comparison between Child-Pugh A and Child-Pugh B cirrhosis demonstrated the latter had significantly higher transfusion rates and longer hospitalization after PSM, but not after CEM. Comparison of patients with cirrhosis of all grades with and without portal hypertension demonstrated no significant difference in all major perioperative outcomes after PSM and CEM.
CONCLUSIONS
CONCLUSIONS
The presence and severity of cirrhosis affected the difficulty and impacted the outcomes of MIMH, resulting in higher blood transfusion rates, increased postoperative morbidity, and longer hospitalization in patients with more advanced cirrhosis. As such, future difficulty scoring systems for MIMH should incorporate liver cirrhosis and its severity as variables.
Identifiants
pubmed: 37936020
doi: 10.1245/s10434-023-14376-5
pii: 10.1245/s10434-023-14376-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
97-114Subventions
Organisme : National Cancer Institute MSKCC core grant
ID : P30 CA008747
Organisme : zhejiang provincial public welfare fund
ID : LGF20H160028
Investigateurs
Nicholas L Syn
(NL)
Mikel Prieto
(M)
Celine De Meyere
(C)
Juul Meurs
(J)
Kelvin K Ng
(KK)
Kit-Fai Lee
(KF)
Diana Salimgereeva
(D)
Ruslan Alikhanov
(R)
Nita Thiruchelvam
(N)
Jae Young Jang
(JY)
Masayuki Kojima
(M)
Jaime Arthur Pirola Kruger
(JAP)
Victor Lopez-Lopez
(V)
Margarida Casellas I Robert
(MCI)
Roberto Montalti
(R)
Mariano Giglio
(M)
Boram Lee
(B)
Mizelle D'Silva
(M)
Hao-Ping Wang
(HP)
Franco Pascual
(F)
Mansour Saleh
(M)
Shian Yu
(S)
Zewei Chen
(Z)
Simone Vani
(S)
Francesco Ardito
(F)
Ugo Giustizieri
(U)
Davide Citterio
(D)
Federico Mocchegiani
(F)
Marco Colasanti
(M)
Giammauro Berardi
(G)
Yoelimar Guzmán
(Y)
Kevin P Labadie
(KP)
Maria Conticchio
(M)
Epameinondas Dogeas
(E)
Emanuele F Kauffmann
(EF)
Mario Giuffrida
(M)
Daniele Sommacale
(D)
Alexis Laurent
(A)
Paolo Magistri
(P)
Kohei Mishima
(K)
Moritz Schmelzle
(M)
Felix Krenzien
(F)
Prashant Kadam
(P)
Chung-Ngai Tang
(CN)
Jacob Ghotbi
(J)
Åsmund Avdem Fretland
(ÅA)
Fabio Forchino
(F)
Bernardo Dalla Valle
(B)
Junhao Zheng
(J)
Alessandro Mazzotta
(A)
Phan Phuoc Nghia
(PP)
Francois Cauchy
(F)
Informations de copyright
© 2023. Society of Surgical Oncology.
Références
Choo SP, Tan WL, Goh BKP, Tai WM, Zhu AX. Comparison of hepatocellular carcinoma in Eastern versus Western populations. Cancer. 2016;122(22):3430–46.
doi: 10.1002/cncr.30237
pubmed: 27622302
Hackl C, Schlitt HJ, Renner P, Lang SA. Liver surgery in cirrhosis and portal hypertension. World J Gastroenterol. 2016;22(9):2725–35.
doi: 10.3748/wjg.v22.i9.2725
pubmed: 26973411
pmcid: 4777995
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(4):761–77.
doi: 10.1097/SLA.0000000000001413
pubmed: 26700223
Goh BK, Wang Z, Koh YX, Lim KI. Evolution and trends in the adoption of laparoscopic liver resection in Singapore: analysis of 300 cases. Ann Acad Med Singap. 2021;50(10):742–50.
doi: 10.47102/annals-acadmedsg.2021213
pubmed: 34755168
Goh BKP, Lee SY, Teo JY, Kam JH, Jeyaraj PR, Cheow 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
Goh BKP, Lee SY, Koh YX, Kam JH, Chan CY. Minimally invasive major hepatectomies: a Southeast Asian single institution contemporary experience with its first 120 consecutive cases. ANZ J Surg. 2020;90(4):553–7.
doi: 10.1111/ans.15563
pubmed: 31721400
le Linn Y, 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 Hepatobiliary Pancreat Sci. 2022;5:63.
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
Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, et al. A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci. 2014;21(10):745–53.
doi: 10.1002/jhbp.166
pubmed: 25242563
Halls MC, Berardi 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. Ann Surg. 2018;267(1):13–7.
doi: 10.1097/SLA.0000000000002176
pubmed: 28187043
Wakabayashi 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
pubmed: 27500140
pmcid: 4960417
Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg. 2005;12(5):351–5.
doi: 10.1007/s00534-005-0999-7
pubmed: 16258801
Chiow AKH, Fuks D, Choi GH, Syn N, Sucandy I, Marino MV, et al. International multicentre propensity score-matched analysis comparing robotic versus laparoscopic right posterior sectionectomy. Br J Surg. 2021;108(12):1513–20.
doi: 10.1093/bjs/znab321
pubmed: 34750608
pmcid: 8743054
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
Kabir T, Syn NL, Guo Y, Lim KI, Goh BKP. Laparoscopic liver resection for huge (≥10 cm) hepatocellular carcinoma: a coarsened exact-matched single-surgeon study. Surg Oncol. 2021;37:101569.
doi: 10.1016/j.suronc.2021.101569
pubmed: 33839442
Kabir T, Tan ZZX, Chua DW, Syn N, Goh BKP. Early experience with laparoscopic liver resection for spontaneously ruptured hepatocellular carcinoma. J Minim Access Surg. 2020;16(3):239–45.
doi: 10.4103/jmas.JMAS_47_19
pubmed: 31031321
pmcid: 7440014
Mohan R, Kabir T, Wu AGR, Lim KI, Goh BKP. Analysis of perioperative outcomes following laparoscopic repeat liver resection compared to laparoscopic primary liver resection based on a single surgeon’s experience: a 1:2 propensity score-matched study. Surg Oncol. 2020;1(35):382–7.
doi: 10.1016/j.suronc.2020.09.020
Yeow M, Soh S, Starkey G, Perini MV, Koh YX, Tan EK, et al. A systematic review and network meta-analysis of outcomes after open, mini-laparotomy, hybrid, totally laparoscopic, and robotic living donor right hepatectomy. Surgery. 2022;172(2):741–50.
doi: 10.1016/j.surg.2022.03.042
pubmed: 35644687
Wells AR, Hamar B, Bradley C, Gandy WM, Harrison PL, Sidney JA, et al. Exploring robust methods for evaluating treatment and comparison groups in chronic care management programs. Popul Health Manag. 2013;16(1):35–45.
doi: 10.1089/pop.2011.0104
pubmed: 22788834
pmcid: 3698674
Kabir T, Tan ZZ, Syn NL, Wu E, Lin JD, Zhao JJ, et al. Laparoscopic versus open resection of hepatocellular carcinoma in patients with cirrhosis: meta-analysis. Br J Surg. 2022;109(1):21–9.
doi: 10.1093/bjs/znab376
Troisi RI, Berardi G, Morise Z, Cipriani F, Ariizumi S, Sposito C, et al. Laparoscopic and open liver resection for hepatocellular carcinoma with Child-Pugh B cirrhosis: multicentre propensity score-matched study. Br J Surg. 2021;108(2):196–204.
doi: 10.1093/bjs/znaa041
pubmed: 33711132
Hobeika C, Fuks D, Cauchy F, Goumard C, Soubrane O, Gayet B, et al. Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey. Br J Surg. 2020;107(3):268–77.
doi: 10.1002/bjs.11406
pubmed: 31916594
Watanabe Y, Aikawa M, Kato T, Takase K, Watanabe Y, Okada K, et al. Influence of Child-Pugh B7 and B8/9 cirrhosis on laparoscopic liver resection for hepatocellular carcinoma: a retrospective cohort study. Surg Endosc. 2022;5:96.
Goh BKP, Syn N, Lee SY, Koh YX, Teo JY, Kam JH, et al. Impact of liver cirrhosis on the difficulty of minimally-invasive liver resections: a 1:1 coarsened exact-matched controlled study. Surg Endosc. 2021;35(9):5231–8.
doi: 10.1007/s00464-020-08018-0
pubmed: 32974782
Ciria R, Ayllon MD, Briceño J. Difficulty scores in laparoscopic liver surgery—getting closer to a powerful and necessary tool. Hepatobiliary Surg Nutr. 2019;8(4):428–30.
doi: 10.21037/hbsn.2019.02.11
pubmed: 31489323
pmcid: 6700008
Coletta D, de Padua C, Parrino C, de Peppo V, Oddi A, Frigieri C, et al. Laparoscopic liver surgery: what are the advantages in patients with cirrhosis and portal hypertension? systematic review and meta-analysis with personal experience. J Laparoendosc Adv Surg Tech A. 2020;30(10):1054–65.
doi: 10.1089/lap.2020.0408
pubmed: 32707003
Uchida H, Iwashita Y, Tada K, Saga K, Takayama H, Hirashita T, et al. Laparoscopic liver resection in cirrhotic patients with specific reference to a difficulty scoring system. Langenbecks Arch Surg. 2018;403(3):371–7.
doi: 10.1007/s00423-018-1671-4
pubmed: 29619626
Beard RE, Wang Y, Khan S, Marsh JW, Tsung A, Geller DA. Laparoscopic liver resection for hepatocellular carcinoma in early and advanced cirrhosis. HPB. 2018;20(6):521–9.
doi: 10.1016/j.hpb.2017.11.011
pubmed: 29317157
Cipriani F, Fantini C, Ratti F, Lauro R, Tranchart H, Halls M, et al. Laparoscopic liver resections for hepatocellular carcinoma. Can we extend the surgical indication in cirrhotic patients? Surg Endosc. 2018;32(2):617–26.
doi: 10.1007/s00464-017-5711-x
pubmed: 28717870
Morise Z, Sugioka A, Kawabe N, Umemoto S, Nagata H, Ohshima H, et al. Pure laparoscopic hepatectomy for hepatocellular carcinoma patients with severe liver cirrhosis. Asian J Endosc Surg. 2011;4(3):143–6.
doi: 10.1111/j.1758-5910.2011.00081.x
pubmed: 22776279
Cheung TT, Dai WC, Tsang SHY, Chan ACY, Chok KSH, Chan SC, et al. Pure laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma in 110 patients with liver cirrhosis: a propensity analysis at a single center. Ann Surg. 2016;264(4):612–20.
doi: 10.1097/SLA.0000000000001848
pubmed: 27433917
Vega EA, Kutlu OC, Joechle K, de La Cruz N, Ko D, Conrad C. Preoperative prognosticators of safe laparoscopic hepatocellular carcinoma resection in advanced cirrhosis: a propensity score matching population-based analysis of 1799 western patients. J Gastrointest Surg. 2019;23(6):1157–65.
doi: 10.1007/s11605-019-04139-7
pubmed: 30820798
Brown KM, Geller DA. What is the learning curve for laparoscopic major hepatectomy? J Gastrointest Surg. 2016;20(5):1065–71.
doi: 10.1007/s11605-016-3100-8
pubmed: 26956007