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.

Impact of Tumor Size on the Difficulty of Laparoscopic Major Hepatectomies: An International Multicenter Study / Kato, Yutaro; Sugioka, Atsushi; Kojima, Masayuki; Syn, Nicholas L; Zhongkai, Wang; Liu, Rong; Cipriani, Federica; Armstrong, Thomas; Aghayan, Davit L; Siow, Tiing-Foong; Lim, Chetana; Scatton, Olivier; Herman, Paulo; Coelho, Fabricio Ferreira; Marino, Marco V; Mazzaferro, Vincenzo; Chiow, Adrian K H; Sucandy, Iswanto; Ivanecz, Arpad; Choi, Sung Hoon; Lee, Jae Hoon; Gastaca, Mikel; Vivarelli, Marco; Giuliante, Felice; Dalla Valle, Bernardo; Ruzzenente, Andrea; Yong, Chee-Chien; Fondevila, Constantino; Efanov, Mikhail; Di Benedetto, Fabrizio; Belli, Andrea; Park, James O; Rotellar, Fernando; Choi, Gi-Hong; Robles-Campos, Ricardo; Wang, Xiaoying; Sutcliffe, Robert P; Schmelzle, Moritz; Pratschke, Johann; Lai, Eric C H; Chong, Charing C N; D'Hondt, Mathieu; Monden, Kazuteru; Lopez-Ben, Santiago; Kingham, T Peter; Forchino, Fabio; Ferrero, Alessandro; Ettorre, Giuseppe Maria; Levi Sandri, Giovanni Battista; Pascual, Franco; Cherqui, Daniel; Soubrane, Olivier; Wakabayashi, Go; Troisi, Roberto I; Cheung, Tan-To; Chen, Zewei; Yin, Mengqiu; D'Silva, Mizelle; Han, Ho-Seong; Nghia, Phan Phuoc; Long, Tran Cong Duy; Edwin, Bjørn; Fuks, David; Chen, Kuo-Hsin; Abu Hilal, Mohammad; Aldrighetti, Luca; Goh, Brian K P. - In: ANNALS OF SURGICAL ONCOLOGY. - ISSN 1068-9265. - (2023). [10.1245/s10434-023-13863-z]

Impact of Tumor Size on the Difficulty of Laparoscopic Major Hepatectomies: An International Multicenter Study

Vivarelli, Marco;
2023-01-01

Abstract

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.
2023
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11566/322019
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