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 maneu-ver 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.
Sub-classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes / Ruzzenente, Andrea; Valle, Bernardo Dalla; Poletto, Edoardo; Syn, Nicholas L; Kabir, Tousif; Sugioka, Atsushi; Cipriani, Federica; Cherqui, Daniel; Han, Ho-Seong; Armstrong, Thomas; Long, Tran Cong Duy; Scatton, Olivier; Herman, Paolo; Pratschke, Johann; Aghayan, Davit L; Liu, Rong; Marino, Marco V; Chiow, Adrian K H; Sucandy, Iswanto; Ivanecz, Arpad; Vivarelli, Marco; Di Benedetto, Fabrizio; Choi, Sung-Hoon; Lee, Jae Hoon; Prieto, Mikel; Fondevila, Constantino; Efanov, Mikhail; Rotellar, Fernando; Choi, Gi-Hong; Robles-Campos, Ricardo; Wang, Xiaoying; Sutcliffe, Robert P; Lai, Eric C H; Chong, Charing C; D'Hondt, Mathieu; Yong, Chee Chien; Troisi, Roberto I; Kingham, T Peter; Ferrero, Alessandro; Levi Sandri, Giovanni Battista; Soubrane, Olivier; Yin, Mengqiu; Lopez-Ben, Santiago; Mazzaferro, Vincenzo; Giuliante, Felice; Monden, Kazateru; Mishima, Kohei; Wakabayashi, Go; Cheung, Tan-To; Fuks, David; Abu Hilal, Mohammad; Chen, Kuo-Hsin; Aldrighetti, Luca; Edwin, Bjorn; Goh, Brian K P. - In: JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES. - ISSN 1868-6974. - 30:9(2023), pp. 1098-1110. [10.1002/jhbp.1323]