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

被引：9

作者：

Kato, Yutaro ^{[1
]}

Sugioka, Atsushi L. ^{[1
]}

Kojima, Masayuki ^{[1
]}

Syn, Nicholas ^{[2
,3
]}

Zhongkai, Wang ^{[4
,5
]}

Liu, Rong ^{[6
]}

Cipriani, Federica L. ^{[7
]}

Armstrong, Thomas ^{[8
]}

Aghayan, Davit ^{[9
,10
]}

Siow, Tiing-Foong ^{[11
]}

Lim, Chetana ^{[12
]}

Scatton, Olivier ^{[12
]}

Herman, Paulo V. ^{[13
]}

Coelho, Fabricio Ferreira ^{[13
]}

Marino, Marco ^{[14
,15
]}

Mazzaferro, Vincenzo ^{[16
,17
]}

Chiow, Adrian K. H. ^{[18
]}

Sucandy, Iswanto ^{[19
]}

Ivanecz, Arpad ^{[20
]}

Choi, Sung Hoon ^{[21
]}

Lee, Jae Hoon ^{[22
]}

Gastaca, Mikel ^{[23
]}

Vivarelli, Marco ^{[24
]}

Giuliante, Felice ^{[25
]}

Dalla Valle, Bernardo ^{[26
]}

Ruzzenente, Andrea ^{[26
]}

Yong, Chee-Chien ^{[27
]}

Fondevila, Constantino ^{[28
,29
]}

Efanov, Mikhail ^{[30
]}

Di Benedetto, Fabrizio O. ^{[31
]}

Belli, Andrea ^{[32
]}

Park, James ^{[33
]}

Rotellar, Fernando ^{[34
,35
]}

Choi, Gi-Hong ^{[36
]}

Robles-Campos, Ricardo P. ^{[37
]}

Wang, Xiaoying ^{[38
]}

Sutcliffe, Robert ^{[39
]}

Schmelzle, Moritz ^{[40
,41
,42
,43
]}

Pratschke, Johann ^{[40
,41
,42
,43
]}

Lai, Eric C. H. ^{[44
]}

Chong, Charing C. N. ^{[45
]}

D'Hondt, Mathieu ^{[46
]}

Monden, Kazuteru ^{[47
]}

Lopez-Ben, Santiago ^{[48
]}

Kingham, T. Peter ^{[49
]}

Forchino, Fabio ^{[50
]}

Ferrero, Alessandro ^{[50
]}

Ettorre, Giuseppe Maria ^{[51
]}

Levi Sandri, Giovanni Battista ^{[51
]}

Pascual, Franco ^{[52
]}

机构：

[1] Fujita Hlth Univ, Dept Surg, Sch Med, Toyoake, Aichi, Japan

[2] Natl Univ Singapore, Yong Loo Lin Sch Med, Singapore, Singapore

[3] Minist Hlth Holdings, Singapore, Singapore

[4] Singapore Gen Hosp, Dept Hepatopancreatobiliary & Transplant Surg, Singapore, Singapore

[5] Natl Canc Ctr Singapore, Singapore, Singapore

[6] Chinese Peoples Liberat Army PLA Gen Hosp, Fac Hepatopancreatobiliary Surg, Med Ctr 1, Beijing, Peoples R China

[7] IRCCS San Raffaele Hosp, Hepatobiliary Surg Div, Milan, Italy

[8] Univ Hosp Southampton, Dept Surg, Southampton, Hants, England

[9] Univ Oslo, Oslo Univ Hosp, Inst Clin Med, Intervent Ctr, Oslo, Norway

[10] Univ Oslo, Oslo Univ Hosp, Inst Clin Med, Dept HPB Surg, Oslo, Norway

[11] Far Eastern Mem Hosp, Div Gen Surg, Dept Surg, New Taipei, Taiwan

[12] Sorbonne Univ, Dept Digest HBP & Liver Transplantat, Hop Pitie Salpetriere, Paris, France

[13] Univ Sao Paulo, Dept Gastroenterol, Surg Unit, Sch Med, Sao Paulo, Brazil

[14] Azienda Osped Osped Riuniti Villa Sofia, Dept Gen Surg, Palermo, Italy

[15] P Giaccone Univ Hosp, Dept Surg Oncol, Palermo, Italy

[16] Fdn IRCCS Ist Nazl Tumori Milano, HPB Surg & Liver Transplantat, Milan, Italy

[17] Univ Milan, Milan, Italy

[18] Changi Gen Hosp, Dept Surg, Hepatopancreatobiliary Unit, Singapore, Singapore

[19] Advent Hlth Tampa, Digest Hlth Inst, Tampa, FL USA

[20] Univ Med Ctr Maribor, Dept Abdominal & Gen Surg, Maribor, Slovenia

[21] CHA Univ, CHA Bundang Med Ctr, Dep Gen Surg, Sch Med, Seongnam, South Korea

[22] Univ Ulsan, Dept Surg, Asan Med Ctr, Div Hepato Biliary & Pancreat Surg,Coll Med, Seoul, South Korea

[23] Univ Basque Country, Cruces Univ Hosp, Biocruces Bizkaia Hlth Res Inst, Hepatobiliary Surg & Liver Transplantat Unit, Bilbao, Spain

[24] Univ Marche, United Hosp Ancona, Dept Expt & Clin Med Polytechn, HPB Surg & Transplantat Unit, Ancona, Italy

[25] Univ Cattolica Sacro Cuore, Hepatobiliary Surg Unit, Fdn Policlin Univ Gemelli, IRCCS, Rome, Italy

[26] Gynecol & Pediat Univ Verona, GB Rossi Hosp, Dept Surg, Gen & Hepatobiliary Surg, Verona, Italy

[27] Chang Gung Mem Hosp, Dept Surg, Kaohsiung, Taiwan

[28] Hosp Univ La Paz, Gen & Digest Surg, IdiPAZ, Madrid, Spain

[29] Univ Barcelona, Hosp Clin, Gen & Digest Surg, IDIBAPS, Barcelona, Spain

[30] Moscow Clin Sci Ctr, Dept Hepato Pancreato Biliary Surg, Moscow, Russia

[31] Univ Modena & Reggio Emilia, HPB Surg & Liver Transplant Unit, Modena, Italy

[32] IRCCS G Pascale, Natl Canc Ctr, Div Hepatopancreatobiliary Surg Oncol, Dept Abdominal Oncol, Naples, Italy

[33] Univ Washington, Dept Surg, Med Ctr, Seattle, WA USA

[34] Univ Navarra, Dept Gen Surg, HPB & Liver Transplant Unit, Univ Navarra Clin, Pamplona, Spain

[35] Inst Hlth Res Navarra IdisNA, Pamplona, Spain

[36] Yonsei Univ, Severance Hosp, Dept Surg, Div Hepatopancreatobiliary Surg,Coll Med, Seoul, South Korea

[37] Clin & Univ Hosp Virgen Arrixaca, Dept Gen Visceral & Transplantat Surg, IMIB ARRIXACA, Murcia, Spain

[38] Fudan Univ, Liver Canc Inst, Zhongshan Hosp, Dept Liver Surg & Transplantat, Shanghai, Peoples R China

[39] Univ Hosp Birmingham NHS Fdn Trust, Dept Hepatopancreatobiliary & Liver Trans, Birmingham, W Midlands, England

[40] Charite, Dept Surg, Campus Charite Mitte, Berlin, Germany

[41] Charite, Campus Virchow Klinikum, Berlin, Germany

[42] Free Univ Berlin, Berlin, Germany

[43] Berlin Inst Hlth, Berlin, Germany

[44] Pamela Youde Nethersole Eastern Hosp, Dept Surg, Hong Kong, Peoples R China

[45] Chinese Univ Hong Kong, Prince Wales Hosp, Dept Surg, Hong Kong, Peoples R China

[46] Groeninge Hosp, Dept Digest & Hepatobiliary Pancreat Surg, Kortrijk, Belgium

[47] Fukuyama City Hosp, Dept Surg, Hiroshima, Japan

[48] Dr Josep Trueta Hosp, Dept Surg, Hepatobiliary & Pancreat Surg Unit, IdIBGi, Girona, Spain

[49] Mem Sloan Kettering Canc Ctr, Dept Surg, New York, NY USA

[50] Mauriziano Hosp, Dept Gen & Oncol Surg, Turin, Italy

来源：

ANNALS OF SURGICAL ONCOLOGY | 2023年 / 30卷 / 11期

关键词：

Laparoscopic liver resection; Major hepatectomy; Size; Difficulty; Minimally invasive liver; LIVER RESECTION; PROPOSAL;

D O I：

10.1245/s10434-023-13863-z

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

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.

引用

页码：6628 / 6636

页数：9

共 20 条

[1]

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