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

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 investi...

Full description

Saved in:
Bibliographic Details
Published in:Annals of surgical oncology 2024, Vol.31 (1), p.97-114
Main Authors: Cipriani, Federica, Aldrighetti, Luca, Ratti, Francesca, Wu, Andrew G. R., Kabir, Tousif, Scatton, Olivier, Lim, Chetana, Zhang, Wanguang, Sijberden, Jasper, Aghayan, Davit L., Siow, Tiing-Foong, Dokmak, Safi, Coelho, Fabricio Ferreira, Herman, Paulo, 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, Ruzzenente, Andrea, Yong, Chee-Chien, Yin, Mengqiu, Fondevila, Constantino, Efanov, Mikhail, Morise, Zenichi, Di Benedetto, Fabrizio, Brustia, Raffaele, Dalla Valle, Raffaele, Boggi, Ugo, Geller, David, Belli, Andrea, Memeo, Riccardo, Gruttadauria, Salvatore, Mejia, Alejandro, Park, James O., Rotellar, Fernando, Choi, Gi-Hong, Robles-Campos, Ricardo, Wang, Xiaoying, Sutcliffe, Robert P., Pratschke, Johann, Lai, Eric C. H., Chong, Charing C. N., D’Hondt, Mathieu, Monden, Kazuteru, Lopez-Ben, Santiago, Kingham, T. Peter, Ferrero, Alessandro, Ettorre, Giuseppe Maria, Cherqui, Daniel, Liang, Xiao, Soubrane, Olivier, Wakabayashi, Go, Troisi, Roberto I., Cheung, Tan-To, Kato, Yutaro, Sugioka, Atsushi, Han, Ho-Seong, Long, Tran Cong duy, Liu, Qu, Liu, Rong, Edwin, Bjørn, Fuks, David, Chen, Kuo-Hsin, Abu Hilal, Mohammad, Goh, Brian K. P.
Format: Article
Language:English
Subjects:
Blood transfusion
Cirrhosis
Hepatectomy
Hepatectomy - methods
Hepatobiliary Tumors
Hospitalization
Humans
Hypertension
Hypertension, Portal - etiology
Hypertension, Portal - surgery
Laparoscopy
Laparoscopy - methods
Length of Stay
Liver
Liver cancer
Liver cirrhosis
Liver Cirrhosis - complications
Liver Cirrhosis - pathology
Liver Cirrhosis - surgery
Liver Neoplasms - complications
Liver Neoplasms - surgery
Malignancy
Medicine
Medicine & Public Health
Morbidity
Oncology
Postoperative Complications - etiology
Postoperative Complications - surgery
Propensity Score
Retrospective Studies
Robotic Surgical Procedures
Statistical analysis
Surgery
Surgical Oncology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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 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 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 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.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-023-14376-5