J Hepatobiliary Pancreat Sci. 2022 Nov 19. doi: 10.1002/jhbp.1279. Online ahead of print.
ABSTRACT
INTRODUCTION: Tumor size(TS) represents a critical parameter in the risk assessment of laparoscopic liver resections(LLR). Moreover, TS has been rarely related to the extent of liver resection. The aim of this study was to study the relationship between tumor size and difficulty of laparoscopic left lateral sectionectomy( L-LLS).
METHODS: The impact of TS cutoffs was investigated by stratifying tumor size at each 10mm-interval. The optimal cut-offs were chosen taking into consideration the number of endpoints which show a statistically significant split around the cut-points of interest and the magnitude of relative risk after correction for multiple risk factors.
RESULTS: 1910 L-LLS were included. Overall, open conversion and intraoperative blood transfusion were 3.1% and 3.3%, respectively. The major morbidity rate was 2.7% and 90-days mortality 0.6%. Three optimal TS cut-offs were identified: 40-mm, 70-mm, and 100-mm. All the selected cut-offs showed a significant discriminative power for the prediction of open conversion, operative time, blood transfusion and need of Pringle manoeuvre. Moreover, 70-mm and 100-mm cut-offs were both discriminative for estimated blood loss and major complications. A stepwise increase in rates of open conversion rate (Z=3.90,p<0.001), operative time (Z=3.84,p<0.001), blood loss (Z=6.50,p<0.001), intraoperative blood transfusion rate (Z=5.15,p<0.001), Pringle manoeuvre use (Z=6.48,p<0.001), major morbidity(Z=2.17,p=0.030) and 30-days readmission (Z=1.99, p=0.047) was registered as the size increased.
CONCLUSIONS: L-LLS for tumours of increasing size was associated with poorer intraoperative and early postoperative outcomes suggesting increasing difficulty of the procedure. We determined 3 optimal TS cutoffs(40-mm, 70-mm and 100-mm) to accurately stratify surgical difficulty after L-LLS.
PMID:36401813 | DOI:10.1002/jhbp.1279
