Scientific publications
Impact of liver cirrhosis, the severity of cirrhosis, and portal hypertension on the outcomes of minimally invasive left lateral sectionectomies for primary liver malignancies
Fabricio Ferreira Coelho 1 , Paulo Herman 1 , Jaime A P Kruger 1 , Andrew G R Wu 2 , Ken-Min Chin 3 , Kiyoshi Hasegawa 4 , Wanguang Zhang 5 , Mohammad Alzoubi 6 , Davit L Aghayan 7 , Tiing-Foong Siow 8 , Olivier Scatton 9 , T Peter Kingham 10 , Marco V Marino 11 , Vincenzo Mazzaferro 12 , Adrian K H Chiow 13 , Iswanto Sucandy 14 , Arpad Ivanecz 15 , Sung Hoon Choi 16 , Jae Hoon Lee 17 , Mikel Gastaca 18 , Marco Vivarelli 19 , Felice Giuliante 20 , Andrea Ruzzenente 21 , Chee-Chien Yong 22 , Safi Dokmak 23 , Constantino Fondevila 24 , Mikhail Efanov 25 , Zenichi Morise 26 , Fabrizio Di Benedetto 27 , Raffaele Brustia 28 , Raffaele Dalla Valle 29 , Ugo Boggi 30 , David Geller 31 , Andrea Belli 32 , Riccardo Memeo 33 , Salvatore Gruttadauria 34 , Alejandro Mejia 35 , James O Park 36 , Fernando Rotellar 37 , Gi Hong Choi 38 , Ricardo Robles-Campos 39 , Xiaoying Wang 40 , Robert P Sutcliffe 41 , Johann Pratschke 42 , Eric C H Lai 43 , Charing C N Chong 44 , Mathieu D'Hondt 45 , Kazuteru Monden 46 , Santiago Lopez-Ben 47 , Rong Liu 48 , Alessandro Ferrero 49 , Giuseppe Maria Ettorre 50 , Federica Cipriani 51 , Daniel Cherqui 52 , Xiao Liang 53 , Olivier Soubrane 54 , Go Wakabayashi 55 , Roberto I Troisi 56 , Mengqiu Yin 57 , Tan-To Cheung 58 , Atsushi Sugioka 59 , Ho-Seong Han 60 , Tran Cong Duy Long 61 , David Fuks 54 , Mohammad Abu Hilal 62 , Kuo-Hsin Chen 8 , Luca Aldrighetti 51 , Bjørn Edwin 7 , Brian K P Goh 63 ; International Robotic and Laparoscopic Liver Resection study group investigators are coauthors of this study
Background: The impact of cirrhosis and portal hypertension on perioperative outcomes of minimally invasive left lateral sectionectomies remains unclear. We aimed to compare the perioperative outcomes between patients with preserved and compromised liver function (noncirrhotics versus Child-Pugh A) when undergoing minimally invasive left lateral sectionectomies. In addition, we aimed to determine if the extent of cirrhosis (Child-Pugh A versus B) and the presence of portal hypertension had a significant impact on perioperative outcomes.
Methods: This was an international multicenter retrospective analysis of 1,526 patients who underwent minimally invasive left lateral sectionectomies for primary liver malignancies at 60 centers worldwide between 2004 and 2021. In the study, 1,370 patients met the inclusion criteria and formed the final study group. Baseline clinicopathological characteristics and perioperative outcomes of these patients were compared. To minimize confounding factors, 1:1 propensity score matching and coarsened exact matching were performed.
Results: The study group comprised 559, 753, and 58 patients who did not have cirrhosis, Child-Pugh A, and Child-Pugh B cirrhosis, respectively. Six-hundred and thirty patients with cirrhosis had portal hypertension, and 170 did not. After propensity score matching and coarsened exact matching, Child-Pugh A patients with cirrhosis undergoing minimally invasive left lateral sectionectomies had longer operative time, higher intraoperative blood loss, higher transfusion rate, and longer hospital stay than patients without cirrhosis. The extent of cirrhosis did not significantly impact perioperative outcomes except for a longer duration of hospital stay.
Conclusion: Liver cirrhosis adversely affected the intraoperative technical difficulty and perioperative outcomes of minimally invasive left lateral sectionectomies.
CITATION Surgery. 2023 Sep;174(3):581-592. doi: 10.1016/j.surg.2023.04.057. Epub 2023 Jun 9.
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