Scientific publications
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
Federica Cipriani # 1 , Luca Aldrighetti # 1 , Francesca Ratti 1 , Andrew G R Wu 2 , Tousif Kabir 3 , Olivier Scatton 4 , Chetana Lim 4 , Wanguang Zhang 5 , Jasper Sijberden 6 , Davit L Aghayan 7 , Tiing-Foong Siow 8 , Safi Dokmak 9 , Fabricio Ferreira Coelho 10 , Paulo Herman 10 , Marco V Marino 11 12 , Vincenzo Mazzaferro 13 , Adrian K H Chiow 14 , Iswanto Sucandy 15 , Arpad Ivanecz 16 , Sung-Hoon Choi 17 , Jae Hoon Lee 18 , Mikel Gastaca 19 , Marco Vivarelli 20 , Felice Giuliante 21 , Andrea Ruzzenente 22 , Chee-Chien Yong 23 , Mengqiu Yin 24 , Constantino Fondevila 25 26 , Mikhail Efanov 27 , Zenichi Morise 28 , Fabrizio Di Benedetto 29 , Raffaele Brustia 30 , Raffaele Dalla Valle 31 , Ugo Boggi 32 , David Geller 33 , Andrea Belli 34 , Riccardo Memeo 35 , Salvatore Gruttadauria 36 37 , Alejandro Mejia 38 , James O Park 39 , Fernando Rotellar 40 41 , Gi-Hong Choi 42 , Ricardo Robles-Campos 43 , Xiaoying Wang 44 , Robert P Sutcliffe 45 , Johann Pratschke 46 , Eric C H Lai 47 , Charing C N Chong 48 , Mathieu D'Hondt 49 , Kazuteru Monden 50 , Santiago Lopez-Ben 51 , T Peter Kingham 52 , Alessandro Ferrero 53 , Giuseppe Maria Ettorre 54 , Daniel Cherqui 55 , Xiao Liang 56 , Olivier Soubrane 57 , Go Wakabayashi 58 , Roberto I Troisi 59 , Tan-To Cheung 60 , Yutaro Kato 61 , Atsushi Sugioka 61 , Ho-Seong Han 62 , Tran Cong Duy Long 63 , Qu Liu 64 , Rong Liu 64 , Bjørn Edwin 7 , David Fuks 57 , Kuo-Hsin Chen 8 , Mohammad Abu Hilal 6 65 , Brian K P Goh 66 67 ; International Robotic and Laparoscopic Liver Resection Study Group Investigators
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.
CITATION Ann Surg Oncol. 2024 Jan;31(1):97-114. doi: 10.1245/s10434-023-14376-5. Epub 2023 Nov 7
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