Publicaciones científicas
Impact of liver cirrhosis and portal hypertension on minimally invasive limited liver resection for primary liver malignancies in the posterosuperior segments
Chetana Lim 1 , Olivier Scatton 1 , Andrew G R Wu 2 , Wanguang Zhang 3 , Kiyoshi Hasegawa 4 , Federica Cipriani 5 , Jasper Sijberden 6 , Davit L Aghayan 7 , Tiing-Foong Siow 8 , Safi Dokmak 9 , Paulo Herman 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 Prieto 18 , Marco Vivarelli 19 , Felice Giuliante 20 , Andrea Ruzzenente 21 , Chee-Chien Yong 22 , Mengqiu Yin 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 , T Peter Kingham 48 , Alessandro Ferrero 49 , Giuseppe Maria Ettorre 50 , Daniel Cherqui 51 , Xiao Liang 52 , Olivier Soubrane 53 , Go Wakabayashi 54 , Roberto I Troisi 55 , Tan-To Cheung 56 , Atsushi Sugioka 57 , Ho-Seong Han 58 , Tran Cong Duy Long 59 , Rong Liu 60 , Bjørn Edwin 7 , David Fuks 53 , Kuo-Hsin Chen 61 , Mohammad Abu Hilal 62 , Luca Aldrighetti 5 , Brian K P Goh 63 ; International robotic and laparoscopic liver resection study group investigators
Introduction: To assess the impact of cirrhosis and portal hypertension (PHT) on technical difficulty and outcomes of minimally invasive liver resection (MILR) in the posterosuperior segments.
Methods: This is a post-hoc analysis of patients with primary malignancy who underwent laparoscopic and robotic wedge resection and segmentectomy in the posterosuperior segments between 2004 and 2019 in 60 centers. Surrogates of difficulty (i.e, open conversion rate, operation time, blood loss, blood transfusion, and use of the Pringle maneuver) and outcomes were compared before and after propensity-score matching (PSM) and coarsened exact matching (CEM).
Results: Of the 1954 patients studied, 1290 (66%) had cirrhosis. Among the cirrhotic patients, 310 (24%) had PHT. After PSM, patients with cirrhosis had higher intraoperative blood transfusion (14% vs. 9.3%; p = 0.027) and overall morbidity rates (20% vs. 14.5%; p = 0.023) than those without cirrhosis. After coarsened exact matching (CEM), patients with cirrhosis tended to have higher intraoperative blood transfusion rate (12.1% vs. 6.7%; p = 0.059) and have higher overall morbidity rate (22.8% vs. 12.5%; p = 0.007) than those without cirrhosis. After PSM, Pringle maneuver was more frequently applied in cirrhotic patients with PHT (62.2% vs. 52.4%; p = 0.045) than those without PHT.
Conclusion: MILR in the posterosuperior segments in cirrhotic patients is associated with higher intraoperative blood transfusion and postoperative morbidity. This parameter should be utilized in the difficulty assessment of MILR.
CITA DEL ARTÍCULO Eur J Surg Oncol. 2023 Oct;49(10):106997. doi: 10.1016/j.ejso.2023.106997. Epub 2023 Aug 6
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