Publicaciones científicas
Impact of liver cirrhosis, severity of cirrhosis and portal hypertension on the difficulty of laparoscopic and robotic minor liver resections for primary liver malignancies in the anterolateral segments
Junhao Zheng 1 , Xiao Liang 2 , Andrew G R Wu 3 , Tousif Kabir 4 , Olivier Scatton 5 , Chetana Lim 5 , Kiyoshi Hasegawa 6 , Jasper P Sijberden 7 , Davit L Aghayan 8 , Tiing Foong Siow 9 , Safi Dokmak 10 , Paulo Herman 11 , Marco V Marino 12 , Vincenzo Mazzaferro 13 , Adrian K H Chiow 14 , Iswanto Sucandy 15 , Arpad Ivanecz 16 , Sung Hoon Choi 17 , Jae Hoon Lee 18 , Mikel Prieto 19 , Marco Vivarelli 20 , Felice Giuliante 21 , Andrea Ruzzenente 22 , Chee-Chien Yong 23 , Mengqiu Yin 24 , Zewei Chen 24 , Constantino Fondevila 25 , Mikhail Efanov 26 , Zenichi Morise 27 , Fabrizio Di Benedetto 28 , Raffaele Brustia 29 , Raffaele Dalla Valle 30 , Ugo Boggi 31 , David Geller 32 , Andrea Belli 33 , Riccardo Memeo 34 , Salvatore Gruttadauria 35 , Alejandro Mejia 36 , James O Park 37 , Fernando Rotellar 38 , Gi-Hong Choi 39 , Ricardo Robles-Campos 40 , Xiaoying Wang 41 , Robert P Sutcliffe 42 , Johann Pratschke 43 , Eric C H Lai 44 , Charing C N Chong 45 , Mathieu D'Hondt 46 , Kazuteru Monden 47 , Santiago Lopez-Ben 48 , T Peter Kingham 49 , Alessandro Ferrero 50 , Giuseppe Maria Ettorre 51 , Daniel Cherqui 52 , Federica Cipriani 53 , Olivier Soubrane 54 , Wanguang Zhang 55 , Go Wakabayashi 56 , Roberto I Troisi 57 , Tan-To Cheung 58 , Yutaro Kato 59 , Atsushi Sugioka 59 , Tran Cong Duy Long 60 , Rong Liu 61 , Bjørn Edwin 8 , David Fuks 54 , Mohammad Abu Hilal 62 , Kuo-Hsin Chen 9 , Luca Aldrighetti 53 , Ho-Seong Han 63 , Brian K P Goh 64 ; International robotic and laparoscopic liver resection study group investigators
Introduction: We performed this study in order to investigate the impact of liver cirrhosis (LC) on the difficulty of minimally invasive liver resection (MILR), focusing on minor resections in anterolateral (AL) segments for primary liver malignancies.
Methods: This was an international multicenter retrospective study of 3675 patients who underwent MILR across 60 centers from 2004 to 2021.
Results: 1312 (35.7%) patients had no cirrhosis, 2118 (57.9%) had Child A cirrhosis and 245 (6.7%) had Child B cirrhosis. After propensity score matching (PSM), patients in Child A cirrhosis group had higher rates of open conversion (p = 0.024), blood loss >500 mls (p = 0.001), blood transfusion (p < 0.001), postoperative morbidity (p = 0.004), and in-hospital mortality (p = 0.041). After coarsened exact matching (CEM), Child A cirrhotic patients had higher open conversion rate (p = 0.05), greater median blood loss (p = 0.014) and increased postoperative morbidity (p = 0.001). Compared to Child A cirrhosis, Child B cirrhosis group had longer postoperative stay (p = 0.001) and greater major morbidity (p = 0.012) after PSM, and higher blood transfusion rates (p = 0.002), longer postoperative stay (p < 0.001), and greater major morbidity (p = 0.006) after CEM. After PSM, patients with portal hypertension experienced higher rates of blood loss >500 mls (p = 0.003) and intraoperative blood transfusion (p = 0.025).
Conclusion: The presence and severity of LC affect and compound the difficulty of MILR for minor resections in the AL segments. These factors should be considered for inclusion into future difficulty scoring systems for MILR.
CITA DEL ARTÍCULO Eur J Surg Oncol. 2023 Nov 8;50(1):107252. doi: 10.1016/j.ejso.2023.107252
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