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.
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Zheng Junhao, Liang Xiao, Wu Andrew G R, Kabir Tousif, Scatton Olivier, Lim Chetana, Hasegawa Kiyoshi, Sijberden Jasper P, Aghayan Davit L, Siow Tiing Foong, Dokmak Safi, Herman Paulo, Marino Marco V, Mazzaferro Vincenzo, Chiow Adrian K H, Sucandy Iswanto, Ivanecz Arpad, Choi Sung Hoon, Lee Jae Hoon, Prieto Mikel, Vivarelli Marco, Giuliante Felice, Ruzzenente Andrea, Yong Chee-Chien, Yin Mengqiu, Chen Zewei, Fondevila Constantino, Efanov Mikhail, Morise Zenichi, Di Benedetto Fabrizio, Brustia Raffaele, Dalla Valle Raffaele, Boggi Ugo, Geller David, Belli Andrea, Memeo Riccardo, Gruttadauria Salvatore, Mejia Alejandro, Park James O, Rotellar Fernando, Choi Gi-Hong, Robles-Campos Ricardo, Wang Xiaoying, Sutcliffe Robert P, Pratschke Johann, Lai Eric C H, Chong Charing C N, D'Hondt Mathieu, Monden Kazuteru, Lopez-Ben Santiago, Kingham T Peter, Ferrero Alessandro, Ettorre Giuseppe Maria, Cherqui Daniel, Cipriani Federica, Soubrane Olivier, Zhang Wanguang, Wakabayashi Go, Troisi Roberto I, Cheung Tan-To, Kato Yutaro, Sugioka Atsushi, Long Tran Cong Duy, Liu Rong, Edwin Bjørn, Fuks David, Abu Hilal Mohammad, Chen Kuo-Hsin, Aldrighetti Luca, Han Ho-Seong, Goh Brian K P, International robotic and laparoscopic liver resection study group investigators
Аннотация
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.