Impact of liver cirrhosis and portal hypertension on minimally invasive limited liver resection for primary liver malignancies in the posterosuperior segments: An international multicenter study.
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Lim Chetana, Scatton Olivier, Wu Andrew G R, Zhang Wanguang, Hasegawa Kiyoshi, Cipriani Federica, Sijberden Jasper, 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, 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, Liang Xiao, Soubrane Olivier, Wakabayashi Go, Troisi Roberto I, Cheung Tan-To, Sugioka Atsushi, Han Ho-Seong, Long Tran Cong Duy, Liu Rong, Edwin Bjørn, Fuks David, Chen Kuo-Hsin, Abu Hilal Mohammad, Aldrighetti Luca, Goh Brian K P, International robotic and laparoscopic liver resection study group investigators
Аннотация
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.