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Article: 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

TitleImpact 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
Authors
Cipriani, FedericaAldrighetti, LucaRatti, FrancescaWu, Andrew G RKabir, TousifScatton, OlivierLim, ChetanaZhang, WanguangSijberden, JasperAghayan, Davit LSiow, Tiing-FoongDokmak, SafiCoelho, Fabricio FerreiraHerman, PauloMarino, Marco VMazzaferro, VincenzoChiow, Adrian K HSucandy, IswantoIvanecz, ArpadChoi, Sung-HoonLee, Jae HoonGastaca, MikelVivarelli, MarcoGiuliante, FeliceRuzzenente, AndreaYong, Chee-ChienYin, MengqiuFondevila, ConstantinoEfanov, MikhailMorise, ZenichiDi Benedetto, FabrizioBrustia, RaffaeleDalla, Valle RaffaeleBoggi, UgoGeller, DavidBelli, AndreaMemeo, RiccardoGruttadauria, SalvatoreMejia, AlejandroPark, James ORotellar, FernandoChoi, Gi-HongRobles-Campos, RicardoWang, XiaoyingSutcliffe, Robert PPratschke, JohannLai, Eric C HChong, Charing C ND’Hondt, MathieuMonden, KazuteruLopez-Ben, SantiagoKingham, T PeterFerrero, AlessandroEttorre, Giuseppe MariaCherqui, DanielLiang, XiaoSoubrane, OlivierWakabayashi, GoTroisi, Roberto ICheung, Tan-ToKato, YutaroSugioka, AtsushiHan, Ho-SeongLong, Tran Cong duyLiu, QuLiu, RongEdwin, BjørnFuks, DavidChen, Kuo-HsinAbu, Hilal MohammadGoh, Brian K PSyn, Nicholas LPrieto, Mikelde Meyere, CelineMeurs, JuulNg, Kelvin KLee, Kit-FaiSalimgereeva, DianaAlikhanov, RuslanThiruchelvam, NitaJang, Jae YoungKojima, MasayukiKruger, Jaime Arthur PirolaLopez-Lopez, VictorRobert, Margarida Casellas IMontalti, RobertoGiglio, MarianoLee, BoramD’Silva, MizelleWang, Hao-PingPascual, FrancoSaleh, MansourYu, ShianChen, ZeweiVani, SimoneArdito, FrancescoGiustizieri, UgoCitterio, DavideMocchegiani, FedericoColasanti, MarcoBerardi, GiammauroGuzmán, YoelimarLabadie, Kevin PConticchio, MariaDogeas, EpameinondasKauffmann, Emanuele FGiuffrida, MarioSommacale, DanieleLaurent, AlexisMagistri, PaoloMishima, KoheiSchmelzle, MoritzKrenzien, FelixKadam, PrashantTang, Chung-NgaiGhotbi, JacobFretland, Åsmund AvdemForchino, FabioDalla, Valle BernardoZheng, JunhaoMazzotta, AlessandroNghia, Phan PhuocCauchy, Francois
KeywordsCirrhosis
Difficulty score
Laparoscopic hepatectomy
Laparoscopic liver
Minimally invasive hepatectomy
Minimally invasive liver
Issue Date7-Nov-2023
PublisherSpringer
Citation
Annals of Surgical Oncology, 2023, v. 31, n. 1, p. 97-114 How to Cite?
Abstract

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.


Persistent Identifierhttp://hdl.handle.net/10722/339293
ISSN
2023 Impact Factor: 3.4
2023 SCImago Journal Rankings: 1.037
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorCipriani, Federica-
dc.contributor.authorAldrighetti, Luca-
dc.contributor.authorRatti, Francesca-
dc.contributor.authorWu, Andrew G R-
dc.contributor.authorKabir, Tousif-
dc.contributor.authorScatton, Olivier-
dc.contributor.authorLim, Chetana-
dc.contributor.authorZhang, Wanguang-
dc.contributor.authorSijberden, Jasper-
dc.contributor.authorAghayan, Davit L-
dc.contributor.authorSiow, Tiing-Foong-
dc.contributor.authorDokmak, Safi-
dc.contributor.authorCoelho, Fabricio Ferreira-
dc.contributor.authorHerman, Paulo-
dc.contributor.authorMarino, Marco V-
dc.contributor.authorMazzaferro, Vincenzo-
dc.contributor.authorChiow, Adrian K H-
dc.contributor.authorSucandy, Iswanto-
dc.contributor.authorIvanecz, Arpad-
dc.contributor.authorChoi, Sung-Hoon-
dc.contributor.authorLee, Jae Hoon-
dc.contributor.authorGastaca, Mikel-
dc.contributor.authorVivarelli, Marco-
dc.contributor.authorGiuliante, Felice-
dc.contributor.authorRuzzenente, Andrea-
dc.contributor.authorYong, Chee-Chien-
dc.contributor.authorYin, Mengqiu-
dc.contributor.authorFondevila, Constantino-
dc.contributor.authorEfanov, Mikhail-
dc.contributor.authorMorise, Zenichi-
dc.contributor.authorDi Benedetto, Fabrizio-
dc.contributor.authorBrustia, Raffaele-
dc.contributor.authorDalla, Valle Raffaele-
dc.contributor.authorBoggi, Ugo-
dc.contributor.authorGeller, David-
dc.contributor.authorBelli, Andrea-
dc.contributor.authorMemeo, Riccardo-
dc.contributor.authorGruttadauria, Salvatore-
dc.contributor.authorMejia, Alejandro-
dc.contributor.authorPark, James O-
dc.contributor.authorRotellar, Fernando-
dc.contributor.authorChoi, Gi-Hong-
dc.contributor.authorRobles-Campos, Ricardo-
dc.contributor.authorWang, Xiaoying-
dc.contributor.authorSutcliffe, Robert P-
dc.contributor.authorPratschke, Johann-
dc.contributor.authorLai, Eric C H-
dc.contributor.authorChong, Charing C N-
dc.contributor.authorD’Hondt, Mathieu-
dc.contributor.authorMonden, Kazuteru-
dc.contributor.authorLopez-Ben, Santiago-
dc.contributor.authorKingham, T Peter-
dc.contributor.authorFerrero, Alessandro-
dc.contributor.authorEttorre, Giuseppe Maria-
dc.contributor.authorCherqui, Daniel-
dc.contributor.authorLiang, Xiao-
dc.contributor.authorSoubrane, Olivier-
dc.contributor.authorWakabayashi, Go-
dc.contributor.authorTroisi, Roberto I-
dc.contributor.authorCheung, Tan-To-
dc.contributor.authorKato, Yutaro-
dc.contributor.authorSugioka, Atsushi-
dc.contributor.authorHan, Ho-Seong-
dc.contributor.authorLong, Tran Cong duy-
dc.contributor.authorLiu, Qu-
dc.contributor.authorLiu, Rong-
dc.contributor.authorEdwin, Bjørn-
dc.contributor.authorFuks, David-
dc.contributor.authorChen, Kuo-Hsin-
dc.contributor.authorAbu, Hilal Mohammad-
dc.contributor.authorGoh, Brian K P-
dc.contributor.authorSyn, Nicholas L-
dc.contributor.authorPrieto, Mikel-
dc.contributor.authorde Meyere, Celine-
dc.contributor.authorMeurs, Juul-
dc.contributor.authorNg, Kelvin K-
dc.contributor.authorLee, Kit-Fai-
dc.contributor.authorSalimgereeva, Diana-
dc.contributor.authorAlikhanov, Ruslan-
dc.contributor.authorThiruchelvam, Nita-
dc.contributor.authorJang, Jae Young-
dc.contributor.authorKojima, Masayuki-
dc.contributor.authorKruger, Jaime Arthur Pirola-
dc.contributor.authorLopez-Lopez, Victor-
dc.contributor.authorRobert, Margarida Casellas I-
dc.contributor.authorMontalti, Roberto-
dc.contributor.authorGiglio, Mariano-
dc.contributor.authorLee, Boram-
dc.contributor.authorD’Silva, Mizelle-
dc.contributor.authorWang, Hao-Ping-
dc.contributor.authorPascual, Franco-
dc.contributor.authorSaleh, Mansour-
dc.contributor.authorYu, Shian-
dc.contributor.authorChen, Zewei-
dc.contributor.authorVani, Simone-
dc.contributor.authorArdito, Francesco-
dc.contributor.authorGiustizieri, Ugo-
dc.contributor.authorCitterio, Davide-
dc.contributor.authorMocchegiani, Federico-
dc.contributor.authorColasanti, Marco-
dc.contributor.authorBerardi, Giammauro-
dc.contributor.authorGuzmán, Yoelimar-
dc.contributor.authorLabadie, Kevin P-
dc.contributor.authorConticchio, Maria-
dc.contributor.authorDogeas, Epameinondas-
dc.contributor.authorKauffmann, Emanuele F-
dc.contributor.authorGiuffrida, Mario-
dc.contributor.authorSommacale, Daniele-
dc.contributor.authorLaurent, Alexis-
dc.contributor.authorMagistri, Paolo-
dc.contributor.authorMishima, Kohei-
dc.contributor.authorSchmelzle, Moritz-
dc.contributor.authorKrenzien, Felix-
dc.contributor.authorKadam, Prashant-
dc.contributor.authorTang, Chung-Ngai-
dc.contributor.authorGhotbi, Jacob-
dc.contributor.authorFretland, Åsmund Avdem-
dc.contributor.authorForchino, Fabio-
dc.contributor.authorDalla, Valle Bernardo-
dc.contributor.authorZheng, Junhao-
dc.contributor.authorMazzotta, Alessandro-
dc.contributor.authorNghia, Phan Phuoc-
dc.contributor.authorCauchy, Francois-
dc.date.accessioned2024-03-11T10:35:28Z-
dc.date.available2024-03-11T10:35:28Z-
dc.date.issued2023-11-07-
dc.identifier.citationAnnals of Surgical Oncology, 2023, v. 31, n. 1, p. 97-114-
dc.identifier.issn1068-9265-
dc.identifier.urihttp://hdl.handle.net/10722/339293-
dc.description.abstract<h3>Background</h3><p>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.</p><h3>Methods</h3><p>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.</p><h3>Results</h3><p>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.</p><h3>Conclusions</h3><p>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.</p>-
dc.languageeng-
dc.publisherSpringer-
dc.relation.ispartofAnnals of Surgical Oncology-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectCirrhosis-
dc.subjectDifficulty score-
dc.subjectLaparoscopic hepatectomy-
dc.subjectLaparoscopic liver-
dc.subjectMinimally invasive hepatectomy-
dc.subjectMinimally invasive liver-
dc.titleImpact 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-
dc.typeArticle-
dc.identifier.doi10.1245/s10434-023-14376-5-
dc.identifier.scopuseid_2-s2.0-85176113548-
dc.identifier.volume31-
dc.identifier.issue1-
dc.identifier.spage97-
dc.identifier.epage114-
dc.identifier.eissn1534-4681-
dc.identifier.isiWOS:001102905600003-
dc.identifier.issnl1068-9265-

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