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

International Robotic and Laparoscopic Liver Resection Study Group Investigators

doi:10.1016/j.ejso.2023.106997

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

International Robotic and Laparoscopic Liver Resection Study Group Investigators

Sorbonne Université
National University of Singapore
Huazhong University of Science and Technology
The University of Tokyo
Viral Evolution and Transmission Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
Department of Intensive Care and Anesthesiology, Fondazione Poliambulanza, Brescia, Italy
University of Oslo
Far Eastern Memorial Hospital
Hôpital Beaujon
Universidade de São Paulo
Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello
F. Tappeiner Hospital
IRCCS Fondazione Istituto Nazionale per lo studio e la cura dei tumori - Milano
Changi General Hospital
Digestive Health Institute
Department of Abdominal and General Surgery, Slovenia
CHA University
University of Ulsan
Biocruces Bizkaia
Marche Polytechnic University
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
University of Verona
Chang Gung University
Zhejiang University
University of Barcelona
Universidad Autónoma de Madrid
Moscow Clinical Scientific Center
Fujita Health University
University of Modena and Reggio Emilia
Hôpital Henri Mondor
University of Parma
University of Pisa
Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
IRCCS Istituto nazionale tumori Fondazione Giovanni Pascale - Napoli
COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Bari, Italy
IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT) - Palermo
University of Catania
Methodist Dallas Medical Center
University of Washington
University of Navarra
Instituto de Investigación Sanitaria de Navarra
Yonsei University
Hospital Virgen de la Arrixaca
Fudan University
University Hospitals Birmingham NHS Foundation Trust
Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin
Pamela Youde Nethersole Eastern Hospital
Chinese University of Hong Kong
Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
Fukuyama City Hospital
University of Girona
Memorial Sloan-Kettering Cancer Center
Ospedale Mauriziano Umberto I
San Camillo Hospital
Hôpital Paul Brousse
Institut mutualiste Montsouris
Ageo Central General Hospital
Azienda Ospedaliera Universitaria Federico II
The University of Hong Kong
Seoul National University
University Medical Center Ho Chi Minh City
General Hospital of People's Liberation Army
Yuan Ze University
University Hospital Southampton NHS Foundation Trust
National Cancer Centre
Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
Hospital Clinic Barcelona
Department of Respiratory Functional Exploration, University Medical Center, Ho Chi Minh City, Vietnam
Département de Génétique et Cytogénétique
From the Neuroimaging Research Unit, Division of Neuroscience (P.P.), and Neurology Unite (P.P.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Department of Anatomy and Neurosciences (M.M.S.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
Fondazione Poliambulanza
Oslo University Hospital
Univerzitetni Klinični Center Maribor
Chang Gung Memorial Hospital
University Hospital La Paz
Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation
University of Pittsburgh
Division of Cardiology, Miulli General Hospital, Fonti-Bari, Italy
Methodist Health System, Texas
Navarra's Health Research Institute (IdiSNA)
Humboldt-Universität zu Berlin and Berlin Institute of Health
Department of General and Digestive Surgery, Groeninge Hospital, Kortrijk, Belgium
Duke-NUS Medical School, Singapore, Singapore
Hospital Clinic de Barcelona
University Medical Center

Research output: Contribution to journal › Article › Academic › peer-review

18 Downloads (Pure)

Abstract

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.

Original language	English
Article number	106997
Journal	European journal of surgical oncology
Volume	49
Issue number	10
DOIs	https://doi.org/10.1016/j.ejso.2023.106997
Publication status	Published - 1 Oct 2023

Keywords

Cirrhosis
Difficulty score
Laparoscopic liver
Minimally invasive liver
Posterosuperior segments

Access to Document

10.1016/j.ejso.2023.106997

Impact-of-liver-cirrhosis-and-portal-hypertension-on-minimally-invasive-limited-liver-resection-for-primary-liver-malign.pdfFinal published version, 529 KBLicence: Taverne

Cite this

International Robotic and Laparoscopic Liver Resection Study Group Investigators (2023). 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. European journal of surgical oncology, 49(10), Article 106997. https://doi.org/10.1016/j.ejso.2023.106997

@article{77ad93f6704647f9a3b6e598f3654503,

title = "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",

abstract = "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.",

keywords = "Cirrhosis, Difficulty score, Laparoscopic liver, Minimally invasive liver, Posterosuperior segments",

author = "Chetana Lim and Olivier Scatton and Wu, \{Andrew G. R.\} and Wanguang Zhang and Kiyoshi Hasegawa and Federica Cipriani and Jasper Sijberden and Aghayan, \{Davit L.\} and Tiing-Foong Siow and Safi Dokmak and Paulo Herman and Marino, \{Marco V.\} and Vincenzo Mazzaferro and Chiow, \{Adrian K. H.\} and Iswanto Sucandy and Arpad Ivanecz and Sung-Hoon Choi and Lee, \{Jae Hoon\} and Mikel Prieto and Marco Vivarelli and Felice Giuliante and Andrea Ruzzenente and Chee-Chien Yong and Mengqiu Yin and Constantino Fondevila and Mikhail Efanov and Zenichi Morise and \{di Benedetto\}, Fabrizio and Raffaele Brustia and \{Dalla Valle\}, Raffaele and Ugo Boggi and David Geller and Andrea Belli and Riccardo Memeo and Salvatore Gruttadauria and Alejandro Mejia and Park, \{James O.\} and Fernando Rotellar and Gi-Hong Choi and Ricardo Robles-Campos and Xiaoying Wang and Sutcliffe, \{Robert P.\} and Johann Pratschke and Lai, \{Eric C. H.\} and Chong, \{Charing C. N.\} and Mathieu D'Hondt and Kazuteru Monden and Santiago Lopez-Ben and Kingham, \{T. Peter\} and Alessandro Ferrero and Ettorre, \{Giuseppe Maria\} and Daniel Cherqui and Xiao Liang and Olivier Soubrane and Go Wakabayashi and Troisi, \{Roberto I.\} and Tan-To Cheung and Atsushi Sugioka and Ho-Seong Han and Long, \{Tran Cong duy\} and Rong Liu and Bj{\o}rn Edwin and David Fuks and Kuo-Hsin Chen and \{Abu Hilal\}, Mohammad and Luca Aldrighetti and Goh, \{Brian K. P.\} and Nicholas Syn and Mikel Gastaca and \{de Meyere\}, Celine and Juul Meurs and Ng, \{Kelvin K.\} and Kit-Fai Lee and Diana Salimgereeva and Ruslan Alikhanov and Nita Thiruchelvam and Jang, \{Jae Young\} and Yutaro Kato and Masayuki Kojima and Coelho, \{Fabricio Ferreira\} and \{Pirola Kruger\}, \{Jaime Arthur\} and Victor Lopez-Lopez and \{Casellas I Robert\}, Margarida and Roberto Montalti and Mariano Giglio and Boram Lee and Mizelle D'Silva and Hao-Ping Wang and Franco Pascual and Mansour Saleh and Shian Yu and Zewei Chen and Simone Vani and Francesco Ardito and Ugo Giustizieri and Davide Citterio and Federico Mocchegiani and Marco Colasanti and Giammauro Berardi and Yoelimar Guzm{\'a}n and Labadie, \{Kevin P.\} and Maria Conticchio and Epameinondas Dogeas and Kauffmann, \{Emanuele F.\} and Mario Giuffrida and Daniele Sommacale and Alexis Laurent and Paolo Magistri and Kohei Mishima and Moritz Schmelzle and Felix Krenzien and Prashant Kadam and Chung-Ngai Tang and Jacob Ghotbi and Fretland, \{{\AA}smund Avdem\} and Fabio Forchino and Valle, \{Bernardo Dalla\} and Junhao Zheng and Alessandro Mazzotta and Nghia, \{Phan Phuoc\} and Yoshikuni Kawaguchi and Qu Liu and \{International Robotic and Laparoscopic Liver Resection Study Group Investigators\} and Francois Cauchy",

note = "Funding Information: Dr M. Yin was partially funded by the Research Project of Zhejiang Provincial Public Welfare Fund project in the Field of Social development ( LGF20H160028 ). Funding Information: Dr T. P. Kingham was partially supported by the US National Cancer Institute MSKCC Core Grant number P30 CA008747 for this study. Funding Information: Dr Brian Goh was partially supported by the Intuitive Foundation Grant for this study. Any research findings, conclusions, or recommendations expressed in this work are those of the authors and not of the Intuitive Foundation. Publisher Copyright: {\textcopyright} 2023 Elsevier Ltd, BASO \textasciitilde{} The Association for Cancer Surgery, and the European Society of Surgical Oncology",

year = "2023",

month = oct,

day = "1",

doi = "10.1016/j.ejso.2023.106997",

language = "English",

volume = "49",

journal = "European journal of surgical oncology",

issn = "0748-7983",

publisher = "W.B. Saunders Ltd",

number = "10",

}

International Robotic and Laparoscopic Liver Resection Study Group Investigators 2023, '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', European journal of surgical oncology, vol. 49, no. 10, 106997. https://doi.org/10.1016/j.ejso.2023.106997

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. / International Robotic and Laparoscopic Liver Resection Study Group Investigators.
In: European journal of surgical oncology, Vol. 49, No. 10, 106997, 01.10.2023.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Impact of liver cirrhosis and portal hypertension on minimally invasive limited liver resection for primary liver malignancies in the posterosuperior segments

T2 - An international multicenter study

AU - Lim, Chetana

AU - Scatton, Olivier

AU - Wu, Andrew G. R.

AU - Zhang, Wanguang

AU - Hasegawa, Kiyoshi

AU - Cipriani, Federica

AU - Sijberden, Jasper

AU - Aghayan, Davit L.

AU - Siow, Tiing-Foong

AU - Dokmak, Safi

AU - Herman, Paulo

AU - Marino, Marco V.

AU - Mazzaferro, Vincenzo

AU - Chiow, Adrian K. H.

AU - Sucandy, Iswanto

AU - Ivanecz, Arpad

AU - Choi, Sung-Hoon

AU - Lee, Jae Hoon

AU - Prieto, Mikel

AU - Vivarelli, Marco

AU - Giuliante, Felice

AU - Ruzzenente, Andrea

AU - Yong, Chee-Chien

AU - Yin, Mengqiu

AU - Fondevila, Constantino

AU - Efanov, Mikhail

AU - Morise, Zenichi

AU - di Benedetto, Fabrizio

AU - Brustia, Raffaele

AU - Dalla Valle, Raffaele

AU - Boggi, Ugo

AU - Geller, David

AU - Belli, Andrea

AU - Memeo, Riccardo

AU - Gruttadauria, Salvatore

AU - Mejia, Alejandro

AU - Park, James O.

AU - Rotellar, Fernando

AU - Choi, Gi-Hong

AU - Robles-Campos, Ricardo

AU - Wang, Xiaoying

AU - Sutcliffe, Robert P.

AU - Pratschke, Johann

AU - Lai, Eric C. H.

AU - Chong, Charing C. N.

AU - D'Hondt, Mathieu

AU - Monden, Kazuteru

AU - Lopez-Ben, Santiago

AU - Kingham, T. Peter

AU - Ferrero, Alessandro

AU - Ettorre, Giuseppe Maria

AU - Cherqui, Daniel

AU - Liang, Xiao

AU - Soubrane, Olivier

AU - Wakabayashi, Go

AU - Troisi, Roberto I.

AU - Cheung, Tan-To

AU - Sugioka, Atsushi

AU - Han, Ho-Seong

AU - Long, Tran Cong duy

AU - Liu, Rong

AU - Edwin, Bjørn

AU - Fuks, David

AU - Chen, Kuo-Hsin

AU - Abu Hilal, Mohammad

AU - Aldrighetti, Luca

AU - Goh, Brian K. P.

AU - Syn, Nicholas

AU - Gastaca, Mikel

AU - de Meyere, Celine

AU - Meurs, Juul

AU - Ng, Kelvin K.

AU - Lee, Kit-Fai

AU - Salimgereeva, Diana

AU - Alikhanov, Ruslan

AU - Thiruchelvam, Nita

AU - Jang, Jae Young

AU - Kato, Yutaro

AU - Kojima, Masayuki

AU - Coelho, Fabricio Ferreira

AU - Pirola Kruger, Jaime Arthur

AU - Lopez-Lopez, Victor

AU - Casellas I Robert, Margarida

AU - Montalti, Roberto

AU - Giglio, Mariano

AU - Lee, Boram

AU - D'Silva, Mizelle

AU - Wang, Hao-Ping

AU - Pascual, Franco

AU - Saleh, Mansour

AU - Yu, Shian

AU - Chen, Zewei

AU - Vani, Simone

AU - Ardito, Francesco

AU - Giustizieri, Ugo

AU - Citterio, Davide

AU - Mocchegiani, Federico

AU - Colasanti, Marco

AU - Berardi, Giammauro

AU - Guzmán, Yoelimar

AU - Labadie, Kevin P.

AU - Conticchio, Maria

AU - Dogeas, Epameinondas

AU - Kauffmann, Emanuele F.

AU - Giuffrida, Mario

AU - Sommacale, Daniele

AU - Laurent, Alexis

AU - Magistri, Paolo

AU - Mishima, Kohei

AU - Schmelzle, Moritz

AU - Krenzien, Felix

AU - Kadam, Prashant

AU - Tang, Chung-Ngai

AU - Ghotbi, Jacob

AU - Fretland, Åsmund Avdem

AU - Forchino, Fabio

AU - Valle, Bernardo Dalla

AU - Zheng, Junhao

AU - Mazzotta, Alessandro

AU - Nghia, Phan Phuoc

AU - Kawaguchi, Yoshikuni

AU - Liu, Qu

AU - International Robotic and Laparoscopic Liver Resection Study Group Investigators

AU - Cauchy, Francois

N1 - Funding Information: Dr M. Yin was partially funded by the Research Project of Zhejiang Provincial Public Welfare Fund project in the Field of Social development ( LGF20H160028 ). Funding Information: Dr T. P. Kingham was partially supported by the US National Cancer Institute MSKCC Core Grant number P30 CA008747 for this study. Funding Information: Dr Brian Goh was partially supported by the Intuitive Foundation Grant for this study. Any research findings, conclusions, or recommendations expressed in this work are those of the authors and not of the Intuitive Foundation. Publisher Copyright: © 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology

PY - 2023/10/1

Y1 - 2023/10/1

N2 - 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.

AB - 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.

KW - Cirrhosis

KW - Difficulty score

KW - Laparoscopic liver

KW - Minimally invasive liver

KW - Posterosuperior segments

UR - https://www.scopus.com/pages/publications/85167820703

U2 - 10.1016/j.ejso.2023.106997

DO - 10.1016/j.ejso.2023.106997

M3 - Article

C2 - 37591027

SN - 0748-7983

VL - 49

JO - European journal of surgical oncology

JF - European journal of surgical oncology

IS - 10

M1 - 106997

ER -

International Robotic and Laparoscopic Liver Resection Study Group Investigators. 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. European journal of surgical oncology. 2023 Oct 1;49(10):106997. doi: 10.1016/j.ejso.2023.106997

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

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this