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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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单位: [a]Department of Digestive, HBP and Liver Transplantation, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France [b]Yong Loo Lin School of Medicine, National University of Singapore, Singapore [c]Hepatic Surgery Center and Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China [d]Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan [e]Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy [f]Department of Surgery, Fondazione Poliambulanza, Brescia, Italy [g]The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clincal Medicine, University of Oslo, Oslo, Norway [h]Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan [i]Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University Paris Cite, Clichy, France [j]Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil [k]General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy [l]General Surgery Department, F. Tappeiner Hospital, Merano, Italy [m]HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano and University of Milan, Milan, Italy [n]Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore [o]Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA [p]Department of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia [q]Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea [r]Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea [s]Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain [t]HPB Surgery and Transplantation Unit, United Hospital of Ancona, Department of Experimental and Clinical Medicine Polytechnic University of Marche, Ancona, Italy [u]Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy [v]General and Hepatobiliary Surgery, Department of Surgery, Dentistry, Gynecology and Pediatrics University of Verona, GB Rossi Hospital, Verona, Italy [w]Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan [x]Department of Hepatobiliary Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China [y]General and Digestive Surgery, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain [z]General and Digestive Surgery, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain [aa]Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia [ab]Department of Surgery, Okazaki Medical Center, Fujita Health University School of Medicine, Okazaki, Japan [ac]HPB Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy [ad]Department of Digestive and Hepatobiliary and Pancreatic Surgery, AP-HP, Henri-Mondor Hospital, Creteil, France [ae]Hepatobiliary Surgery Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy [af]Division of General and Transplant Surgery, University of Pisa, Pisa, Italy [ag]Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA [ah]Department of Abdominal Oncology, Division of Hepatopancreatobiliary Surgical Oncology, National Cancer Center – IRCCS-G. Pascale, Naples, Italy [ai]Unit of Hepato-Pancreatc-Biliary Surgery, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti, Bari, Italy [aj]Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center Italy, Palermo, Italy [ak]Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy [al]The Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA [am]Department of Surgery, University of Washington Medical Center, Seattle, USA [an]HPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain [ao]Institute of Health Research of Navarra (IdisNA), Pamplona, Spain [ap]Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea [aq]Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain [ar]Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China [as]Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom [at]Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany [au]Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China [av]Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong, China [aw]Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium [ax]Department of Surgery, Fukuyama City Hospital, Hiroshima, Japan [ay]Hepatobiliary and Pancreatic Surgery Unit, Department of Surgery, Dr. Josep Trueta Hospital, IdIBGi, Girona, Spain [az]Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA [ba]Department of General and Oncological Surgery. Mauriziano Hospital, Turin, Italy [bb]Division of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy [bc]Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France [bd]Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China [be]Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France [bf]Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan [bg]Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy [bh]Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China [bi]Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan [bj]Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, South Korea [bk]Department of Hepato-Pancreato-Biliary Surgery, University Medical Center Ho Chi Minh City, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam [bl]Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China [bm]Department of Surgery, University Hospital Southampton, United Kingdom [bn]Department of Surgery, Fondazione Poliambulanza, Brescia, Italy [bo]Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore [bp]Surgery Academic Clinical Programme, Duke-National University of Singapore Medical School, Singapore [bq]Division of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
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关键词: Laparoscopic liver Posterosuperior segments Minimally invasive liver Cirrhosis Difficulty score

摘要:
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.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).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.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.© 2023 Published by Elsevier Ltd.

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出版当年[2022]版:
大类 | 2 区 医学
小类 | 2 区 外科 3 区 肿瘤学
最新[2025]版:
大类 | 2 区 医学
小类 | 2 区 肿瘤学 2 区 外科
JCR分区:
出版当年[2021]版:
Q1 SURGERY Q3 ONCOLOGY
最新[2023]版:
Q1 SURGERY Q2 ONCOLOGY

影响因子: 最新[2023版] 最新五年平均 出版当年[2021版] 出版当年五年平均 出版前一年[2020版] 出版后一年[2022版]

第一作者:
第一作者单位: [a]Department of Digestive, HBP and Liver Transplantation, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
通讯作者:
通讯机构: [bo]Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore [bp]Surgery Academic Clinical Programme, Duke-National University of Singapore Medical School, Singapore [*1]Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Level 5, 20 College Road, Academia, Singapore 169856
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