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

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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)97-114
Number of pages18
JournalAnnals of Surgical Oncology
Volume31
Issue number1
DOIs
Publication statusPublished - 01-2024

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

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