Sub-classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes

Andrea Ruzzenente, Bernardo Dalla Valle, Edoardo Poletto, Nicholas L. Syn, Tousif Kabir, Atsushi Sugioka, Federica Cipriani, Daniel Cherqui, Ho Seong Han, Thomas Armstrong, Tran Cong Duy Long, Olivier Scatton, Paolo Herman, Johann Pratschke, Davit L. Aghayan, Rong Liu, Marco V. Marino, Adrian K.H. Chiow, Iswanto Sucandy, Arpad IvaneczMarco Vivarelli, Fabrizio Di Benedetto, Sung Hoon Choi, Jae Hoon Lee, Mikel Prieto, Constantino Fondevila, Mikhail Efanov, Fernando Rotellar, Gi Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P. Sutcliffe, Eric C.H. Lai, Charing C. Chong, Mathieu D'Hondt, Chee Chien Yong, Roberto I. Troisi, T. Peter Kingham, Alessandro Ferrero, Giovanni Battista Levi Sandri, Olivier Soubrane, Mengqiu Yin, Santiago Lopez-Ben, Vincenzo Mazzaferro, Felice Giuliante, Kazateru Monden, Kohei Mishima, Go Wakabayashi, Tan To Cheung, David Fuks, Mohammad Abu Hilal, Kuo Hsin Chen, Luca Aldrighetti, Bjorn Edwin, Brian K.P. Goh

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background: The aim of this multicentric study was to investigate the impact of tumor location and size on the difficulty of Laparoscopic-Left Hepatectomy (L-LH). Methods: Patients who underwent L-LH performed across 46 centers from 2004 to 2020 were analyzed. Of 1236 L-LH, 770 patients met the study criteria. Baseline clinical and surgical characteristics with a potential impact on LLR were included in a multi-label conditional interference tree. Tumor size cut-off was algorithmically determined. Results: Patients were stratified into 3 groups based on tumor location and dimension: 457 in antero-lateral location (Group 1), 144 in postero-superior segment (4a) with tumor size ≤40 mm (Group 2), and 169 in postero-superior segment (4a) with tumor size >40 mm (Group 3). Patients in the Group 3 had higher conversion rate (7.0% vs. 7.6% vs. 13.0%, p-value.048), longer operating time (median, 240 min vs. 285 min vs. 286 min, p-value <.001), greater blood loss (median, 150 mL vs. 200 mL vs. 250 mL, p-value <.001) and higher intraoperative blood transfusion rate (5.7% vs. 5.6% vs. 11.3%, p-value.039). Pringle's maneuver was also utilized more frequently in Group 3 (66.7%), compared to Group 1 (53.2%) and Group 2 (51.8%) (p =.006). There were no significant differences in postoperative stay, major morbidity, and mortality between the three groups. Conclusion: L-LH for tumors that are >40 mm in diameter and located in PS Segment 4a are associated with the highest degree of technical difficulty. However, post-operative outcomes were not different from L-LH of smaller tumors located in PS segments, or tumors located in the antero-lateral segments.

Original languageEnglish
Pages (from-to)1098-1110
Number of pages13
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Issue number9
Publication statusPublished - 09-2023

All Science Journal Classification (ASJC) codes

  • Surgery
  • Hepatology


Dive into the research topics of 'Sub-classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes'. Together they form a unique fingerprint.

Cite this