Factors associated with and impact of open conversion on the outcomes of minimally invasive left lateral sectionectomies: An international multicenter study

Wang, Hao Ping; Yong, Chee Chien; Wu, Andrew G.R.; Cherqui, Daniel; Troisi, Roberto; Cipriani, Federica; Marino, Marco Vito; Belli, Andrea; Chiow, Adrian Kah Heng; Sucandy, Iswanto; Ivanecz, Arpad; Vivarelli, Marco; Benedetto, Fabrizio Di; Choi, Sung‐Hoon; Lee, Jae Hoon; Park, James O.; Gastaca, Mikel; Fondevila, Constantino; Ефанов, Михаил; Rotellar, Fernando; Choi, Gi-Hong; Campos, Ricardo Robles; Wang, Xiaoying; Sutcliffe, Robert P.; Pratschke, Johann; Tang, Chung Ngai; Chong, Charing C.N.; D’Hondt, Mathieu; Ruzzenente, Andrea; Herman, Paolo; Kingham, T. Peter; Scatton, Olivier; Liu, Rong; Ferrero, Alessandro; Sandri, Giovanni Battista Levi; Soubrane, Olivier; Mejía, Alejandro; López‐Ben, Santiago; Sijberden, Jasper; Monden, Kazuteru; Wakabayashi, Go; Sugioka, Atsushi; Cheung, Tan‐To; Long, Tran Cong Duy; Edwin, Bjørn; Han, Ho‐Seong; Fuks, David; Aldrighetti, Luca; Hilal, M. Abu; Goh, Brian K. P.; Chan, Chung‐Yip; Syn, Nicholas; Prieto, Mikel; Schotte, Henri; Meyere, Céline De; Krenzien, Felix; Schmelzle, Moritz; Lee, Kit‐Fai; Salimgereeva, Diana; Alikhanov, Ruslan; Lee, Lip Seng; Jang, Jae Young; Labadie, Kevin P.; Kojima, Masayasu; Kato, Yutaro; Ghotbi, Jacob; Coelho, Fabrício Ferreira; Krüger, Jaime Arthur Pirola; López-López, Víctor; Magistri, Paolo; Valle, Bernardo Dalla; Robert, Margarida Casellas I; Mishima, Kazuo; Ettorre, Giuseppe Maria; Mocchegiani, Federico; Kadam, Prashant; Pascual, Franco; Saleh, Mansour; Mazzotta, Alessandro; Montalti, Roberto; Giglio, Mariano Cesare; Lee, Boram; D’Silva, Mizelle; Nghia, Phan Phuoc; Lim, Chetana; Liu, Qu; Lai, Eric C. H.

doi:10.1016/j.surg.2022.03.037

Cited by 13 publications

(7 citation statements)

References 46 publications

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“…18 Not unexpectedly, tumor size has also been shown to be an important predictor of open conversion during L-LLS. 18 We performed this study with the primary objective of examining the relationship between tumor size and difficulty of L-LLS, and to elucidate the optimal tumor size cutoff for stratifying the difficulty of this procedure. Presently, commonly used DSS such as the Iwate Criteria 2 and Southampton score 3 have incorporated tumor size in the calculation of the difficulty score.…”

Section: Discussionmentioning

confidence: 98%

“…12,13,[15][16][17] This is due to the favorable anatomical morphology and topography of the left lateral section. 18 Nonetheless, unexpected difficulties may still be encountered during L-LLS and a small proportion of cases may undergo an unplanned open conversion even in expert centers. 18 Not unexpectedly, tumor size has also been shown to be an important predictor of open conversion during L-LLS.…”

Section: Discussionmentioning

confidence: 99%

“…18 Nonetheless, unexpected difficulties may still be encountered during L-LLS and a small proportion of cases may undergo an unplanned open conversion even in expert centers. 18 Not unexpectedly, tumor size has also been shown to be an important predictor of open conversion during L-LLS. 18 We performed this study with the primary objective of examining the relationship between tumor size and difficulty of L-LLS, and to elucidate the optimal tumor size cutoff for stratifying the difficulty of this procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Today, L‐LLS is one of the most frequently performed types of LLR and it has been proposed to be the standard of care for lesions located in the left lateral section 12,13,15–17 . This is due to the favorable anatomical morphology and topography of the left lateral section 18 . Nonetheless, unexpected difficulties may still be encountered during L‐LLS and a small proportion of cases may undergo an unplanned open conversion even in expert centers 18 .…”

Section: Discussionmentioning

confidence: 99%

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Impact of tumor size on the difficulty of laparoscopic left lateral sectionectomies

Arizza

Russolillo

Ferrero

et al. 2022

J Hepato Biliary Pancreat

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Background Tumor size (TS) represents a critical parameter in the risk assessment of laparoscopic liver resections (LLR). Moreover, TS has been rarely related to the extent of liver resection. The aim of this study was to study the relationship between tumor size and difficulty of laparoscopic left lateral sectionectomy (L‐LLS). Methods The impact of TS cutoffs was investigated by stratifying tumor size at each 10 mm‐interval. The optimal cutoffs were chosen taking into consideration the number of endpoints which show a statistically significant split around the cut‐points of interest and the magnitude of relative risk after correction for multiple risk factors. Results A total of 1910 L‐LLS were included. Overall, open conversion and intraoperative blood transfusion were 3.1 and 3.3%, respectively. The major morbidity rate was 2.7% and 90‐days mortality 0.6%. Three optimal TS cutoffs were identified: 40‐, 70‐, and 100‐mm. All the selected cutoffs showed a significant discriminative power for the prediction of open conversion, operative time, blood transfusion and need of Pringle maneuver. Moreover, 70‐ and 100‐mm cutoffs were both discriminative for estimated blood loss and major complications. A stepwise increase in rates of open conversion rate (Z = 3.90, P < .001), operative time (Z = 3.84, P < .001), blood loss (Z = 6.50, P < .001), intraoperative blood transfusion rate (Z = 5.15, P < .001), Pringle maneuver use (Z = 6.48, P < .001), major morbidity(Z = 2.17, P = .030) and 30‐days readmission (Z = 1.99, P = .047) was registered as the size increased. Conclusion L‐LLS for tumors of increasing size was associated with poorer intraoperative and early postoperative outcomes suggesting increasing difficulty of the procedure. We determined three optimal TS cutoffs (40‐, 70‐ and 100‐mm) to accurately stratify surgical difficulty after L‐LLS.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of tumor size on the difficulty of laparoscopic left lateral sectionectomies

Arizza

Russolillo

Ferrero

et al. 2022

J Hepato Biliary Pancreat

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“…However, no significant difference between the two groups was found in operative time, conversion rate to open surgery, and overall complication rate. Independent risk factors for the conversion rate to open surgery during LH included large tumor size, extensive hepatectomy, cirrhosis, and portal hypertension [ 25 – 27 ]. Through a meta-analysis, Wang et al revealed no significant difference in the conversion rate to open surgery between patients with and without cirrhosis performing LH [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic hepatectomy for hepatocellular carcinoma in patients with clinically significant portal hypertension: a systematic review and meta-analysis

Xiang,

Wu,

et al. 2024

World J Surg Onc

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Objective To compare the effects of laparoscopic hepatectomy (LH) on the short-term and long-term outcomes in hepatocellular carcinoma (HCC) patients with and without clinically significant portal hypertension (CSPH). Methods A systematic literature search of the PubMed, EMBASE, and Cochrane databases was performed for articles published from inception to March 1, 2023. Meta-analysis of surgical and oncological outcomes was performed using a random effects model. Data were summarized as mean difference and risk ratio with 95% confidence intervals. Results Five cohort studies with a total of 310 HCC patients were included (CSPH 143; Non-CSPH 167). In terms of surgical outcomes, estimated blood loss and the length of hospital stay were significantly lower in the Non-CSPH group than in the CSPH group. There were no significant differences between the two groups regarding other surgical outcomes, including the operative time, ratio of conversion to open surgery, and overall complication rate. In addition, there were also no significant differences between the two groups regarding the oncological outcomes, such as 1-, 3-, and 5-year overall survival. Conclusions HCC patients with and without CSPH who underwent LH had comparable surgical and oncological outcomes. LH is a safe and effective treatment for HCC patients with CSPH under the premise of rational screening of patients.

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Robotic versus laparoscopic liver resection for liver malignancy: a systematic review and meta-analysis of propensity score-matched studies

Long,

Li,

Liang

et al. 2023

Surg Endosc

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Factors associated with and impact of open conversion on the outcomes of minimally invasive left lateral sectionectomies: An international multicenter study

Cited by 13 publications

References 46 publications

Impact of tumor size on the difficulty of laparoscopic left lateral sectionectomies

Impact of tumor size on the difficulty of laparoscopic left lateral sectionectomies

Laparoscopic hepatectomy for hepatocellular carcinoma in patients with clinically significant portal hypertension: a systematic review and meta-analysis

Robotic versus laparoscopic liver resection for liver malignancy: a systematic review and meta-analysis of propensity score-matched studies

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