Minimally invasive liver resection for huge (≥10 cm) tumors: an international multicenter matched cohort study with regression discontinuity analyses

Cheung, Tan‐To; Wang, Xiaoying; Ефанов, Михаил; Liu, Rong; Fuks, David; Choi, Gi-Hong; Syn, Nicholas; Chong, Charing C.N.; Sucandy, Iswanto; Chiow, Adrian Kah Heng; Marino, Marco Vito; Gastaca, Mikel; Lee, Jae Hoon; Kingham, T. Peter; D’Hondt, Mathieu; Choi, Sung Hoon; Sutcliffe, Robert P.; Han, Ho‐Seong; Tang, Chung Ngai; Pratschke, Johann; Troisi, Roberto; Goh, Brian K.P.

doi:10.21037/hbsn-21-327

Cited by 23 publications

(19 citation statements)

References 39 publications

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“…Comparison with the group of patients with smaller metastases shows that laparoscopic resection of large liver tumors in expert hands can achieve similar surgical outcomes. The higher blood loss seen in this series is in line with the previous studies on laparoscopic liver resection for large liver tumors [ 32 , 34 ]. The worse overall survival in the large tumor group was somehow expected since the size of the tumor is a prognostic factor and has been included in clinical scoring systems [ 35 , 36 ].…”

Section: Discussionsupporting

confidence: 91%

Laparoscopic parenchyma-sparing liver resection for large (≥ 50 mm) colorectal metastases

et al. 2022

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Background Traditionally, patients with large liver tumors (≥ 50 mm) have been considered for anatomic major hepatectomy. Laparoscopic resection of large liver lesions is technically challenging and often performed by surgeons with extensive experience. The current study aimed to evaluate the surgical and oncologic safety of laparoscopic parenchyma-sparing liver resection in patients with large colorectal metastases. Methods Patients who primarily underwent laparoscopic parenchyma-sparing liver resection (less than 3 consecutive liver segments) for colorectal liver metastases between 1999 and 2019 at Oslo University Hospital were analyzed. In some recent cases, a computer-assisted surgical planning system was used to better visualize and understand the patients’ liver anatomy, as well as a tool to further improve the resection strategy. The surgical and oncologic outcomes of patients with large (≥ 50 mm) and small (< 50 mm) tumors were compared. Multivariable Cox-regression analysis was performed to identify risk factors for survival. Results In total 587 patients met the inclusion criteria (large tumor group, n = 59; and small tumor group, n = 528). Median tumor size was 60 mm (range, 50–110) in the large tumor group and 21 mm (3–48) in the small tumor group (p < 0.001). Patient age and CEA level were higher in the large tumor group (8.4 μg/L vs. 4.6 μg/L, p < 0.001). Operation time and conversion rate were similar, while median blood loss was higher in the large tumor group (500 ml vs. 200 ml, p < 0.001). Patients in the large tumor group had shorter 5 year overall survival (34% vs 49%, p = 0.027). However, in the multivariable Cox-regression analysis tumor size did not impact survival, unlike parameters such as age, ASA score, CEA level, extrahepatic disease at liver surgery, and positive lymph nodes in the primary tumor. Conclusion Laparoscopic parenchyma-sparing resections for large colorectal liver metastases provide satisfactory short and long-term outcomes. Graphical abstract

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Section: Discussionsupporting

confidence: 91%

Laparoscopic parenchyma-sparing liver resection for large (≥ 50 mm) colorectal metastases

et al. 2022

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“…In the study, comparison between MILR for 174 huge tumors with 174 large (3–9.9 cm) tumors demonstrated not unexpectedly poorer outcomes in terms of blood loss, major morbidity and length of stay. However, the perioperative outcomes of MILR for huge tumors compared favourably with previous studies reporting on open LR for huge tumours ( 20 ).…”

Section: Discussionsupporting

confidence: 51%

“…We had previously published an international multicenter study on the application of MILR for huge liver tumours showed that with careful patient selection, MILR could be performed safely in this subset of patients. Many participating specialized centers with expertise had demonstrated the feasibility and safety of resecting huge liver tumours by the minimally invasive approach ( 20 ). In the study, comparison between MILR for 174 huge tumors with 174 large (3–9.9 cm) tumors demonstrated not unexpectedly poorer outcomes in terms of blood loss, major morbidity and length of stay.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous challenges resulting from the space-occupying effect of the huge lesion, include distortion of the normal anatomy, compression of the major portal pedicles, compression of hepatic veins leading to higher venous pressure, limited space for manipulation during surgery, development of large collateral vessels supplying the tumor and presence of tumour invasion or adhesions to adjacent structures. These challenges increase the risk of intraoperative complications such as major bleeding, tumor rupture or compromise in surgical margins ( 20 , 28 ).…”

Section: Discussionmentioning

confidence: 99%

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Robotic versus laparoscopic liver resection for huge (≥10 cm) liver tumors: an international multicenter propensity-score matched cohort study of 799 cases

Cheung¹,

Liu²,

Cipriani³

et al. 2023

Hepatobiliary Surg Nutr

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Background: The use of laparoscopic (LLR) and robotic liver resections (RLR) has been safely performed in many institutions for liver tumours. A large scale international multicenter study would provide stronger evidence and insight into application of these techniques for huge liver tumours ≥10 cm.Methods: This was a retrospective review of 971 patients who underwent LLR and RLR for huge (≥10 cm) tumors at 42 international centers between 2002-2020.Results: One hundred RLR and 699 LLR which met study criteria were included. The comparison between the 2 approaches for patients with huge tumors were performed using 1:3 propensity-score matching (PSM) (73 vs. 219). Before PSM, LLR was associated with significantly increased frequency of previous abdominal surgery, malignant pathology, liver cirrhosis and increased median blood. After PSM, RLR and LLR was associated with no significant difference in key perioperative outcomes including media operation time (242 vs. 290 min, P=0.286), transfusion rate rate (19.2% vs. 16.9%, P=0.652), median blood loss (200 vs. 300 mL, P=0.694), open conversion rate (8.2% vs. 11.0%, P=0.519), morbidity (28.8% vs.21.9%, P=0.221), major morbidity (4.1% vs. 9.6%, P=0.152), mortality and postoperative length of stay (6 vs.6 days, P=0.435).Conclusions: RLR and LLR can be performed safely for selected patients with huge liver tumours with excellent outcomes. There was no significant difference in perioperative outcomes after RLR or LLR.

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“…To select patients with a low-preoperative risk profile for benchmarking,2 only patients aged between 18 and 70 years old5 and with a low American Society of Anesthesiology classification ≤2 were included 5. Patients with very large tumors ≥10 cm,20 Child’s B liver cirrhosis or portal hypertension were excluded 17,21. We also excluded patients who had L-LR for gallbladder cancer, donor hepatectomies, previous liver resections (repeat liver resections),22 associating liver partition and portal vein ligation for staged hepatectomy,11 bilioenteric anastomoses, hilar lymph node clearance, and those who underwent L-LR with concomitant major operations such as colectomies, bowel resections, and stoma reversals 11,23,24.…”

Section: Methodsmentioning

confidence: 99%

Defining Global Benchmarks for Laparoscopic Liver Resections

et al. 2022

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Objective: To establish global benchmark outcomes indicators after laparoscopic liver resections (L-LR). Background: There is limited published data to date on the best achievable outcomes after L-LR. Methods: This is a post hoc analysis of a multicenter database of 11,983 patients undergoing L-LR in 45 international centers in 4 continents between 2015 and 2020. Three specific procedures: left lateral sectionectomy (LLS), left hepatectomy (LH), and right hepatectomy (RH) were selected to represent the 3 difficulty levels of L-LR. Fifteen outcome indicators were selected to establish benchmark cutoffs. Results: There were 3519 L-LR (LLS, LH, RH) of which 1258 L-LR (40.6%) cases performed in 34 benchmark expert centers qualified as low-risk benchmark cases. These included 659 LLS (52.4%), 306 LH (24.3%), and 293 RH (23.3%). The benchmark outcomes established for operation time, open conversion rate, blood loss ≥500 mL, blood transfusion rate, postoperative morbidity, major morbidity, and 90-day mortality after LLS, LH, and RH were 209.5, 302, and 426 minutes; 2.1%, 13.4%, and 13.0%; 3.2%, 20%, and 47.1%; 0%, 7.1%, and 10.5%; 11.1%, 20%, and 50%; 0%, 7.1%, and 20%; and 0%, 0%, and 0%, respectively. Conclusions: This study established the first global benchmark outcomes for L-LR in a large-scale international patient cohort. It provides an up-to-date reference regarding the “best achievable” results for L-LR for which centers adopting L-LR can use as a comparison to enable an objective assessment of performance gaps and learning curves.

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Minimally invasive liver resection for huge (≥10 cm) tumors: an international multicenter matched cohort study with regression discontinuity analyses

Cited by 23 publications

References 39 publications

Laparoscopic parenchyma-sparing liver resection for large (≥ 50 mm) colorectal metastases

Laparoscopic parenchyma-sparing liver resection for large (≥ 50 mm) colorectal metastases

Robotic versus laparoscopic liver resection for huge (≥10 cm) liver tumors: an international multicenter propensity-score matched cohort study of 799 cases

Defining Global Benchmarks for Laparoscopic Liver Resections

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