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

Abstract

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.

Update on the Applications of Radiomics in Diagnosis, Staging, and Recurrence of Intrahepatic Cholangiocarcinoma

“…Precision medicine, and consequently precision oncology, like precision surgery, should be based on these features not immediately visible to the human eye [ 159 , 160 , 161 , 162 ]. Therefore, there is a need for advanced technologies such as radiomics, target therapy, and minimally invasive liver surgery [ 163 , 164 , 165 , 166 , 167 , 168 , 169 , 170 , 171 , 172 , 173 , 174 , 175 , 176 ].…”

Impact of tumor proximity to vessel on conversion in laparoscopic liver resection: A retrospective cohort study

“…Although several types of DSS have focused on tumor location and surgical approach for expanding the surgical field, they have sometimes underestimated the effect of vessel location. Tumor location and size have been reported to influence the difficulty of LLR, while the effect on vessel location and size is not certain 18,19 . The anatomical relationship of the tumor to vessels appears to be an important factor affecting the difficulty of LLR.…”

“…Tumor location and size have been reported to influence the difficulty of LLR, while the effect on vessel location and size is not certain. 18,19 The anatomical relationship of the tumor to vessels appears to be an important factor affecting the difficulty of LLR.…”

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

“…Moreover, many of the cut‐off values were arbitrarily chosen and not based on robust statistical analysis. Intuitively, one would expect that a tumor size >3 cm would have a greater impact on the complexity of LLR in the case of a monosegmentectomy but to a lesser extent in the case of right hepatectomy 33 . Hence, the present study focused purely on patients who underwent L‐LH only, and precise statistical methods were employed to establish the cut‐off of 40 mm.…”