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6. Outcomes after minimally invasive incision-dominant hepatectomy: insights from the amiles database

Author

Ganjouei, A.A., primary, Wang, J., additional, Chung, C., additional, Adam, M., additional, Geller, D., additional, Serrano, P., additional, Iannitti, D., additional, Simo, K., additional, Polanco, P., additional, Kamath, A., additional, Helton, S., additional, Sucandy, I., additional, Hogg, M., additional, Warner, S., additional, Cleary, S., additional, and Alseidi, A., additional

Published
2024
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9. Safety and perioperative outcomes of minimally invasive liver ablation: an AMILES database study

Author

Hoffman, D., primary, Ganjouei, A.A., additional, Wang, J., additional, Adam, M., additional, Geller, D., additional, Helton, S., additional, Iannitti, D., additional, Kamath, A., additional, Polanco, P., additional, Sucandy, I., additional, Serrano, P., additional, Kingham, P., additional, Warner, S.G., additional, Cleary, P., additional, and Alseidi, A., additional

Published
2024
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12. Robotic Versus Laparoscopic Left and Extended Left Hepatectomy: An International Multicenter Study Propensity Score-Matched Analysis

Author

Sucandy I., Rayman S., Lai E. C., Tang C. -N., Chong Y., Efanov M., Fuks D., Choi G. -H., Chong C. C., Chiow A. K. H., Marino M. V., Prieto M., Lee J. -H., Kingham T. P., D'Hondt M., Troisi R. I., Choi S. H., Sutcliffe R. P., Cheung T. -T., Rotellar F., Park J. O., Scatton O., Han H. -S., Pratschke J., Wang X., Liu R., Goh B. K. P., Chan C. -Y., D'Silva M., Schotte H., De Meyere C., Krenzien F., Schmelzle M., Kadam P., Montalti R., Liu Q., Lee K. -F., Salimgereeva D., Alikhanov R., Lee L. S., Gastaca M., Jang J. Y., Lim C., Labadie K. P., Sucandy, I., Rayman, S., Lai, E. C., Tang, C. -N., Chong, Y., Efanov, M., Fuks, D., Choi, G. -H., Chong, C. C., Chiow, A. K. H., Marino, M. V., Prieto, M., Lee, J. -H., Kingham, T. P., D'Hondt, M., Troisi, R. I., Choi, S. H., Sutcliffe, R. P., Cheung, T. -T., Rotellar, F., Park, J. O., Scatton, O., Han, H. -S., Pratschke, J., Wang, X., Liu, R., Goh, B. K. P., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. S., Gastaca, M., Jang, J. Y., Lim, C., and Labadie, K. P.

Subjects
Oncology, Surgery
Abstract

Background: Controversies exist among liver surgeons regarding clinical outcomes of the laparoscopic versus the robotic approach for major complex hepatectomies. The authors therefore designed a study to examine and compare the perioperative outcomes of laparoscopic left hepatectomy or extended left hepatectomy (L-LH/L-ELH) versus robotic left hepatectomy or extended left hepatectomy (R-LH/R-ELH) using a large international multicenter collaborative database. Methods: An international multicenter retrospective analysis of 580 patients undergoing L-LH/L-ELH or R-LH/R-ELH at 25 specialized hepatobiliary centers worldwide was undertaken. Propensity score-matching (PSM) was used at a 1:1 nearest-neighbor ratio according to 15 perioperative variables, including demographics, tumor characteristics, Child-Pugh score, presence of portal hypertension, multiple resections, histologic diagnosis, and Iwate difficulty grade. Results: Before the PSM, 190 (32 %) patients underwent R-LH/R-ELH, and 390 (68 %) patients underwent L-LH/L-ELH. After the matching, 164 patients were identified in each arm without significant differences in demographics, preoperative variables, medical history, tumor pathology, tumor characteristics, or Iwate score. Regarding intra- and postoperative outcomes, the rebotic approach had significantly less estimated blood loss (EBL) (100 ml [IQR 200 ml] vs 200 ml [IQR 235 ml]; p = 0.029), fewer conversions to open operations (n = 4 [2.4 %] vs n = 13, [7.9 %]; p = 0.043), and a shorter hospital stay (6 days [IQR 3 days] vs 7 days [IQR 3.3 days]; p = 0.009). Conclusion: Both techniques are safe and feasible in major hepatic resections. Compared with L-LH/L-ELH, R-LH/R-ELH is associated with less EBL, fewer conversions to open operations, and a shorter hospital stay.

Published
2022

13. ASO Author Reflections: The Robotic Versus Laparoscopic Approach to Left and Extended Left Hepatectomy

Author

Rayman S., Jacoby H., Sucandy I., Goh B. K. P., Chan C. -Y., Han H. -S., D'Silva M., D'Hondt M., Schotte H., De Meyere C., Krenzien F., Schmelzle M., Pratschke J., Sutcliffe R. P., Kadam P., Troisi R. I., Giglio M., Montalti R., Liu R., Liu Q., Chong C. C., Lee K. -F., Efanov M., Salimgereeva D., Alikhanov R., Chiow A. K. H., Lee L. S., Prieto M., Gastaca M., Choi S. -H., Jang J. Y., Scatton O., Lim C., Park J. O., Labadie K. P., Lai E. C., Tang C. -N., Wang X., Chong Y., Fuks D., Choi G. -H., Marino M. V., Lee J. H., Kingham T. P., Cheung T. -T., Rotellar F., Rayman, S., Jacoby, H., Sucandy, I., Goh, B. K. P., Chan, C. -Y., Han, H. -S., D'Silva, M., D'Hondt, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Pratschke, J., Sutcliffe, R. P., Kadam, P., Troisi, R. I., Giglio, M., Montalti, R., Liu, R., Liu, Q., Chong, C. C., Lee, K. -F., Efanov, M., Salimgereeva, D., Alikhanov, R., Chiow, A. K. H., Lee, L. S., Prieto, M., Gastaca, M., Choi, S. -H., Jang, J. Y., Scatton, O., Lim, C., Park, J. O., Labadie, K. P., Lai, E. C., Tang, C. -N., Wang, X., Chong, Y., Fuks, D., Choi, G. -H., Marino, M. V., Lee, J. H., Kingham, T. P., Cheung, T. -T., and Rotellar, F.

Subjects
Oncology, Surgery
Published
2022

14. Impact of neoadjuvant chemotherapy on the difficulty and outcomes of laparoscopic and robotic major liver resections for colorectal liver metastases: A propensity-score and coarsened exact-matched controlled study

Author

Ghotbi, J., Aghayan, D., Fretland, A., Edwin, B., Syn, N. L., Cipriani, F., Alzoubi, M., Lim, C., Scatton, O., Long, T. C. D., Herman, P., Coelho, F. F., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. -H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Fondevila, C., Efanov, M., Morise, Z., Di Benedetto, F., Brustia, R., Dalla Valle, R., Boggi, U., Geller, D., Belli, A., Memeo, R., Mejia, A., Park, J. O., Rotellar, F., Choi, G. -H., Robles-Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. -N., Chong, C. C. N., D'Hondt, M., Monden, K., Lopez-Ben, S., Kingham, T. P., Ferrero, A., Ettorre, G. M., Levi Sandri, G. B., Pascual, F., Cherqui, D., Liang, X., Mazzotta, A., Wakabayashi, G., Giglio, M., Troisi, R. I., Han, H. -S., Cheung, T. -T., Sugioka, A., Chen, K. -H., Liu, R., Soubrane, O., Fuks, D., Aldrighetti, L., Abu Hilal, M., Goh, B. K. P., Gastaca, M., Meurs, J., De Meyere, C., Lee, K. -F., Ng, K. K., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kato, Y., Kojima, M., Pirola Kruger, J. A., Lopez-Lopez, V., Casellas I Robert, M., Montalti, R., Lee, B., D'Silva, M., Wang, H. -P., Saleh, M., Chen, Z., Yu, S., Vani, S., Ardito, Francesco, Giustizieri, U., Citterio, D., Mocchegiani, F., Colasanti, M., Guzman, Y., Labadie, K. P., Conticchio, M., Dogeas, E., Kauffmann, E. F., Giuffrida, M., Sommacale, D., Laurent, A., Magistri, P., Nghia, P. P., Mishima, K., Valle, B. D., Krenzien, F., Schmelzle, M., Kadam, P., Liu, Q., Lai, E. C. H., Zheng, J., Siow, T. F., Forchino, F., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Ghotbi, J., Aghayan, D., Fretland, A., Edwin, B., Syn, N. L., Cipriani, F., Alzoubi, M., Lim, C., Scatton, O., Long, T. C. D., Herman, P., Coelho, F. F., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. -H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Fondevila, C., Efanov, M., Morise, Z., Di Benedetto, F., Brustia, R., Dalla Valle, R., Boggi, U., Geller, D., Belli, A., Memeo, R., Mejia, A., Park, J. O., Rotellar, F., Choi, G. -H., Robles-Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. -N., Chong, C. C. N., D'Hondt, M., Monden, K., Lopez-Ben, S., Kingham, T. P., Ferrero, A., Ettorre, G. M., Levi Sandri, G. B., Pascual, F., Cherqui, D., Liang, X., Mazzotta, A., Wakabayashi, G., Giglio, M., Troisi, R. I., Han, H. -S., Cheung, T. -T., Sugioka, A., Chen, K. -H., Liu, R., Soubrane, O., Fuks, D., Aldrighetti, L., Abu Hilal, M., Goh, B. K. P., Gastaca, M., Meurs, J., De Meyere, C., Lee, K. -F., Ng, K. K., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kato, Y., Kojima, M., Pirola Kruger, J. A., Lopez-Lopez, V., Casellas I Robert, M., Montalti, R., Lee, B., D'Silva, M., Wang, H. -P., Saleh, M., Chen, Z., Yu, S., Vani, S., Ardito, Francesco, Giustizieri, U., Citterio, D., Mocchegiani, F., Colasanti, M., Guzman, Y., Labadie, K. P., Conticchio, M., Dogeas, E., Kauffmann, E. F., Giuffrida, M., Sommacale, D., Laurent, A., Magistri, P., Nghia, P. P., Mishima, K., Valle, B. D., Krenzien, F., Schmelzle, M., Kadam, P., Liu, Q., Lai, E. C. H., Zheng, J., Siow, T. F., Forchino, F., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Background: Minimal invasive liver resections are a safe alternative to open surgery. Different scoring systems considering different risks factors have been developed to predict the risks associated with these procedures, especially challenging major liver resections (MLR). However, the impact of neoadjuvant chemotherapy (NAT) on the difficulty of minimally invasive MLRs remains poorly investigated. Methods: Patients who underwent laparoscopic and robotic MLRs for colorectal liver metastases (CRLM) performed across 57 centers between January 2005 to December 2021 were included in this analysis. Patients who did or did not receive NAT were matched based on 1:1 coarsened exact and 1:2 propensity-score matching. Pre- and post-matching comparisons were performed. Results: In total, the data of 5189 patients were reviewed. Of these, 1411 procedures were performed for CRLM, and 1061 cases met the inclusion criteria. After excluding 27 cases with missing data on NAT, 1034 patients (NAT: n = 641; non-NAT: n = 393) were included. Before matching, baseline characteristics were vastly different. Before matching, the morbidity rate was significantly higher in the NAT-group (33.2% vs. 27.2%, p-value = 0.043). No significant differences were seen in perioperative outcomes after the coarsened exact matching. After the propensity-score matching, statistically significant higher blood loss (mean, 300 (SD 128–596) vs. 250 (SD 100–400) ml, p-value = 0.047) but shorter hospital stay (mean, 6 [4-8] vs. 6 [5-9] days, p-value = 0.043) were found in the NAT-group. Conclusion: The current study demonstrated that NAT had minimal impact on the difficulty and outcomes of minimally-invasive MLR for CRLM.

Published
2023

15. Defining Global Benchmarks for Laparoscopic Liver Resections: An International Multicenter Study

Author

Goh, B. K. P., Han, H. -S., Chen, K. -H., Chua, D. W., Chan, C. -Y., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., D'Silva, M., Siow, T. F., Kato, Y., Lim, C., Nghia, P. P., Herman, P., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Gastaca, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Chen, Z., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Campos, R. R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Coelho, F. F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Sandri, G. B. L., Saleh, M., Cherqui, D., Scatton, O., Soubrane, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Hilal, M. A., Fuks, D., Edwin, B., Aldrighetti, L., Syn, N., Prieto, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kojima, M., Ghotbi, J., Kruger, J. A. P., Lopez-Lopez, V., Valle, B. D., Casellas I Robert, M., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., Wang, H. -P., Pascual, F., Kadam, P., Tang, C. -N., Yu, S., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Goh, B. K. P., Han, H. -S., Chen, K. -H., Chua, D. W., Chan, C. -Y., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., D'Silva, M., Siow, T. F., Kato, Y., Lim, C., Nghia, P. P., Herman, P., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Gastaca, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Chen, Z., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Campos, R. R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Coelho, F. F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Sandri, G. B. L., Saleh, M., Cherqui, D., Scatton, O., Soubrane, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Hilal, M. A., Fuks, D., Edwin, B., Aldrighetti, L., Syn, N., Prieto, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kojima, M., Ghotbi, J., Kruger, J. A. P., Lopez-Lopez, V., Valle, B. D., Casellas I Robert, M., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., Wang, H. -P., Pascual, F., Kadam, P., Tang, C. -N., Yu, S., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

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.

Published
2023

16. Comparison between the difficulty of laparoscopic limited liver resections of tumors located in segment 7 versus segment 8: An international multicenter propensity-score matched study

Author

Efanov, M., Salimgereeva, D., Alikhanov, R., Wu, A. G. R., Geller, D., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., Belli, A., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Fondevila, C., Rotellar, F., Choi, G. -H., Robless Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Herman, P., Di Benedetto, F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Levi Sandri, G. B., Cherqui, D., Scatton, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Han, H. -S., Abu Hilal, M., Soubrane, O., Fuks, D., Aldrighetti, L., Edwin, B., Goh, B. K. P., Chan, C. -Y., Syn, N., D'Silva, M., Lee, B., Lim, C., Nghia, P. P., Gastaca, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Lee, L. S., Jang, J. Y., Kojima, M., Kato, Y., Ghotbi, J., Kruger, J. A. P., Coelho, F. F., Lopez-Lopez, V., Valle, B. D., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Wang, H. -P., Pascual, F., Saleh, M., Kadam, P., Tang, C. -N., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Efanov, M., Salimgereeva, D., Alikhanov, R., Wu, A. G. R., Geller, D., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., Belli, A., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Fondevila, C., Rotellar, F., Choi, G. -H., Robless Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Herman, P., Di Benedetto, F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Levi Sandri, G. B., Cherqui, D., Scatton, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Han, H. -S., Abu Hilal, M., Soubrane, O., Fuks, D., Aldrighetti, L., Edwin, B., Goh, B. K. P., Chan, C. -Y., Syn, N., D'Silva, M., Lee, B., Lim, C., Nghia, P. P., Gastaca, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Lee, L. S., Jang, J. Y., Kojima, M., Kato, Y., Ghotbi, J., Kruger, J. A. P., Coelho, F. F., Lopez-Lopez, V., Valle, B. D., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Wang, H. -P., Pascual, F., Saleh, M., Kadam, P., Tang, C. -N., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Background: Presently, according to different difficulty scoring systems, there is no difference in complexity estimation of laparoscopic liver resection (LLR) of segments 7 and 8. However, there is no published data supporting this assumption. To date, no studies have compared the outcomes of laparoscopic parenchyma-sparing resection of the liver segments 7 and 8. Methods: A post hoc analysis of patients undergoing LLR of segments 7 and 8 in 46 centers between 2004 and 2020 was performed. 1:1 Propensity score matching (PSM) was used to compare isolated LLR of segments 7 and 8. Subset analyses were also performed to compare atypical resections and segmentectomies of 7 and 8. Results: A total of 2411 patients were identified, and 1691 patients met the inclusion criteria. Comparison after PSM between the entire cohort of segment 7 and segment 8 resections revealed inferior results for segment 7 resection in terms of increased blood loss, blood transfusions, and conversions to open surgery. Subset analyses of only atypical resections similarly demonstrated poorer outcomes for segment 7 in terms of increased blood loss, operation time, blood transfusions, and conversions to open surgery. Conversely, a subgroup analysis of segmentectomies after PSM found better outcomes for segment 7 in terms of a shorter operation time and hospital stay. Conclusion: Differences in the outcomes of segments 7 and 8 resections suggest a greater difficulty of laparoscopic atypical resection of segment 7 compared to segment 8, and greater difficulty of segmentectomy 8 compared to segmentectomy 7.

Published
2023

18. An international multicenter propensity-score matched and coarsened-exact matched analysis comparing robotic versus laparoscopic partial liver resections of the anterolateral segments

Author

Kadam P., Sutcliffe R. P., Scatton O., Sucandy I., Kingham T. P., Liu R., Choi G. H., Syn N. L., Gastaca M., Choi S. -H., Chiow A. K. H., Marino M. V., Efanov M., Lee J. -H., Chong C. C., Tang C. -N., Cheung T. -T., Pratschke J., Wang X., Campos R. R., Ivanecz A., Park J. O., Rotellar F., Fuks D., D'Hondt M., Han H. -S., Troisi R. I., Goh B. K. P., Chan C. -Y., Prieto M., Schotte H., De Meyere C., Lai E., Krenzien F., Schmelzle M., Montalti R., Liu Q., Lee K. -F., Salimgereeva D., Alikhanov R., Lee L. -S., Jang J. Y., Lim C., Labadie K. P., Lopez-Lopez V., Kadam, P., Sutcliffe, R. P., Scatton, O., Sucandy, I., Kingham, T. P., Liu, R., Choi, G. H., Syn, N. L., Gastaca, M., Choi, S. -H., Chiow, A. K. H., Marino, M. V., Efanov, M., Lee, J. -H., Chong, C. C., Tang, C. -N., Cheung, T. -T., Pratschke, J., Wang, X., Campos, R. R., Ivanecz, A., Park, J. O., Rotellar, F., Fuks, D., D'Hondt, M., Han, H. -S., Troisi, R. I., Goh, B. K. P., Chan, C. -Y., Prieto, M., Schotte, H., De Meyere, C., Lai, E., Krenzien, F., Schmelzle, M., Montalti, R., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Lim, C., Labadie, K. P., and Lopez-Lopez, V.

Subjects
Carcinoma, Hepatocellular, robotic liver resection, Hepatology, Liver Neoplasms, anterolateral segment, laparoscopic liver resection, Length of Stay, Postoperative Complications, Robotic Surgical Procedures, Hepatectomy, Humans, Laparoscopy, Surgery, Propensity Score, Retrospective Studies, minimally invasive liver surgery
Abstract

Background: Robotic liver resections (RLR) may have the ability to address some of the drawbacks of laparoscopic liver resections (LLR) but few studies have done a head-to-head comparison of the outcomes after anterolateral segment resections by the two techniques. Methods: A retrospective study was conducted of 3202 patients who underwent minimally invasive LR of the anterolateral liver segments at 26 international centres from 2005 to 2020. Two thousand six hundred and six cases met study criteria of which there were 358 RLR and 1868 LLR cases. Perioperative outcomes were compared between the two groups using a 1:3 Propensity Score Matched (PSM) and 1:1 Coarsened Exact Matched (CEM) analysis. Results: Patients matched after 1:3 PSM (261 RLR vs 783 LLR) and 1:1 CEM (296 RLR vs 296 LLR) revealed no significant differences in length of stay, readmission rates, morbidity, mortality, and involvement of or close oncological margins. RLR surgeries were associated with significantly less blood loss (50 mL vs 100 ml, P

Published
2022

19. Utility of the Iwate difficulty scoring system for laparoscopic right posterior sectionectomy: do surgical outcomes differ for tumors in segments VI and VII?

Author

Choi S. H., Chen K. -H., Syn N. L., Cipriani F., Cheung T. -T., Chiow A. K. H., Choi G. -H., Siow T. -F., Sucandy I., Marino M. V., Gastaca M., Chong C. C., Lee J. H., Ivanecz A., Mazzaferro V., Lopez-Ben S., Fondevila C., Rotellar F., Campos R. R., Efanov M., Kingham T. P., Sutcliffe R. P., Troisi R. I., Pratschke J., Wang X., D'Hondt M., Yong C. C., Levi Sandri G. B., Tang C. N., Ruzzenente A., Cherqui D., Ferrero A., Wakabayashi G., Scatton O., Aghayan D., Edwin B., Coelho F. F., Giuliante F., Liu R., Sijberden J., Abu Hilal M., Sugioka A., Long T. C. D., Fuks D., Aldrighetti L., Han H. -S., Goh B. K. P., Kang I., Jang J. Y., Chan C. -Y., D'Silva M., Schotte H., De Meyere C., Lai E., Krenzien F., Schmelzle M., Kadam P., Montalti R., Giglio M., Liu Q., Lee K. -F., Salimgereeva D., Alikhanov R., Lee L. -S., Prieto M., Lim C., Nghia P. P., Kojima M., Kato Y., Forchino F., Herman P., Kruger J. A. P., Saleh M., Pascual F., Dalla Valle B., Lopez-Lopez V., Casellas-Robert M., Giustizieri U., Citterio D., Mishima K., Fretland A. A., Ghotbi J., Ettorre G. M., Colasanti M., Guzman Y., Ardito F., Vani S., Wang H. -P., Choi, S. H., Chen, K. -H., Syn, N. L., Cipriani, F., Cheung, T. -T., Chiow, A. K. H., Choi, G. -H., Siow, T. -F., Sucandy, I., Marino, M. V., Gastaca, M., Chong, C. C., Lee, J. H., Ivanecz, A., Mazzaferro, V., Lopez-Ben, S., Fondevila, C., Rotellar, F., Campos, R. R., Efanov, M., Kingham, T. P., Sutcliffe, R. P., Troisi, R. I., Pratschke, J., Wang, X., D'Hondt, M., Yong, C. C., Levi Sandri, G. B., Tang, C. N., Ruzzenente, A., Cherqui, D., Ferrero, A., Wakabayashi, G., Scatton, O., Aghayan, D., Edwin, B., Coelho, F. F., Giuliante, F., Liu, R., Sijberden, J., Abu Hilal, M., Sugioka, A., Long, T. C. D., Fuks, D., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Kang, I., Jang, J. Y., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Lai, E., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Giglio, M., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Prieto, M., Lim, C., Nghia, P. P., Kojima, M., Kato, Y., Forchino, F., Herman, P., Kruger, J. A. P., Saleh, M., Pascual, F., Dalla Valle, B., Lopez-Lopez, V., Casellas-Robert, M., Giustizieri, U., Citterio, D., Mishima, K., Fretland, A. A., Ghotbi, J., Ettorre, G. M., Colasanti, M., Guzman, Y., Ardito, F., Vani, S., Wang, H. -P., Choi, Sung Hoon, Chen, Kuo-Hsin, Syn, Nicholas L, Cipriani, Federica, Cheung, Tan-To, Chiow, Adrian K H, Choi, Gi-Hong, Siow, Tiing-Foong, Sucandy, Iswanto, Marino, Marco V, Gastaca, Mikel, Chong, Charing C, Lee, Jae Hoon, Ivanecz, Arpad, Mazzaferro, Vincenzo, Lopez-Ben, Santiago, Fondevila, Constantino, Rotellar, Fernando, Campos, Ricardo Roble, Efanov, Mikhail, Kingham, T Peter, Sutcliffe, Robert P, Troisi, Roberto I, Pratschke, Johann, Wang, Xiaoying, D'Hondt, Mathieu, Yong, Chee Chien, Levi Sandri, Giovanni Battista, Tang, Chung Ngai, Ruzzenente, Andrea, Cherqui, Daniel, Ferrero, Alessandro, Wakabayashi, Go, Scatton, Olivier, Aghayan, Davit, Edwin, Bjørn, Coelho, Fabricio Ferreira, Giuliante, Felice, Liu, Rong, Sijberden, Jasper, Abu Hilal, Mohammad, Sugioka, Atsushi, Long, Tran Cong Duy, Fuks, David, Aldrighetti, Luca, Han, Ho-Seong, and Goh, Brian K P

Subjects
Carcinoma, Hepatocellular, Laparoscopic liver, Settore MED/18 - CHIRURGIA GENERALE, Operative Time, Liver Neoplasms, Carcinoma, Hepatocellular, Difficulty score, Length of Stay, Iwate, Laparoscopic hepatectomy, Right posterior sectionectomy, Treatment Outcome, Postoperative Complications, Humans, Hepatectomy, Surgery, Laparoscopy, Retrospective Studies
Abstract

Introduction: The Iwate Score (IS) have not been well-validated for specific procedures, especially for right posterior sectionectomy (RPS). In this study, the utility of the IS was determined for laparoscopic (L)RPS and the effect of tumor location on surgical outcomes was investigated. Methods: Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria. Baseline characteristics and perioperative outcomes of patients stratified based on the Iwate score were compared to determine whether a correlation with surgical difficulty existed. A 1:1 Mahalanobis distance matching was utilized to investigate the effect of tumor location on L-RPS outcomes. Results: The patients were stratified into 3 levels of difficulty (31 intermediate, 143 advanced, and 422 expert) based on the IS. When using a stepwise increase of the IS excluding the tumor location score, only Pringle’s maneuver was more frequently used in the higher surgical difficulty level (35.5%, 54.6%, and 65.2%, intermediate, advanced, and expert levels, respectively, Z = 3.34, p = 0.001). Other perioperative results were not associated with a statistical gradation toward higher difficulty level. 80 of 85 patients with a segment VI lesion and 511 patients with a segment VII lesion were matched 1:1. There were no significant differences in the perioperative outcomes of the two groups including open conversion, operating time, blood loss, intraoperative blood transfusion, postoperative stay, major morbidity, and mortality. Conclusion: Among patients undergoing L-RPS, the IS did not significantly correlate with most outcome measures associated with intraoperative difficulty and postoperative outcomes. Similarly, tumor location had no effect on L-RPS outcomes.

Published
2022

20. Comparison between the difficulty of laparoscopic limited liver resections of tumors located in segment 7 versus segment 8

Author

Efanov, M., Salimgereeva, D., Alikhanov, R., A. G. R., Wu, Geller, D., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., Belli, A., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Fondevila, C., Rotellar, F., Choi, G. -H., Robless Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Herman, P., Di Benedetto, F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Levi Sandri, G. B., Cherqui, D., Scatton, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Han, H. -S., Abu Hilal, M., Soubrane, O., Fuks, D., Aldrighetti, L., Edwin, B., Goh, B. K. P., Chan, C. -Y., Syn, N., D'Silva, M., Lee, B., Lim, C., Nghia, P. P., Gastaca, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Lee, L. S., Jang, J. Y., Kojima, M., Kato, Y., Ghotbi, J., Kruger, J. A. P., Coelho, F. F., Lopez-Lopez, V., Valle, B. D., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Wang, H. -P., Pascual, F., Saleh, M., Kadam, P., Tang, C. -N., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Graduate School, Surgery, CCA - Cancer Treatment and Quality of Life, Efanov, M., Salimgereeva, D., Alikhanov, R., Wu, A. G. R., Geller, D., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., Belli, A., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, F., Ruzzenente, A., Yong, C. -C., Fondevila, C., Rotellar, F., Choi, G. -H., Robless Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Herman, P., Di Benedetto, F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Levi Sandri, G. B., Cherqui, D., Scatton, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Han, H. -S., Abu Hilal, M., Soubrane, O., Fuks, D., Aldrighetti, L., Edwin, B., Goh, B. K. P., Chan, C. -Y., Syn, N., D'Silva, M., Lee, B., Lim, C., Nghia, P. P., Gastaca, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Lee, L. S., Jang, J. Y., Kojima, M., Kato, Y., Ghotbi, J., Kruger, J. A. P., Coelho, F. F., Lopez-Lopez, V., Valle, B. D., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Wang, H. -P., Pascual, F., Saleh, M., Kadam, P., Tang, C. -N., Ardito, F., Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Efanov, Mikhail, Salimgereeva, Diana, Alikhanov, Ruslan, Wu, Andrew G R, Geller, David, Cipriani, Federica, Aghayan, Davit L, Fretland, Asmund Avdem, Sijberden, Jasper, Belli, Andrea, Marino, Marco V, Mazzaferro, Vincenzo, Chiow, Adrian K H, Sucandy, Iswanto, Ivanecz, Arpad, Choi, Sung Hoon, Lee, Jae Hoon, Prieto, Mikel, Vivarelli, Marco, Giuliante, Felice, Ruzzenente, Andrea, Yong, Chee-Chien, Fondevila, Constantino, Rotellar, Fernando, Choi, Gi-Hong, Robless Campos, Ricardo, Wang, Xiaoying, Sutcliffe, Robert P, Pratschke, Johann, Lai, Eric, Chong, Charing C, D'Hondt, Mathieu, Monden, Kazuteru, Lopez-Ben, Santiago, Herman, Paulo, Di Benedetto, Fabrizio, Kingham, T Peter, Liu, Rong, Long, Tran Cong Duy, Ferrero, Alessandro, Levi Sandri, Giovanni Battista, Cherqui, Daniel, Scatton, Olivier, Wakabayashi, Go, Troisi, Roberto I, Cheung, Tan-To, Sugioka, Atsushi, Han, Ho-Seong, Abu Hilal, Mohammad, Soubrane, Olivier, Fuks, David, Aldrighetti, Luca, Edwin, Bjorn, and Goh, Brian K P

Subjects
hepatectomy, laparoscopy, liver resection, posterosuperior segments, risk score, Hepatology, Settore MED/18 - CHIRURGIA GENERALE, Surgery, posterosuperior segment
Abstract

Background: Presently, according to different difficulty scoring systems, there is no difference in complexity estimation of laparoscopic liver resection (LLR) of segments 7 and 8. However, there is no published data supporting this assumption. To date, no studies have compared the outcomes of laparoscopic parenchyma-sparing resection of the liver segments 7 and 8. Methods: A post hoc analysis of patients undergoing LLR of segments 7 and 8 in 46 centers between 2004 and 2020 was performed. 1:1 Propensity score matching (PSM) was used to compare isolated LLR of segments 7 and 8. Subset analyses were also performed to compare atypical resections and segmentectomies of 7 and 8. Results: A total of 2411 patients were identified, and 1691 patients met the inclusion criteria. Comparison after PSM between the entire cohort of segment 7 and segment 8 resections revealed inferior results for segment 7 resection in terms of increased blood loss, blood transfusions, and conversions to open surgery. Subset analyses of only atypical resections similarly demonstrated poorer outcomes for segment 7 in terms of increased blood loss, operation time, blood transfusions, and conversions to open surgery. Conversely, a subgroup analysis of segmentectomies after PSM found better outcomes for segment 7 in terms of a shorter operation time and hospital stay. Conclusion: Differences in the outcomes of segments 7 and 8 resections suggest a greater difficulty of laparoscopic atypical resection of segment 7 compared to segment 8, and greater difficulty of segmentectomy 8 compared to segmentectomy 7.

Published
2022

21. An international multicentre propensity score matched analysis comparing between robotic versus laparoscopic left lateral sectionectomy

Author

Chong Y., Prieto M., Gastaca M., Choi S. -H., Sucandy I., Chiow A. K. H., Marino M. V., Wang X., Efanov M., Schotte H., D'Hondt M., Choi G. -H., Krenzien F., Schmelzle M., Pratschke J., Kingham T. P., Giglio M., Troisi R., Lee J. H., Lai E. C., Tang C. N., Fuks D., D'Silva M., Han H. -S., Kadam P., Sutcliffe R. P., Lee K. -F., Chong C. C., Cheung T. -T., Liu Q., Liu R., Goh B. K. P., Chan C. -Y., De Meyere C., Salimgereeva D., Alikhanov R., Lee L. -S., Jang J. Y., Montalti R., Chong, Y., Prieto, M., Gastaca, M., Choi, S. -H., Sucandy, I., Chiow, A. K. H., Marino, M. V., Wang, X., Efanov, M., Schotte, H., D'Hondt, M., Choi, G. -H., Krenzien, F., Schmelzle, M., Pratschke, J., Kingham, T. P., Giglio, M., Troisi, R., Lee, J. H., Lai, E. C., Tang, C. N., Fuks, D., D'Silva, M., Han, H. -S., Kadam, P., Sutcliffe, R. P., Lee, K. -F., Chong, C. C., Cheung, T. -T., Liu, Q., Liu, R., Goh, B. K. P., Chan, C. -Y., De Meyere, C., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., and Montalti, R.

Subjects
Laparoscopic, Left lateral sectionectomy, Minimally invasive surgery, Robotic
Abstract

Background: Left lateral sectionectomy (LLS) is one of the most commonly performed minimally invasive liver resections. While laparoscopic (L)-LLS is a well-established technique, over traditional open resection, it remains controversial if robotic (R)-LLS provides any advantages of L-LLS. Methods: A post hoc analysis of 997 patients from 21 international centres undergoing L-LLS or R-LLS from 2006 to 2020 was conducted. A total of 886 cases (214 R-LLS, 672 L-LLS) met study criteria. 1:1 and 1:2 propensity score matched (PSM) comparison was performed between R-LLS & L-LLS. Further subset analysis by Iwate difficulty was also performed. Outcomes measured include operating time, blood loss, open conversion, readmission rates, morbidity and mortality. Results: Comparison between R-LLS and L-LLS after PSM 1:2 demonstrated statistically significantly lower open conversion rate in R-LLS than L-LLS (0.6% versus 5%, p = 0.009) and median blood loss was also statistically significantly lower in R-LLS at 50 (80) versus 100 (170) in L-LLS (p = 0.011) after PSM 1:1 although there was no difference in the blood transfusion rate. Pringle manoeuvre was also found to be used more frequently in R-LLS, with 53(24.8%) cases versus to 84(12.5%) L-LLS cases (p < 0.001). There was no significant difference in the other key perioperative outcomes such as operating time, length of stay, postoperative morbidity, major morbidity and 90-day mortality between both groups. Conclusion: R-LLS was associated with similar key perioperative outcomes compared to L-LLS. It was also associated with significantly lower blood loss and open conversion rates compared to L-LLS.

Published
2022

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

Author

Arizza, G., Russolillo, N., Ferrero, A., Syn, N. L., Cipriani, F., Aghayan, D., Marino, M. V., Memeo, R., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Vivarelli, M., Di Benedetto, F., Choi, S. -H., Lee, J. H., Park, J. O., Gastaca, M., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Robles-Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. N., Chong, C. C., D'Hondt, M., Yong, C. C., Ruzzenente, A., Herman, P., Kingham, T. P., Scatton, O., Liu, R., Levi Sandri, G. B., Soubrane, O., Mejia, A., Lopez-Ben, S., Monden, K., Wakabayashi, G., Cherqui, D., Troisi, R. I., Yin, M., Giuliante, Felice, Geller, D., Sugioka, A., Edwin, B., Cheung, T. -T., Long, T. C. D., Hilal, M. A., Fuks, D., Chen, K. -H., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Chan, C. -Y., Prieto, M., Meurs, J., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., K. K., Ng, Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Labadie, K. P., Kato, Y., Kojima, M., Fretland, A. A., Ghotbi, J., Coelho, F. F., Kruger, J. A. P., Lopez-Lopez, V., Magistri, P., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., D'Silva, M., Wang, H. -P., Saleh, M., Pascual, F., Suhool, A., Nghia, P. P., Lim, C., Liu, Q., Kadam, P., Dalla Valle, B., Lai, E. C., Conticchio, M., Giustizieri, U., Citterio, D., Chen, Z., Yu, S., Ardito, Francesco, Vani, S., Dogeas, E., Siow, T. F., Mocchegianni, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Arizza, G., Russolillo, N., Ferrero, A., Syn, N. L., Cipriani, F., Aghayan, D., Marino, M. V., Memeo, R., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Vivarelli, M., Di Benedetto, F., Choi, S. -H., Lee, J. H., Park, J. O., Gastaca, M., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Robles-Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. N., Chong, C. C., D'Hondt, M., Yong, C. C., Ruzzenente, A., Herman, P., Kingham, T. P., Scatton, O., Liu, R., Levi Sandri, G. B., Soubrane, O., Mejia, A., Lopez-Ben, S., Monden, K., Wakabayashi, G., Cherqui, D., Troisi, R. I., Yin, M., Giuliante, F., Geller, D., Sugioka, A., Edwin, B., Cheung, T. -T., Long, T. C. D., Hilal, M. A., Fuks, D., Chen, K. -H., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Chan, C. -Y., Prieto, M., Meurs, J., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Ng, K. K., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Labadie, K. P., Kato, Y., Kojima, M., Fretland, A. A., Ghotbi, J., Coelho, F. F., Kruger, J. A. P., Lopez-Lopez, V., Magistri, P., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., D'Silva, M., Wang, H. -P., Saleh, M., Pascual, F., Suhool, A., Nghia, P. P., Lim, C., Liu, Q., Kadam, P., Dalla Valle, B., Lai, E. C., Conticchio, M., Giustizieri, U., Citterio, D., Chen, Z., Yu, S., Ardito, F., Vani, S., Dogeas, E., Siow, T. F., Mocchegianni, F., Ettorre, G. M., Colasanti, M., and Guzman, Y.

Subjects
difficulty, laparoscopic hepatectomy, laparoscopic liver, left lateral sectionectomy, size, Hepatology, Settore MED/18 - CHIRURGIA GENERALE, Surgery
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

Published
2022

23. Defining Global Benchmarks for Laparoscopic Liver Resections: An International Multicenter Study

Author

Goh, B. K. P., Han, H. -S., Chen, K. -H., Chua, D. W., Chan, C. -Y., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., D'Silva, M., Siow, T. F., Kato, Y., Lim, C., Nghia, P. P., Herman, P., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Gastaca, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Chen, Z., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Campos, R. R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Coelho, F. F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Sandri, G. B. L., Saleh, M., Cherqui, D., Scatton, O., Soubrane, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Hilal, M. A., Fuks, D., Edwin, B., Aldrighetti, L., Syn, N., Prieto, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kojima, M., Ghotbi, J., Kruger, J. A. P., Lopez-Lopez, V., Valle, B. D., Casellas I Robert, M., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., Wang, H. -P., Pascual, F., Kadam, P., Tang, C. -N., Yu, S., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Goh, Brian K P, Han, Ho-Seong, Chen, Kuo-Hsin, Chua, Darren W, Chan, Chung-Yip, Cipriani, Federica, Aghayan, Davit L, Fretland, Asmund A, Sijberden, Jasper, D'Silva, Mizelle, Siow, Tiing Foong, Kato, Yutaro, Lim, Chetana, Nghia, Phan Phuoc, Herman, Paulo, Marino, Marco V, Mazzaferro, Vincenzo, Chiow, Adrian K H, Sucandy, Iswanto, Ivanecz, Arpad, Choi, Sung Hoon, Lee, Jae Hoon, Gastaca, Mikel, Vivarelli, Marco, Giuliante, Felice, Ruzzenente, Andrea, Yong, Chee-Chien, Yin, Mengqui, Chen, Zewei, Fondevila, Constantino, Efanov, Mikhail, Rotellar, Fernando, Choi, Gi-Hong, Campos, Ricardo R, Wang, Xiaoying, Sutcliffe, Robert P, Pratschke, Johann, Lai, Eric, Chong, Charing C, D'Hondt, Mathieu, Monden, Kazuteru, Lopez-Ben, Santiago, Coelho, Fabricio F, Kingham, Thomas Peter, Liu, Rong, Long, Tran Cong Duy, Ferrero, Alessandro, Sandri, Giovanni B Levi, Saleh, Mansour, Cherqui, Daniel, Scatton, Olivier, Soubrane, Olivier, Wakabayashi, Go, Troisi, Roberto I, Cheung, Tan-To, Sugioka, Atsushi, Hilal, Mohammad Abu, Fuks, David, Edwin, Bjørn, and Aldrighetti, Luca

Subjects
benchmark, hepatectomy, quality assessment, Settore MED/18 - CHIRURGIA GENERALE, minimally invasive, Surgery, laparoscopic liver resection, global
Abstract

To establish global benchmark outcomes indicators after laparoscopic liver resections (L-LR).There is limited published data to date on the best achievable outcomes after L-LR.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.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.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.

Published
2022

24. Utility of the Iwate difficulty scoring system for laparoscopic right posterior sectionectomy: do surgical outcomes differ for tumors in segments VI and VII?

Author

Choi, S. H., Chen, K. -H., Syn, N. L., Cipriani, F., Cheung, T. -T., Chiow, A. K. H., Choi, G. -H., Siow, T. -F., Sucandy, I., Marino, M. V., Gastaca, M., Chong, C. C., Lee, J. H., Ivanecz, A., Mazzaferro, V., Lopez-Ben, S., Fondevila, C., Rotellar, F., Campos, R. R., Efanov, M., Kingham, T. P., Sutcliffe, R. P., Troisi, R. I., Pratschke, J., Wang, X., D'Hondt, M., Yong, C. C., Levi Sandri, G. B., Tang, C. N., Ruzzenente, A., Cherqui, D., Ferrero, A., Wakabayashi, G., Scatton, O., Aghayan, D., Edwin, B., Coelho, F. F., Giuliante, Felice, Liu, R., Sijberden, J., Abu Hilal, M., Sugioka, A., Long, T. C. D., Fuks, D., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Kang, I., Jang, J. Y., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Lai, E., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Giglio, M., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Prieto, M., Lim, C., Nghia, P. P., Kojima, M., Kato, Y., Forchino, F., Herman, P., Kruger, J. A. P., Saleh, M., Pascual, F., Dalla Valle, B., Lopez-Lopez, V., Casellas-Robert, M., Giustizieri, U., Citterio, D., Mishima, K., Fretland, A. A., Ghotbi, J., Ettorre, G. M., Colasanti, M., Guzman, Y., Ardito, Francesco, Vani, S., Wang, H. -P., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Choi, S. H., Chen, K. -H., Syn, N. L., Cipriani, F., Cheung, T. -T., Chiow, A. K. H., Choi, G. -H., Siow, T. -F., Sucandy, I., Marino, M. V., Gastaca, M., Chong, C. C., Lee, J. H., Ivanecz, A., Mazzaferro, V., Lopez-Ben, S., Fondevila, C., Rotellar, F., Campos, R. R., Efanov, M., Kingham, T. P., Sutcliffe, R. P., Troisi, R. I., Pratschke, J., Wang, X., D'Hondt, M., Yong, C. C., Levi Sandri, G. B., Tang, C. N., Ruzzenente, A., Cherqui, D., Ferrero, A., Wakabayashi, G., Scatton, O., Aghayan, D., Edwin, B., Coelho, F. F., Giuliante, Felice, Liu, R., Sijberden, J., Abu Hilal, M., Sugioka, A., Long, T. C. D., Fuks, D., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Kang, I., Jang, J. Y., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Lai, E., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Giglio, M., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Prieto, M., Lim, C., Nghia, P. P., Kojima, M., Kato, Y., Forchino, F., Herman, P., Kruger, J. A. P., Saleh, M., Pascual, F., Dalla Valle, B., Lopez-Lopez, V., Casellas-Robert, M., Giustizieri, U., Citterio, D., Mishima, K., Fretland, A. A., Ghotbi, J., Ettorre, G. M., Colasanti, M., Guzman, Y., Ardito, Francesco, Vani, S., Wang, H. -P., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Introduction: The Iwate Score (IS) have not been well-validated for specific procedures, especially for right posterior sectionectomy (RPS). In this study, the utility of the IS was determined for laparoscopic (L)RPS and the effect of tumor location on surgical outcomes was investigated. Methods: Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria. Baseline characteristics and perioperative outcomes of patients stratified based on the Iwate score were compared to determine whether a correlation with surgical difficulty existed. A 1:1 Mahalanobis distance matching was utilized to investigate the effect of tumor location on L-RPS outcomes. Results: The patients were stratified into 3 levels of difficulty (31 intermediate, 143 advanced, and 422 expert) based on the IS. When using a stepwise increase of the IS excluding the tumor location score, only Pringle’s maneuver was more frequently used in the higher surgical difficulty level (35.5%, 54.6%, and 65.2%, intermediate, advanced, and expert levels, respectively, Z = 3.34, p = 0.001). Other perioperative results were not associated with a statistical gradation toward higher difficulty level. 80 of 85 patients with a segment VI lesion and 511 patients with a segment VII lesion were matched 1:1. There were no significant differences in the perioperative outcomes of the two groups including open conversion, operating time, blood loss, intraoperative blood transfusion, postoperative stay, major morbidity, and mortality. Conclusion: Among patients undergoing L-RPS, the IS did not significantly correlate with most outcome measures associated with intraoperative difficulty and postoperative outcomes. Similarly, tumor location had no effect on L-RPS outcomes.

Published
2022

27. Comparison Between Minimally-Invasive Right Anterior and Right Posterior Sectionectomy versus Right Hepatectomy: An International Multicenter Propensity-Score Matched and Coarsened-Exact Matched Analysis of 1100 Patients

Author

Willems, E., primary, D'Hondt, M., additional, Kingham, P.T., additional, Fuks, D., additional, Choi, G.-H., additional, Syn, N., additional, Sucandy, I., additional, Marino, M.V., additional, Calvo, M. Prieto, additional, Chong, C.C.N., additional, Lee, J.-H., additional, Efanov, M., additional, Chiow, A.K., additional, Choi, S.-H., additional, Sutcliffe, R., additional, Troisi, R.I., additional, Pratschke, J., additional, Cheung, T.-T., additional, Wang, X.-Y., additional, Liu, R., additional, Tang, C.N., additional, Han, H.-S., additional, and Goh, B.K.P., additional

Published
2022
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