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Laparoscopic liver resection in cirrhotic patients with specific reference to a difficulty scoring system

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Abstract

Purpose

Laparoscopic liver resection is widely used for liver tumors, but its utility in patients with cirrhosis remains controversial. The aim of this study was to assess the surgical outcomes of laparoscopic liver resection in patients with liver cirrhosis with specific reference to a difficulty scoring system.

Methods

From January 2010 to March 2016, the outcomes of laparoscopic liver resection in 95 patients were retrospectively reviewed. Surgical outcomes were analyzed to identify differences between the liver cirrhosis and non-liver cirrhosis groups; these groups were further stratified to high and low difficulty scores. The surgical outcomes of both groups were compared according to the difficulty scores.

Results

Overall, 53/95 (55.8%) patients were diagnosed with liver cirrhosis. There were no significant differences in surgical duration, blood loss, postoperative hospital stay, and morbidity between groups, although liver function was worse in the liver cirrhosis group than in the non-liver cirrhosis group. Multivariate analysis showed that the difficulty score was an independent predictor of increased blood loss. In particular, blood loss in cirrhotic patients was significantly greater with a high difficulty score than with a low difficulty score.

Conclusions

The safety profile of laparoscopic liver resection was the same in patients with and without liver cirrhosis. However, patients with liver cirrhosis and a high difficulty score require extra attention, because of a higher risk for perioperative blood loss.

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Acknowledgments

The authors would like to thank Crimson Interactive Japan (https://www.crimsonjapan.co.jp) for the English language review.

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Authors and Affiliations

  1. Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan

    Hiroki Uchida, Yukio Iwashita, Kazuhiro Tada, Kunihiro Saga, Hiroomi Takayama, Teijiro Hirashita, Yuichi Endo, Masayuki Ohta & Masafumi Inomata

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  1. Hiroki Uchida
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  2. Yukio Iwashita
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  3. Kazuhiro Tada
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Correspondence to Hiroki Uchida.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standard of our institution and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Uchida, H., Iwashita, Y., Tada, K. et al. Laparoscopic liver resection in cirrhotic patients with specific reference to a difficulty scoring system. Langenbecks Arch Surg 403, 371–377 (2018). https://doi.org/10.1007/s00423-018-1671-4

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  • DOI: https://doi.org/10.1007/s00423-018-1671-4

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