Langenbeck's Archives of Surgery

, Volume 403, Issue 3, pp 371–377 | Cite as

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

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



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.


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.


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.


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.


Laparoscopic liver resection Liver cirrhosis Difficulty scoring system Intraoperative blood loss 



The authors would like to thank Crimson Interactive Japan ( for the English language review.

Compliance with ethical standards

Conflict of interest

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.

Informed consent

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

Supplementary material

423_2018_1671_MOESM1_ESM.pdf (148 kb)
ESM 1 (PDF 147 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Hiroki Uchida
    • 1
  • Yukio Iwashita
    • 1
  • Kazuhiro Tada
    • 1
  • Kunihiro Saga
    • 1
  • Hiroomi Takayama
    • 1
  • Teijiro Hirashita
    • 1
  • Yuichi Endo
    • 1
  • Masayuki Ohta
    • 1
  • Masafumi Inomata
    • 1
  1. 1.Department of Gastroenterological and Pediatric Surgery, Faculty of MedicineOita UniversityYufuJapan

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