Laparoscopic liver resection in cirrhotic patients with specific reference to a difficulty scoring system
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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.
KeywordsLaparoscopic liver resection Liver cirrhosis Difficulty scoring system Intraoperative blood loss
The authors would like to thank Crimson Interactive Japan (https://www.crimsonjapan.co.jp) for the English language review.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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 was obtained from all individual participants included in the study.
- 2.Belghiti J, Dokmak S Liver resection in cirrhosis. In: Jarnagin WR (ed) Blumgart’s surgery of the liver, biliary tract, and pancreas. Elsevier, Philadelphia, pp 1537–1543Google Scholar
- 11.Nguyen KT, Laurent A, Dagher I, Geller DA, Steel J, Thomas MT, Marvin M, Ravindra KV, Mejia A, Lainas P, Franco D, Cherqui D, Buell JF, Gamblin TC (2009) Minimally invasive liver resection for metastatic colorectal cancer: a multi-institutional, international report of safety, feasibility, and early outcomes. Ann Surg 250:842–848CrossRefPubMedGoogle Scholar
- 12.Ettorre GM, Laurenzi A, Lionetti R, Santoro R, Lepiane P, Colasanti M, Colace L, Piselli P, Puoti C, D’Offizi G, Antonini M, Vennarecci G (2014) Laparoscopic liver resections in normal and cirrhotic livers: a retrospective analysis in a tertiary hepato-biliary unit. Dig Liver Dis 46:353–357CrossRefPubMedGoogle Scholar
- 14.Worhunsky DJ, Dua MM, Tran TB, Siu B, Poultsides GA, Norton JA, Visser BC (2016) Laparoscopic hepatectomy in cirrhotics: safe if you adjust technique. Surg Endosc 19Google Scholar
- 30.Arii S, Yamaoka Y, Futagawa S, Inoue K, Kobayashi K, Kojiro M, Makuuchi M, Nakamura Y, Okita K, Yamada R (2000) Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. The Liver Cancer Study Group of Japan. Hepatology 32:1224–1229CrossRefPubMedGoogle Scholar
- 32.Hallet J, Gayet B, Tsung A, Wakabayashi G, Pessaux P, 2nd International Consensus Conference on Laparoscopic Liver Resection Group (2015) Systematic review of the use of pre-operative simulation and navigation for hepatectomy: current status and future perspectives. J Hepatobiliary Pancreat Sci 22:353–362CrossRefPubMedGoogle Scholar
- 34.Tanaka S, Kubo S, Kanazawa A, Takeda Y, Hirokawa F, Nitta H, Nakajima T, Kaizu T, Kaneko H, Wakabayashi G (2017) Validation of a difficulty scoring system for laparoscopic liver resection: a multicenter analysis by the endoscopic liver surgery study group in Japan. J Am Coll Surg 225:249–258CrossRefPubMedGoogle Scholar
- 35.Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schön MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629PubMedGoogle Scholar