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Impact of anthropometric data on technical difficulty of laparoscopic liver of resections of segments 7 and 8: the CHALLENGE index

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Abstract

Background

The high technical difficulty of using a laparoscopic approach to reach the posterosuperior liver segments is mainly associated with their poor accessibility. This study was performed to analyze correlations between anthropometric data and intraoperative outcomes.

Study design

All patients who underwent segmentectomy or wedge laparoscopic liver resection (LLR) of segments seven and/or eight from June 2012 to November 2019 were retrospectively analyzed. The exclusion criteria were intrahepatic cholangiocarcinoma, associated resection, multiple concomitant LLR, redo resection, and lack of preoperative imaging. Anthropometric data were correlated with intraoperative outcomes.

Results

Forty-one patients (wedge resection, n = 32; segmentectomy, n = 9) were analyzed. A strong correlation was found between the craniocaudal liver diameter (CCliv) and liver volume (r = 0.655, p < 0.001). The anteroposterior liver diameter was moderately correlated with both the laterolateral abdominal diameter (LLabd) (r = 0.372, p = 0.008) and anteroposterior abdominal diameter (r = 0.371, p = 0.008). The body mass index (BMI) was not correlated with liver diameters. Women had a longer CCliv (p = 0.002) and shorter LLabd (p < 0.001) than men. The liver and abdominal measurements were combined to reduce this sex-related disparity. The CCliv/LLabd ratio (CHALLENGE index) was significantly correlated with the time of transection (r = 0.382, p = 0.037) and blood loss (r = 0.352, p = 0.029). The association between the CHALLENGE index and intraoperative blood loss was even stronger when considering only anatomical resection (r = 0.577, p = 0.048). A CHALLENGE index of > 0.4 (area under the curve, 0.757; p = 0.046) indicated a higher bleeding risk. The BMI predicted no intraoperative outcomes.

Conclusion

Anthropometric data rather than the BMI can help anticipate the difficulty of LLR of segments seven and eight.

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Data availability

Data for the current study is owned by the Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy. Authors have full control of all primary data. Data may be requested to the corresponding author.

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Authors and Affiliations

  1. Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati, 62-10128, Turin, Italy

    Nadia Russolillo, Cecilia Maina, Serena Langella, Roberto Lo Tesoriere, Michele Casella & Alessandro Ferrero

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  1. Nadia Russolillo
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  2. Cecilia Maina
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  3. Serena Langella
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  4. Roberto Lo Tesoriere
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  6. Alessandro Ferrero
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Contributions

Nadia Russolillo (PhD), Cecilia Maina (MD), Serena Langella (MD), Roberto Lo Tesoriere (MD), Michele Casella (MD), Alessandro Ferrero (MD) meet all of the conditions of the Authorship Criteria Published in the Consensus Statement on Submission and Publication of Manuscripts and have approved the final article.

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Correspondence to Nadia Russolillo.

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Nadia Russolillo, Cecilia Maina, Serena Langella, Roberto Lo Tesoriere, Michele Casella, Alessandro Ferrero have no conflicts of interest or financial ties to disclose.

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Russolillo, N., Maina, C., Langella, S. et al. Impact of anthropometric data on technical difficulty of laparoscopic liver of resections of segments 7 and 8: the CHALLENGE index. Surg Endosc 35, 5088–5095 (2021). https://doi.org/10.1007/s00464-020-07993-8

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