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Resection type is a predictor of postoperative complications in laparoscopic partial liver resection

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Abstract

Background

Partial laparoscopic liver resection (LLR) is a procedure that can have varying levels of surgical difficulty depending on the tumor status and procedure. Therefore, we aimed to evaluate the surgical outcomes of partial LLR using a new resection classification system.

Methods

From January 2009 to May 2021, 156 patients underwent LLR; of them, 87 patients who underwent pure partial LLR were included in this study. They were classified according to the IWATE criteria as the low (n = 56) and intermediate (n = 31) difficulty groups and reclassified according to the resection type as the edge (ER, n = 45), bowl-shaped (BSR, n = 27), and dome-shaped resection (DSR, n = 15) groups. The following surgical outcomes were comparatively analyzed among the groups: intraoperative blood loss, the operation time, and complication rates. Preoperative risk factors for intraoperative blood transfusion and complications were evaluated.

Results

In the IWATE criteria-based analysis, the intermediate-difficulty group had significantly higher intraoperative blood loss (p = 0.005), operation time (p = 0.005), and Clavien–Dindo (CD) grade-based complication rates (CD grade 2 or higher, p = 0.03) than the low-difficulty group. When analyzing the resection type, the CD grade-based complication rate (p = 0.013) and surgical site infection (SSI, p = 0.005) were significantly higher and the postoperative hospitalization was significantly longer (p = 0.028) in the bowl-shaped resection (BSR) group than in the edge- (ER) and dome-shaped resection (DSR) groups. The tumor size (p = 0.011) and IWATE criteria score (p = 0.006) were independent risk factors for intraoperative blood transfusion in the multivariate analysis. The tumor depth (p = 0.011) and BSR (p = 0.002) were independent risk factors for complications of CD grade 2 or higher in the multivariate analysis. BSR was an independent risk factor for SSI in the multivariate analysis (p = 0.017).

Conclusions

Resection type could predict the rate of postoperative complications, while the IWATE criteria could predict the intraoperative surgical difficulty.

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Authors and Affiliations

  1. Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan

    Akihiro Tanemura, Shugo Mizuno, Koki Maeda, Toru Shinkai, Takahiro Ito, Aoi Hayasaki, Kazuyuki Gyoten, Takehiro Fujii, Yusuke Iizawa, Yasuhiro Murata, Naohisa Kuriyama, Masashi Kishiwada & Hiroyuki Sakurai

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  1. Akihiro Tanemura
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  2. Shugo Mizuno
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  3. Koki Maeda
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Correspondence to Akihiro Tanemura.

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Akihiro Tanemura, Koki Maeda, Toru Shinkai, Takahiro Ito, Aoi Hayasaki, Kazuyuki Gyoten, Takehiro Fujii, Yusuke Iizawa, Yasuhiro Murata, Naohisa Kuriyama, Masashi Kishiwada, Hiroyuki Sakurai and Shugo Mizuno have no conflict of interest or financial ties to disclose.

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Tanemura, A., Mizuno, S., Maeda, K. et al. Resection type is a predictor of postoperative complications in laparoscopic partial liver resection. Surg Endosc 36, 9054–9063 (2022). https://doi.org/10.1007/s00464-022-09372-x

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