Predictive Ability of Preoperative CT Scan for the Intraoperative Difficulty and Postoperative Outcomes of Laparoscopic Liver Resection

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2020 Jun 20

PMID 32556771

Citations 2

Authors

Theophile Guilbaud

Ugo Scemama

Anthony Sarran

Ecoline Tribillon

Alexandra Nassar

Brice Gayet

David Fuks

Affiliations

Soon will be listed here.

Abstract

Background: The surgical difficulty and postoperative outcomes of laparoscopic liver resection (LLR) are related to the size of the cut liver surface. This study assessed whether the estimated parenchymal transection surface area could predict intraoperative difficulty and postoperative outcomes.

Methods: LLRs performed between 2008 and 2018, for whom a preoperative CT scan was available for 3D review, were included in the study. The area of scheduled parenchymal transection was measured on the preoperative CT scan and cut-off values that could predict intraoperative difficulty were analyzed.

Results: 152 patients who underwent left lateral sectionectomy (n = 27, median estimated area 30.1 cm [range 16.6-65.9]), left/right hepatectomy (n = 17 and n = 70, 76.8 cm [range 43.9-150.9] and 72.2 cm [range 39.4-124.9], respectively), right posterior sectionectomy (n = 7, 113.3 cm [range 102.1-136.3]), central hepatectomy (n = 11, 109.1 cm [range 66.1-186.1]) and extended left/right hepatectomy (n = 6 and n = 14, 115.3 cm [range 92.9-128.9] and 50.7 cm [range 13.3-74.9], respectively) were included. An estimated parenchymal transection surface area ≥ 100 cm was associated with significant increase in operative time (AUC 0.81, 95% CI [0.70, 0.93], p < 0.001) and estimated blood loss (AUC 0.92, 95% CI [0.86, 0.97], p < 0.001), as well as a higher conversion rate (22.2% vs. 4.0%, p < 0.001). Overall (p = 0.017) and major morbidity (p = 0.003), biliary leakage (p < 0.001) and pulmonary complications (p < 0.001) were significantly higher in patients with an estimated parenchymal transection surface area ≥ 100 cm.

Conclusions: An estimated parenchymal transection surface area ≥ 100 cm is a relevant indicator of surgical difficulty and postoperative complications in LLR.

Citing Articles

Sub-classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes.

Ruzzenente A, Dalla Valle B, Poletto E, Syn N, Kabir T, Sugioka A J Hepatobiliary Pancreat Sci. 2023; 30(9):1098-1110.

PMID: 36872098 PMC: 10966966. DOI: 10.1002/jhbp.1323.

A novel difficulty scoring system of laparoscopic liver resection for liver tumor.

Xi C, Zhu M, Ji T, Tan Y, Zhuang L, Yuan Z Front Oncol. 2022; 12:1019763.

PMID: 36248965 PMC: 9557292. DOI: 10.3389/fonc.2022.1019763.

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