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

• Published in: Surgical endoscopy Vol. 36; no. 12; pp. 9054 - 9063
• Main Authors: Tanemura, Akihiro, Mizuno, Shugo, Maeda, Koki, Shinkai, Toru, Ito, Takahiro, Hayasaki, Aoi, Gyoten, Kazuyuki, Fujii, Takehiro, Iizawa, Yusuke, Murata, Yasuhiro, Kuriyama, Naohisa, Kishiwada, Masashi, Sakurai, Hiroyuki
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2022; Springer Nature B.V
• Subjects: Abdominal Surgery; Blood Loss, Surgical; Blood transfusions; Gastroenterology; Gynecology; Hepatectomy - adverse effects; Hepatectomy - methods; Hepatology; Humans; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - methods; Length of Stay; Liver Neoplasms - complications; Liver Neoplasms - surgery; Medicine; Medicine & Public Health; Multivariate analysis; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Postoperative period; Proctology; Retrospective Studies; Risk factors; Surgery; Surgical outcomes; Laparoscopic liver resection; Tumor depth; Resection type; Difficulty score; Partial liver resection; IWATE criteria
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-022-09372-x

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.