Department of Digestive, Oncological and Metabolic Surgery - Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.
Université Paris Descartes, 15 rue de l'école de médecine, 75005, Paris, France.
Surg Endosc. 2021 Jun;35(6):2942-2952. doi: 10.1007/s00464-020-07734-x. Epub 2020 Jun 15.
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.
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.
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.
An estimated parenchymal transection surface area ≥ 100 cm is a relevant indicator of surgical difficulty and postoperative complications in LLR.
腹腔镜肝切除术（LLR）的手术难度和术后结果与肝切除表面的大小有关。本研究评估了估计的肝实质横断面积是否可以预测术中难度和术后结果。
纳入了 2008 年至 2018 年期间进行的 LLR 患者，这些患者术前 CT 扫描可进行 3D 回顾。在术前 CT 扫描上测量预定肝实质横断面积，并分析可预测术中困难的截断值。
共纳入 152 例接受左外侧叶切除术（n=27，中位估计面积 30.1cm[范围 16.6-65.9]）、左/右半肝切除术（n=17 和 n=70，76.8cm[范围 43.9-150.9]和 72.2cm[范围 39.4-124.9]）、右后叶切除术（n=7，113.3cm[范围 102.1-136.3]）、中央肝切除术（n=11，109.1cm[范围 66.1-186.1]）和扩大左/右半肝切除术（n=6 和 n=14，115.3cm[范围 92.9-128.9]和 50.7cm[范围 13.3-74.9]）。估计的肝实质横断面积≥100cm2与手术时间（AUC 0.81，95%CI[0.70，0.93]，p<0.001）和估计的出血量（AUC 0.92，95%CI[0.86，0.97]，p<0.001）显著增加以及更高的转化率（22.2%比 4.0%，p<0.001）相关。总体而言（p=0.017）和主要并发症（p=0.003）、胆漏（p<0.001）和肺部并发症（p<0.001）在估计的肝实质横断面积≥100cm2的患者中明显更高。
估计的肝实质横断面积≥100cm2是 LLR 手术难度和术后并发症的一个相关指标。
