C Hobeika1, D Fuks2, F Cauchy3, C Goumard1, O Soubrane3, B Gayet2, E Salamé4, D Cherqui5, E Vibert5, O Scatton1, T Nomi6, N Oudafal7, T Kawai8, S Komatsu8, S Okumura8, N Petrucciani9, A Laurent9, P Bucur10, L Barbier10, B Trechot11, J Nunèz11, M Tedeschi11, M-A Allard11, N Golse11, O Ciacio11, G Pittau11, A Sa Cunha11, R Adam11, C Laurent12, L Chiche12, P Leourier13, L Rebibo13, J-M Regimbeau13, L Ferre14, F R Souche14, J Chauvat14, J-M Fabre14, F Jehaes15, K Mohkam15, M Lesurtel15, C Ducerf15, J-Y Mabrut15, T Hor16, F Paye16, P Balladur16, B Suc17, F Muscari17, G Millet18, M El Amrani18, C Ratajczak18, K Lecolle18, E Boleslawski18, S Truant18, F-R Pruvot18, A-R Kianmanesh19, T Codjia20, L Schwarz20, E Girard21, J Abba21, C Letoublon21, M Chirica21, A Carmelo22, C VanBrugghe22, Z Cherkaoui23, X Unterteiner23, R Memeo23, P Pessaux23, E Buc24, E Lermite25, J Barbieux25, M Bougard25, U Marchese26, J Ewald26, O Turini26, A Thobie27, B Menahem27, A Mulliri27, J Lubrano27, J Zemour28, H Fagot28, G Passot29, E Gregoire30, J Hardwigsen30, Y-P le Treut30, D Patrice31. 1. Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France. 2. Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France. 3. Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France. 4. Department of Digestive Surgery and Liver Transplantation, Trousseau University Hospital, Tours University, Tours, France. 5. Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France. 6. Nara Medical University, Nara, Japan. 7. Institut Mutualiste Montsouris, Paris, France. 8. Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France. 9. Hôpital Henri Mondor, APHP, Creteil, France. 10. Trousseau Hospital, University Hospital Centre of Tours, Tours, France. 11. Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France. 12. Hospital University Centre of Bordeaux, Bordeaux, France. 13. Hospital University Centre of Amiens-Picardie, Amiens, France. 14. Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France. 15. Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France. 16. St Antoine Hospital, APHP, Paris, France. 17. Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France. 18. Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France. 19. Robert Debré Hospital, Hospital University Centre of Reims, Reims, France. 20. Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France. 21. Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France. 22. Hôpital Européen, Marseille, France. 23. Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France. 24. Hospital University Centre of Clermont-Ferrand, Clermont-Ferrand, France. 25. Hospital University Centre of Angers, Angers, France. 26. Institut Paoli-Calmettes, Marseille, France. 27. Hospital University Centre of Caen Normandie, Caen, France. 28. Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France. 29. Hospital University Centre of Lyon Sud, Lyon, France. 30. La Timone Hospital, Hospital University Centre of Marseille, Marseille, France. 31. Louis Pasteur Hospital, Colmar, France.
Abstract
BACKGROUND: The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study. METHODS: This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection. RESULTS: Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010). CONCLUSION: Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres.
BACKGROUND: The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study. METHODS: This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection. RESULTS: Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010). CONCLUSION: Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres.
Authors: Rebecca Marino; Pim B Olthof; Hong J Shi; Khe T C Tran; Jan N M Ijzermans; Türkan Terkivatan Journal: World J Surg Date: 2022-09-26 Impact factor: 3.282
Authors: J-J Tuech; A Gangloff; F Di Fiore; P Michel; C Brigand; K Slim; M Pocard; L Schwarz Journal: J Visc Surg Date: 2020-03-31 Impact factor: 2.043