Abstract
The indications for laparoscopic liver resection have expanded; however, the safety and benefits of laparoscopic repeat hepatectomy (LRH) remain unclear. We retrospectively reviewed data from 137 patients who underwent partial hepatectomy or left lateral sectionectomy without thoracotomy. We compared patients’ clinical factors using a difficulty scoring system for LRH. We defined factors associated with blood loss volumes in the 75th percentile or above as risk factors for bleeding in open repeat hepatectomy, and determined whether these factors were useful for LRH risk assessment. Open repeat hepatectomy and LRH was performed in 96 and 41 patients, respectively. Four of 41 (9.8%) patients undergoing LRH were converted to laparotomy. Blood loss volume was significantly greater in the intermediate-risk group than in the low-risk group (P = 0.046). Multivariate analysis revealed that the presence of tumours located adjacent and caudal or dorsal to the primary tumour site was an independent risk factor for bleeding in LRH (odds ratio 3.21, 95% confidence interval 1.16–8.88, P = 0.024). Our study validated the usefulness of a difficulty scoring system, identified patient factors that predicted the difficulty of LRH, and presented a novel difficulty scoring system for LRH based on an existing difficulty scoring system.
Highlights
The indications for laparoscopic liver resection have expanded; the safety and benefits of laparoscopic repeat hepatectomy (LRH) remain unclear
Age# Gender ASA-PS [3] Tumour type (HCC/metastatic tumour) Type of approach to the previous hepatectomy (Lap-Hx) Number of the previous hepatectomy (3 or more) Pringle manoeuvre Time of Pringle manoeuvre# Year of surgery (2015–2018) Tumour diameter# Tumour number Tumour location (S1, S7 or S8) Tumours located in the ipsilateral of the previous surgical site Tumours located in the adjacent area on the cranial or dorsal side of the previous surgical site
Age# Gender ASA-PS [3] Tumour type (HCC/metastatic tumour) Type of approach to the previous hepatectomy (Lap-Hx) Number of the previous hepatectomy (3 or more) Pringle manoeuvre Time of Pringle manoeuvre# Year of surgery (2015–2018) Tumour diameter # Tumour number Tumour location (S1, S7 or S8) Tumours located in the ipsilateral of the previous surgical site Tumours located in the adjacent area on the cranial or dorsal side of the previous surgical site
Summary
The indications for laparoscopic liver resection have expanded; the safety and benefits of laparoscopic repeat hepatectomy (LRH) remain unclear. We defined factors associated with blood loss volumes in the 75th percentile or above as risk factors for bleeding in open repeat hepatectomy, and determined whether these factors were useful for LRH risk assessment. It is difficult to use the scoring system to evaluate the difficulty of LRH, as the system does not assess factors related to repeat hepatectomy. To identify the factors affecting intraoperative blood loss in LRH, we retrospectively analysed data from patients undergoing open repeat hepatectomy and evaluated whether the patient factors indicative of a high risk of blood loss in open repeat hepatectomy were useful for risk assessment in LRH. We validated the utility of the difficulty scoring system proposed by Ban et al., modified the system to include our novel patient-related risk factors, and evaluated the modified system for assessing the risk of bleeding in patients undergoing LRH
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