Short-term Outcomes of "Difficult" Laparoscopic Liver Resection at Specialized Centers: Report From INSTALL (International Survey on Technical Aspects of Laparoscopic Liver Resection)-2 on 4478 Patients. Issue 5 (1st May 2022)

• Record Type: Journal Article
• Authors: Ibuki, Sho; Hibi, Taizo; Tanabe, Minoru; Geller, David A.; Cherqui, Daniel; Wakabayashi, Go
• Other Names: collaborator.
• Is Part Of: Annals of surgery. Volume 275:Issue 5(2022)
• Page Start: 940
• Page End: 946
• Publication Date: 2022-05-01
• Subjects: 90-day mortality -- iLLS (international laparoscopic liver society) -- INSTALL (international survey on technical aspects of laparoscopic liver resection) -- international registry -- laparoscopic liver resection -- postoperative complications; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000004434
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: To define the current status of "difficult" LLR, a global database was created and investigated. Background: In the Second International Consensus Conference in 2014, minor LLR was considered as a standard practice and major LLR remained an innovative procedure. Since then, no updates on worldwide trends have been available. Methods: A questionnaire on all consecutive patients who underwent difficult LLR (major hepatectomy, posterosuperior segmentectomy, sectionec-tomy, living donor hepatectomy, tumor size ≥10 cm, Child-Pugh grade ≥B, combined with biliary reconstruction, and Iwate criteria difficulty score ≥7) in 2014–2018 was distributed via email to 65 high-volume LLR centers worldwide. individual data on patient and tumor demographics, surgical information, and short-term outcomes were obtained to create a large-scale international registry for analyses. Results: Overall, 58 centers in 19 countries performed 4478 difficult LLR (median, 58.5; range, 5–418) during the study period. Hepatocellular carcinoma accounted for ≥ 40% of all indications. Half of the patients underwent major hepatectomy, followed by sectionectomy, posterosuperior segmentectomy, and living donor hepatectomy. in the vast majority of procedures, Clavien-Dindo grade ≥IIIa complication rates of ≈10% and 90-day mortality rates of ≈1% were achieved. Left or right trisectionectomy had the worst Clavien-Dindo grade ≥IIIa complication rate of ≥10% and 90-day mortality rate of 5%–10%. No significant correlation was observed between center volume and short-term outcomes. Conclusions: Total 4478 patients underwent difficult LLR worldwide in 2014–2018. Most procedures are safe and feasible when conducted in specialized centers.