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2. Heterogeneity of management practices surrounding operable gallbladder cancer – results of the OMEGA-S international HPB surgical survey

Author

Abe, T., Achalandabaso, M., Adham, M., Ahmet, A., Al-Sarireh, B., Albiol Quer, M., Alconchel, F., Alsammani, M., Alseidi, A., Anand, A., Anselmo, A., Antonakis, P., Arabadzhieva, E., de Aretxabala, X., Aroori, S., Ashley, S., Ausania, F., Banerjee, A., Barabino, M., Bartlett, A., Bartsch, F., Belli, A., Beristain-Hernandez, J., Berrevoet, F., Bhatti, A.B.H., Bhojwani, R., Bjornsson, B., Blaz, T., Byrne, M., Calvo, M.P., Castellanos, J., Castro, M.J., Cavallucci, D., Chang, D., Christodoulis, G., Ciacio, O., Clavien, P.A., Coker, A., Conde-Rodriguez, M., D'Amico, F.E., D'Hondt, M., Daams, F., Dasari, B.V.M., De Bellis, M., de Meijer, V.E., Dede, K., Deiro, G., Delgado, F.J.B., Desai, G., Di Gioia, A., Di Martino, M., Dixon, M., Dorovinis, P., Dumitrascu, T., Ebata, T., Eilard, M.S., Erdmann, J., Erkan, M., Famularo, S., Felli, E., Fergadi, M., Fernandez, G.B., Fox, A., Galodha, S., Galun, D., Ganandha, S., Garcia, R.J.R., Gemenetzis, G., Giannone, F., Gil, L., Giorgakis, E., Giovinazzo, F., Giuffrida, M., Giuliani, T., Giuliante, F., Gkekas, I., Goel, M., Goh, B.K., Gomes, A., Gruenberger, T., Guevara, O., Gulla, A., Gupta, A., Gupta, R., Hakeem, A.R., Hamid, H.K.S., Heinrich, S., Helton, S., Hernandez-Alejandro, R., Heumann, A., Higuchi, R., Hughes, D., Inarejos, B.C., Ivanecz, A., Iwao, Y., Iype, S., Jaen, I., Jie, M.J., Jones, R., Kacirek, K., Kalayarasan, R., Kaldarov, A., Kaman, L., Kanhere, H., Kapoor, V.K., Karanicolas, P., Karayiannakis, A., Kausar, A., Khan, Z.A., Kim, D.-S., Klose, J., Knowles, B., Koh, P.S., Kolodziejczyk, P., Komorowski, A.L., Koong, J.K., Kozyrin, I., Krishna, A., Kron, P., Kumar, N., van Laarhoven, S., Lakhey, P.J., Lanari, J., Laurenzi, A., Leow, V.M., Limbu, Y., Liu, Y.-B., Lob, S., Lolis, E., Lopez-Lopez, V., Lozano, R.C., Lundgren, L., Machairas, N., Magouliotis, D., Mahamid, A., Malde, D., Malek, A., Malik, H., Malleo, G., Marino, M.V., Mayo, S.C., Mazzola, M., Memeo, R., Menon, K., Menzulin, R., Mohan, R., Morgul, H., Moris, D., Mulita, F., Muttillo, E.M., Nahm, C., Nandasena, M., Nashidengo, P.R., Nickkholgh, A., Nikov, A., Noel, C., O'Reilly, D., O'Rourke, T., Ohtsuka, M., Omoshoro-Jones, J.A.O., Pandanaboyana, S., Pararas, N., Patel, R., Patkar, S., Peng, J.S., Perfecto, A., Perinel, J., Perivoliotis, K., Perra, T., Phan, M.T., Piccolo, G., Porcu, A., Primavesi, F., Primrose, J., Pueyo-Periz, E., Radenkovic, D., Rammohan, A., Rowcroft, A., Sakata, J., Saladino, E., Schena, C.A., Scholer, A., Schwarz, C., Serrano, P., Silva, M., Soreide, K., Sparrelid, E., Stattner, S., Sturesson, C., Sugiura, T., Sumo, M., Sutcliffe, R., Teh, C., Teo, J.Y., Tepetes, K., Thapa, P.B., Thepbunchonchai, A., Torres, J.B.P., Torres, O.J.M., Torzili, G., Tovikkai, C., Troncoso, A., Tsoulfas, G., Tuzuher, A., Tzimas, G., Umar, G.I., Urbani, L., Vanagas, T., Varga, Velayutham, V., Vigano, L., Wakai, T., Yang, Z., Yip, V., Zacharoulis, D., Zakharov, E.A., Zimmitti, G., Balakrishnan, Anita, Jah, Asif, Lesurtel, Mickael, Andersson, Bodil, Gibbs, Paul, Harper, Simon J.F., Huguet, Emmanuel L., Kosmoliaptsis, Vasilis, Liau, Siong S., Praseedom, Raaj K., Ramia, Jose M., Branes, Alejandro, Lendoire, Javier, Maithel, Shishir, and Serrablo, Alejandro

Published
2022
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5. Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

Author

De'Angelis, N, Marchegiani, F, Schena, C, Khan, J, Agnoletti, V, Ansaloni, L, Barria Rodriguez, A, Bianchi, P, Biffl, W, Bravi, F, Ceccarelli, G, Ceresoli, M, Chiara, O, Chirica, M, Cobianchi, L, Coccolini, F, Coimbra, R, Cotsoglou, C, D'Hondt, M, Damaskos, D, De Simone, B, Di Saverio, S, Diana, M, Espin-Basany, E, Fichtner-Feigl, S, Fugazzola, P, Gavriilidis, P, Gronnier, C, Kashuk, J, Kirkpatrick, A, Ammendola, M, Kouwenhoven, E, Laurent, A, Leppaniemi, A, Lesurtel, M, Memeo, R, Milone, M, Moore, E, Pararas, N, Peitzmann, A, Pessaux, P, Picetti, E, Pikoulis, M, Pisano, M, Ris, F, Robison, T, Sartelli, M, Shelat, V, Spinoglio, G, Sugrue, M, Tan, E, Van Eetvelde, E, Kluger, Y, Weber, D, Catena, F, de'Angelis N., Marchegiani F., Schena C. A., Khan J., Agnoletti V., Ansaloni L., Barria Rodriguez A. G., Bianchi P. P., Biffl W., Bravi F., Ceccarelli G., Ceresoli M., Chiara O., Chirica M., Cobianchi L., Coccolini F., Coimbra R., Cotsoglou C., D'Hondt M., Damaskos D., De Simone B., Di Saverio S., Diana M., Espin-Basany E., Fichtner-Feigl S., Fugazzola P., Gavriilidis P., Gronnier C., Kashuk J., Kirkpatrick A. W., Ammendola M., Kouwenhoven E. A., Laurent A., Leppaniemi A., Lesurtel M., Memeo R., Milone M., Moore E., Pararas N., Peitzmann A., Pessaux P., Picetti E., Pikoulis M., Pisano M., Ris F., Robison T., Sartelli M., Shelat V. G., Spinoglio G., Sugrue M., Tan E., Van Eetvelde E., Kluger Y., Weber D., Catena F., De'Angelis, N, Marchegiani, F, Schena, C, Khan, J, Agnoletti, V, Ansaloni, L, Barria Rodriguez, A, Bianchi, P, Biffl, W, Bravi, F, Ceccarelli, G, Ceresoli, M, Chiara, O, Chirica, M, Cobianchi, L, Coccolini, F, Coimbra, R, Cotsoglou, C, D'Hondt, M, Damaskos, D, De Simone, B, Di Saverio, S, Diana, M, Espin-Basany, E, Fichtner-Feigl, S, Fugazzola, P, Gavriilidis, P, Gronnier, C, Kashuk, J, Kirkpatrick, A, Ammendola, M, Kouwenhoven, E, Laurent, A, Leppaniemi, A, Lesurtel, M, Memeo, R, Milone, M, Moore, E, Pararas, N, Peitzmann, A, Pessaux, P, Picetti, E, Pikoulis, M, Pisano, M, Ris, F, Robison, T, Sartelli, M, Shelat, V, Spinoglio, G, Sugrue, M, Tan, E, Van Eetvelde, E, Kluger, Y, Weber, D, Catena, F, de'Angelis N., Marchegiani F., Schena C. A., Khan J., Agnoletti V., Ansaloni L., Barria Rodriguez A. G., Bianchi P. P., Biffl W., Bravi F., Ceccarelli G., Ceresoli M., Chiara O., Chirica M., Cobianchi L., Coccolini F., Coimbra R., Cotsoglou C., D'Hondt M., Damaskos D., De Simone B., Di Saverio S., Diana M., Espin-Basany E., Fichtner-Feigl S., Fugazzola P., Gavriilidis P., Gronnier C., Kashuk J., Kirkpatrick A. W., Ammendola M., Kouwenhoven E. A., Laurent A., Leppaniemi A., Lesurtel M., Memeo R., Milone M., Moore E., Pararas N., Peitzmann A., Pessaux P., Picetti E., Pikoulis M., Pisano M., Ris F., Robison T., Sartelli M., Shelat V. G., Spinoglio G., Sugrue M., Tan E., Van Eetvelde E., Kluger Y., Weber D., and Catena F.

Abstract

Background: Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS. Methods: This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements. Results: Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20–107) depending on the initial surgeon’s experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon’s proficiency. Conclusions: Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.

Published
2023

6. Are the current difficulty scores for laparoscopic liver surgery telling the whole story? An international survey and recommendations for the future

Author

Abu Hilal, M., Aldrighetti, L., Al Saati, H., Alseidi, A., Aroori, S., Belli, G., Besselink, M., Edwin, B., D'Hondt, M., Dagher, I., Dejong, C., Geller, D., Hamady, Z., Hamoui, M., Isaksson, B., Ivanecz, A., Le Roux, G., Lesurtel, M., O'Rouke, N., Prasad, R., Prieto Calvo, M., Reddy, S., Rotellar, F., Santoyo, J., Soonawalla, Z., Soubrane, O., Stavrou, G., Subar, D., Sutcliffe, R., Tanis, P., Troisi, R., Van Dam, Ronald, Wakabayashi, G., White, S., Halls, Mark C., Cherqui, Daniel, Taylor, Mark A., Primrose, John N., and Abu Hilal, Mohammed

Published
2018
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8. Robotic Versus Laparoscopic Left and Extended Left Hepatectomy: An International Multicenter Study Propensity Score-Matched Analysis

Author

Sucandy I., Rayman S., Lai E. C., Tang C. -N., Chong Y., Efanov M., Fuks D., Choi G. -H., Chong C. C., Chiow A. K. H., Marino M. V., Prieto M., Lee J. -H., Kingham T. P., D'Hondt M., Troisi R. I., Choi S. H., Sutcliffe R. P., Cheung T. -T., Rotellar F., Park J. O., Scatton O., Han H. -S., Pratschke J., Wang X., Liu R., Goh B. K. P., Chan C. -Y., D'Silva M., Schotte H., De Meyere C., Krenzien F., Schmelzle M., Kadam P., Montalti R., Liu Q., Lee K. -F., Salimgereeva D., Alikhanov R., Lee L. S., Gastaca M., Jang J. Y., Lim C., Labadie K. P., Sucandy, I., Rayman, S., Lai, E. C., Tang, C. -N., Chong, Y., Efanov, M., Fuks, D., Choi, G. -H., Chong, C. C., Chiow, A. K. H., Marino, M. V., Prieto, M., Lee, J. -H., Kingham, T. P., D'Hondt, M., Troisi, R. I., Choi, S. H., Sutcliffe, R. P., Cheung, T. -T., Rotellar, F., Park, J. O., Scatton, O., Han, H. -S., Pratschke, J., Wang, X., Liu, R., Goh, B. K. P., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. S., Gastaca, M., Jang, J. Y., Lim, C., and Labadie, K. P.

Subjects
Oncology, Surgery
Abstract

Background: Controversies exist among liver surgeons regarding clinical outcomes of the laparoscopic versus the robotic approach for major complex hepatectomies. The authors therefore designed a study to examine and compare the perioperative outcomes of laparoscopic left hepatectomy or extended left hepatectomy (L-LH/L-ELH) versus robotic left hepatectomy or extended left hepatectomy (R-LH/R-ELH) using a large international multicenter collaborative database. Methods: An international multicenter retrospective analysis of 580 patients undergoing L-LH/L-ELH or R-LH/R-ELH at 25 specialized hepatobiliary centers worldwide was undertaken. Propensity score-matching (PSM) was used at a 1:1 nearest-neighbor ratio according to 15 perioperative variables, including demographics, tumor characteristics, Child-Pugh score, presence of portal hypertension, multiple resections, histologic diagnosis, and Iwate difficulty grade. Results: Before the PSM, 190 (32 %) patients underwent R-LH/R-ELH, and 390 (68 %) patients underwent L-LH/L-ELH. After the matching, 164 patients were identified in each arm without significant differences in demographics, preoperative variables, medical history, tumor pathology, tumor characteristics, or Iwate score. Regarding intra- and postoperative outcomes, the rebotic approach had significantly less estimated blood loss (EBL) (100 ml [IQR 200 ml] vs 200 ml [IQR 235 ml]; p = 0.029), fewer conversions to open operations (n = 4 [2.4 %] vs n = 13, [7.9 %]; p = 0.043), and a shorter hospital stay (6 days [IQR 3 days] vs 7 days [IQR 3.3 days]; p = 0.009). Conclusion: Both techniques are safe and feasible in major hepatic resections. Compared with L-LH/L-ELH, R-LH/R-ELH is associated with less EBL, fewer conversions to open operations, and a shorter hospital stay.

Published
2022

9. ASO Author Reflections: The Robotic Versus Laparoscopic Approach to Left and Extended Left Hepatectomy

Author

Rayman S., Jacoby H., Sucandy I., Goh B. K. P., Chan C. -Y., Han H. -S., D'Silva M., D'Hondt M., Schotte H., De Meyere C., Krenzien F., Schmelzle M., Pratschke J., Sutcliffe R. P., Kadam P., Troisi R. I., Giglio M., Montalti R., Liu R., Liu Q., Chong C. C., Lee K. -F., Efanov M., Salimgereeva D., Alikhanov R., Chiow A. K. H., Lee L. S., Prieto M., Gastaca M., Choi S. -H., Jang J. Y., Scatton O., Lim C., Park J. O., Labadie K. P., Lai E. C., Tang C. -N., Wang X., Chong Y., Fuks D., Choi G. -H., Marino M. V., Lee J. H., Kingham T. P., Cheung T. -T., Rotellar F., Rayman, S., Jacoby, H., Sucandy, I., Goh, B. K. P., Chan, C. -Y., Han, H. -S., D'Silva, M., D'Hondt, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Pratschke, J., Sutcliffe, R. P., Kadam, P., Troisi, R. I., Giglio, M., Montalti, R., Liu, R., Liu, Q., Chong, C. C., Lee, K. -F., Efanov, M., Salimgereeva, D., Alikhanov, R., Chiow, A. K. H., Lee, L. S., Prieto, M., Gastaca, M., Choi, S. -H., Jang, J. Y., Scatton, O., Lim, C., Park, J. O., Labadie, K. P., Lai, E. C., Tang, C. -N., Wang, X., Chong, Y., Fuks, D., Choi, G. -H., Marino, M. V., Lee, J. H., Kingham, T. P., Cheung, T. -T., and Rotellar, F.

Subjects
Oncology, Surgery
Published
2022

11. Proficiency‐based progression training for robotic surgery skills training: a randomized clinical trial

Author

De Groote, R., Puliatti, S., Amato, M., Mazzone, E., Rosiello, G., Farinha, R., Paludo, A., Desender, L., Van Cleynenbreugel, B., Bunting, B. P., Mottrie, A., Gallagher, A. G., Larcher, A., Uvin, P., Decoene, J., Tuyten, T., D'Hondt, M., Hubert, N., Chatzopoulos, C., and De Troyer, B.

Subjects
#Urology, basic skills training, proficiency-based progression, robotic surgery, surgical simulation, training, Urology
Published
2022

14. Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper.

Author

De'Angelis, N., Marchegiani, F., Schena, C.A., Khan, J., Agnoletti, V., Ansaloni, L., arría Rodríguez, A.G. B, Bianchi, P.P., Biffl, W., Bravi, F., Ceccarelli, G., Ceresoli, M., Chiara, O., Chirica, M., Cobianchi, L., Coccolini, F., Coimbra, R., Cotsoglou, C., D'Hondt, M., Damaskos, D., Simone, B. De, Saverio, S. Di, Diana, M., Espin-Basany, E., Fichtner-Feigl, S., Fugazzola, P., Gavriilidis, P., Gronnier, C., Kashuk, J., Kirkpatrick, A.W., Ammendola, M., Kouwenhoven, E.A., Laurent, A., Leppaniemi, A., Lesurtel, M., Memeo, R., Milone, M., Moore, E., Pararas, N., Peitzmann, A., Pessaux, P., Picetti, E., Pikoulis, M., Pisano, M., Ris, F., Robison, T., Sartelli, M., Shelat, V.G., Spinoglio, G., Sugrue, M., Tan, E.C.T.H., Eetvelde, E. Van, Kluger, Y., Weber, D., Catena, F., De'Angelis, N., Marchegiani, F., Schena, C.A., Khan, J., Agnoletti, V., Ansaloni, L., arría Rodríguez, A.G. B, Bianchi, P.P., Biffl, W., Bravi, F., Ceccarelli, G., Ceresoli, M., Chiara, O., Chirica, M., Cobianchi, L., Coccolini, F., Coimbra, R., Cotsoglou, C., D'Hondt, M., Damaskos, D., Simone, B. De, Saverio, S. Di, Diana, M., Espin-Basany, E., Fichtner-Feigl, S., Fugazzola, P., Gavriilidis, P., Gronnier, C., Kashuk, J., Kirkpatrick, A.W., Ammendola, M., Kouwenhoven, E.A., Laurent, A., Leppaniemi, A., Lesurtel, M., Memeo, R., Milone, M., Moore, E., Pararas, N., Peitzmann, A., Pessaux, P., Picetti, E., Pikoulis, M., Pisano, M., Ris, F., Robison, T., Sartelli, M., Shelat, V.G., Spinoglio, G., Sugrue, M., Tan, E.C.T.H., Eetvelde, E. Van, Kluger, Y., Weber, D., and Catena, F.

Abstract

Item does not contain fulltext, BACKGROUND: Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS. METHODS: This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements. RESULTS: Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20-107) depending on the initial surgeon's experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon's proficiency. CONCLUSIONS: Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.

Published
2023

15. Learning Curves of Minimally Invasive Distal Pancreatectomy in Experienced Pancreatic Centers.

Author

Lof, S., Claassen, L., Hannink, G.J., Al-Sarireh, B., Björnsson, B., Boggi, U., Burdio, F., Butturini, G., Capretti, G., Casadei, R., Dokmak, S., Edwin, B., Esposito, A., Fabre, J.M., Ferrari, G., Fretland, A.A., Ftériche, F.S., Fusai, G.K., Giardino, A., Groot Koerkamp, B., D'Hondt, M., Jah, A., Kamarajah, S.K., Kauffmann, E.F., Keck, T., Laarhoven, S. van, Manzoni, A., Marino, M.V., Marudanayagam, R., Molenaar, I.Q., Pessaux, P., Rosso, E., Salvia, R., Soonawalla, Z., Souche, R., White, S., Workum, F.T.W.E. van, Zerbi, A., Rosman, C., Stommel, M.W.J., Abu Hilal, M., Besselink, M.G., Lof, S., Claassen, L., Hannink, G.J., Al-Sarireh, B., Björnsson, B., Boggi, U., Burdio, F., Butturini, G., Capretti, G., Casadei, R., Dokmak, S., Edwin, B., Esposito, A., Fabre, J.M., Ferrari, G., Fretland, A.A., Ftériche, F.S., Fusai, G.K., Giardino, A., Groot Koerkamp, B., D'Hondt, M., Jah, A., Kamarajah, S.K., Kauffmann, E.F., Keck, T., Laarhoven, S. van, Manzoni, A., Marino, M.V., Marudanayagam, R., Molenaar, I.Q., Pessaux, P., Rosso, E., Salvia, R., Soonawalla, Z., Souche, R., White, S., Workum, F.T.W.E. van, Zerbi, A., Rosman, C., Stommel, M.W.J., Abu Hilal, M., and Besselink, M.G.

Abstract

Contains fulltext : 296536.pdf (Publisher’s version ) (Closed access), IMPORTANCE: Understanding the learning curve of a new complex surgical technique helps to reduce potential patient harm. Current series on the learning curve of minimally invasive distal pancreatectomy (MIDP) are mostly small, single-center series, thus providing limited data. OBJECTIVE: To evaluate the length of pooled learning curves of MIDP in experienced centers. DESIGN, SETTING, AND PARTICIPANTS: This international, multicenter, retrospective cohort study included MIDP procedures performed from January 1, 2006, through June 30, 2019, in 26 European centers from 8 countries that each performed more than 15 distal pancreatectomies annually, with an overall experience exceeding 50 MIDP procedures. Consecutive patients who underwent elective laparoscopic or robotic distal pancreatectomy for all indications were included. Data were analyzed between September 1, 2021, and May 1, 2022. EXPOSURES: The learning curve for MIDP was estimated by pooling data from all centers. MAIN OUTCOMES AND MEASURES: The learning curve was assessed for the primary textbook outcome (TBO), which is a composite measure that reflects optimal outcome, and for surgical mastery. Generalized additive models and a 2-piece linear model with a break point were used to estimate the learning curve length of MIDP. Case mix-expected probabilities were plotted and compared with observed outcomes to assess the association of changing case mix with outcomes. The learning curve also was assessed for the secondary outcomes of operation time, intraoperative blood loss, conversion to open rate, and postoperative pancreatic fistula grade B/C. RESULTS: From a total of 2610 MIDP procedures, the learning curve analysis was conducted on 2041 procedures (mean [SD] patient age, 58 [15.3] years; among 2040 with reported sex, 1249 were female [61.2%] and 791 male [38.8%]). The 2-piece model showed an increase and eventually a break point for TBO at 85 procedures (95% CI, 13-157 procedures), with a plateau TBO rate at

Published
2023

16. Impact of neoadjuvant chemotherapy on the difficulty and outcomes of laparoscopic and robotic major liver resections for colorectal liver metastases: A propensity-score and coarsened exact-matched controlled study

Author

Ghotbi, J., Aghayan, D., Fretland, A., Edwin, B., Syn, N. L., Cipriani, F., Alzoubi, M., Lim, C., Scatton, O., Long, T. C. D., Herman, P., Coelho, F. F., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. -H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Fondevila, C., Efanov, M., Morise, Z., Di Benedetto, F., Brustia, R., Dalla Valle, R., Boggi, U., Geller, D., Belli, A., Memeo, R., Mejia, A., Park, J. O., Rotellar, F., Choi, G. -H., Robles-Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. -N., Chong, C. C. N., D'Hondt, M., Monden, K., Lopez-Ben, S., Kingham, T. P., Ferrero, A., Ettorre, G. M., Levi Sandri, G. B., Pascual, F., Cherqui, D., Liang, X., Mazzotta, A., Wakabayashi, G., Giglio, M., Troisi, R. I., Han, H. -S., Cheung, T. -T., Sugioka, A., Chen, K. -H., Liu, R., Soubrane, O., Fuks, D., Aldrighetti, L., Abu Hilal, M., Goh, B. K. P., Gastaca, M., Meurs, J., De Meyere, C., Lee, K. -F., Ng, K. K., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kato, Y., Kojima, M., Pirola Kruger, J. A., Lopez-Lopez, V., Casellas I Robert, M., Montalti, R., Lee, B., D'Silva, M., Wang, H. -P., Saleh, M., Chen, Z., Yu, S., Vani, S., Ardito, Francesco, Giustizieri, U., Citterio, D., Mocchegiani, F., Colasanti, M., Guzman, Y., Labadie, K. P., Conticchio, M., Dogeas, E., Kauffmann, E. F., Giuffrida, M., Sommacale, D., Laurent, A., Magistri, P., Nghia, P. P., Mishima, K., Valle, B. D., Krenzien, F., Schmelzle, M., Kadam, P., Liu, Q., Lai, E. C. H., Zheng, J., Siow, T. F., Forchino, F., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Ghotbi, J., Aghayan, D., Fretland, A., Edwin, B., Syn, N. L., Cipriani, F., Alzoubi, M., Lim, C., Scatton, O., Long, T. C. D., Herman, P., Coelho, F. F., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. -H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Fondevila, C., Efanov, M., Morise, Z., Di Benedetto, F., Brustia, R., Dalla Valle, R., Boggi, U., Geller, D., Belli, A., Memeo, R., Mejia, A., Park, J. O., Rotellar, F., Choi, G. -H., Robles-Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. -N., Chong, C. C. N., D'Hondt, M., Monden, K., Lopez-Ben, S., Kingham, T. P., Ferrero, A., Ettorre, G. M., Levi Sandri, G. B., Pascual, F., Cherqui, D., Liang, X., Mazzotta, A., Wakabayashi, G., Giglio, M., Troisi, R. I., Han, H. -S., Cheung, T. -T., Sugioka, A., Chen, K. -H., Liu, R., Soubrane, O., Fuks, D., Aldrighetti, L., Abu Hilal, M., Goh, B. K. P., Gastaca, M., Meurs, J., De Meyere, C., Lee, K. -F., Ng, K. K., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kato, Y., Kojima, M., Pirola Kruger, J. A., Lopez-Lopez, V., Casellas I Robert, M., Montalti, R., Lee, B., D'Silva, M., Wang, H. -P., Saleh, M., Chen, Z., Yu, S., Vani, S., Ardito, Francesco, Giustizieri, U., Citterio, D., Mocchegiani, F., Colasanti, M., Guzman, Y., Labadie, K. P., Conticchio, M., Dogeas, E., Kauffmann, E. F., Giuffrida, M., Sommacale, D., Laurent, A., Magistri, P., Nghia, P. P., Mishima, K., Valle, B. D., Krenzien, F., Schmelzle, M., Kadam, P., Liu, Q., Lai, E. C. H., Zheng, J., Siow, T. F., Forchino, F., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Background: Minimal invasive liver resections are a safe alternative to open surgery. Different scoring systems considering different risks factors have been developed to predict the risks associated with these procedures, especially challenging major liver resections (MLR). However, the impact of neoadjuvant chemotherapy (NAT) on the difficulty of minimally invasive MLRs remains poorly investigated. Methods: Patients who underwent laparoscopic and robotic MLRs for colorectal liver metastases (CRLM) performed across 57 centers between January 2005 to December 2021 were included in this analysis. Patients who did or did not receive NAT were matched based on 1:1 coarsened exact and 1:2 propensity-score matching. Pre- and post-matching comparisons were performed. Results: In total, the data of 5189 patients were reviewed. Of these, 1411 procedures were performed for CRLM, and 1061 cases met the inclusion criteria. After excluding 27 cases with missing data on NAT, 1034 patients (NAT: n = 641; non-NAT: n = 393) were included. Before matching, baseline characteristics were vastly different. Before matching, the morbidity rate was significantly higher in the NAT-group (33.2% vs. 27.2%, p-value = 0.043). No significant differences were seen in perioperative outcomes after the coarsened exact matching. After the propensity-score matching, statistically significant higher blood loss (mean, 300 (SD 128–596) vs. 250 (SD 100–400) ml, p-value = 0.047) but shorter hospital stay (mean, 6 [4-8] vs. 6 [5-9] days, p-value = 0.043) were found in the NAT-group. Conclusion: The current study demonstrated that NAT had minimal impact on the difficulty and outcomes of minimally-invasive MLR for CRLM.

Published
2023

17. Defining Global Benchmarks for Laparoscopic Liver Resections: An International Multicenter Study

Author

Goh, B. K. P., Han, H. -S., Chen, K. -H., Chua, D. W., Chan, C. -Y., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., D'Silva, M., Siow, T. F., Kato, Y., Lim, C., Nghia, P. P., Herman, P., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Gastaca, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Chen, Z., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Campos, R. R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Coelho, F. F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Sandri, G. B. L., Saleh, M., Cherqui, D., Scatton, O., Soubrane, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Hilal, M. A., Fuks, D., Edwin, B., Aldrighetti, L., Syn, N., Prieto, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kojima, M., Ghotbi, J., Kruger, J. A. P., Lopez-Lopez, V., Valle, B. D., Casellas I Robert, M., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., Wang, H. -P., Pascual, F., Kadam, P., Tang, C. -N., Yu, S., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Goh, B. K. P., Han, H. -S., Chen, K. -H., Chua, D. W., Chan, C. -Y., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., D'Silva, M., Siow, T. F., Kato, Y., Lim, C., Nghia, P. P., Herman, P., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Gastaca, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Chen, Z., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Campos, R. R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Coelho, F. F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Sandri, G. B. L., Saleh, M., Cherqui, D., Scatton, O., Soubrane, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Hilal, M. A., Fuks, D., Edwin, B., Aldrighetti, L., Syn, N., Prieto, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kojima, M., Ghotbi, J., Kruger, J. A. P., Lopez-Lopez, V., Valle, B. D., Casellas I Robert, M., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., Wang, H. -P., Pascual, F., Kadam, P., Tang, C. -N., Yu, S., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Objective: To establish global benchmark outcomes indicators after laparoscopic liver resections (L-LR). Background: There is limited published data to date on the best achievable outcomes after L-LR. Methods: This is a post hoc analysis of a multicenter database of 11,983 patients undergoing L-LR in 45 international centers in 4 continents between 2015 and 2020. Three specific procedures: left lateral sectionectomy (LLS), left hepatectomy (LH), and right hepatectomy (RH) were selected to represent the 3 difficulty levels of L-LR. Fifteen outcome indicators were selected to establish benchmark cutoffs. Results: There were 3519 L-LR (LLS, LH, RH) of which 1258 L-LR (40.6%) cases performed in 34 benchmark expert centers qualified as low-risk benchmark cases. These included 659 LLS (52.4%), 306 LH (24.3%), and 293 RH (23.3%). The benchmark outcomes established for operation time, open conversion rate, blood loss ≥500 mL, blood transfusion rate, postoperative morbidity, major morbidity, and 90-day mortality after LLS, LH, and RH were 209.5, 302, and 426 minutes; 2.1%, 13.4%, and 13.0%; 3.2%, 20%, and 47.1%; 0%, 7.1%, and 10.5%; 11.1%, 20%, and 50%; 0%, 7.1%, and 20%; and 0%, 0%, and 0%, respectively. Conclusions: This study established the first global benchmark outcomes for L-LR in a large-scale international patient cohort. It provides an up-to-date reference regarding the "best achievable" results for L-LR for which centers adopting L-LR can use as a comparison to enable an objective assessment of performance gaps and learning curves.

Published
2023

18. Comparison between the difficulty of laparoscopic limited liver resections of tumors located in segment 7 versus segment 8: An international multicenter propensity-score matched study

Author

Efanov, M., Salimgereeva, D., Alikhanov, R., Wu, A. G. R., Geller, D., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., Belli, A., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Fondevila, C., Rotellar, F., Choi, G. -H., Robless Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Herman, P., Di Benedetto, F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Levi Sandri, G. B., Cherqui, D., Scatton, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Han, H. -S., Abu Hilal, M., Soubrane, O., Fuks, D., Aldrighetti, L., Edwin, B., Goh, B. K. P., Chan, C. -Y., Syn, N., D'Silva, M., Lee, B., Lim, C., Nghia, P. P., Gastaca, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Lee, L. S., Jang, J. Y., Kojima, M., Kato, Y., Ghotbi, J., Kruger, J. A. P., Coelho, F. F., Lopez-Lopez, V., Valle, B. D., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Wang, H. -P., Pascual, F., Saleh, M., Kadam, P., Tang, C. -N., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Efanov, M., Salimgereeva, D., Alikhanov, R., Wu, A. G. R., Geller, D., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., Belli, A., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Fondevila, C., Rotellar, F., Choi, G. -H., Robless Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Herman, P., Di Benedetto, F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Levi Sandri, G. B., Cherqui, D., Scatton, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Han, H. -S., Abu Hilal, M., Soubrane, O., Fuks, D., Aldrighetti, L., Edwin, B., Goh, B. K. P., Chan, C. -Y., Syn, N., D'Silva, M., Lee, B., Lim, C., Nghia, P. P., Gastaca, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Lee, L. S., Jang, J. Y., Kojima, M., Kato, Y., Ghotbi, J., Kruger, J. A. P., Coelho, F. F., Lopez-Lopez, V., Valle, B. D., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Wang, H. -P., Pascual, F., Saleh, M., Kadam, P., Tang, C. -N., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Background: Presently, according to different difficulty scoring systems, there is no difference in complexity estimation of laparoscopic liver resection (LLR) of segments 7 and 8. However, there is no published data supporting this assumption. To date, no studies have compared the outcomes of laparoscopic parenchyma-sparing resection of the liver segments 7 and 8. Methods: A post hoc analysis of patients undergoing LLR of segments 7 and 8 in 46 centers between 2004 and 2020 was performed. 1:1 Propensity score matching (PSM) was used to compare isolated LLR of segments 7 and 8. Subset analyses were also performed to compare atypical resections and segmentectomies of 7 and 8. Results: A total of 2411 patients were identified, and 1691 patients met the inclusion criteria. Comparison after PSM between the entire cohort of segment 7 and segment 8 resections revealed inferior results for segment 7 resection in terms of increased blood loss, blood transfusions, and conversions to open surgery. Subset analyses of only atypical resections similarly demonstrated poorer outcomes for segment 7 in terms of increased blood loss, operation time, blood transfusions, and conversions to open surgery. Conversely, a subgroup analysis of segmentectomies after PSM found better outcomes for segment 7 in terms of a shorter operation time and hospital stay. Conclusion: Differences in the outcomes of segments 7 and 8 resections suggest a greater difficulty of laparoscopic atypical resection of segment 7 compared to segment 8, and greater difficulty of segmentectomy 8 compared to segmentectomy 7.

Published
2023

23. An international multicenter propensity-score matched and coarsened-exact matched analysis comparing robotic versus laparoscopic partial liver resections of the anterolateral segments

Author

Kadam P., Sutcliffe R. P., Scatton O., Sucandy I., Kingham T. P., Liu R., Choi G. H., Syn N. L., Gastaca M., Choi S. -H., Chiow A. K. H., Marino M. V., Efanov M., Lee J. -H., Chong C. C., Tang C. -N., Cheung T. -T., Pratschke J., Wang X., Campos R. R., Ivanecz A., Park J. O., Rotellar F., Fuks D., D'Hondt M., Han H. -S., Troisi R. I., Goh B. K. P., Chan C. -Y., Prieto M., Schotte H., De Meyere C., Lai E., Krenzien F., Schmelzle M., Montalti R., Liu Q., Lee K. -F., Salimgereeva D., Alikhanov R., Lee L. -S., Jang J. Y., Lim C., Labadie K. P., Lopez-Lopez V., Kadam, P., Sutcliffe, R. P., Scatton, O., Sucandy, I., Kingham, T. P., Liu, R., Choi, G. H., Syn, N. L., Gastaca, M., Choi, S. -H., Chiow, A. K. H., Marino, M. V., Efanov, M., Lee, J. -H., Chong, C. C., Tang, C. -N., Cheung, T. -T., Pratschke, J., Wang, X., Campos, R. R., Ivanecz, A., Park, J. O., Rotellar, F., Fuks, D., D'Hondt, M., Han, H. -S., Troisi, R. I., Goh, B. K. P., Chan, C. -Y., Prieto, M., Schotte, H., De Meyere, C., Lai, E., Krenzien, F., Schmelzle, M., Montalti, R., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Lim, C., Labadie, K. P., and Lopez-Lopez, V.

Subjects
Carcinoma, Hepatocellular, robotic liver resection, Hepatology, Liver Neoplasms, anterolateral segment, laparoscopic liver resection, Length of Stay, Postoperative Complications, Robotic Surgical Procedures, Hepatectomy, Humans, Laparoscopy, Surgery, Propensity Score, Retrospective Studies, minimally invasive liver surgery
Abstract

Background: Robotic liver resections (RLR) may have the ability to address some of the drawbacks of laparoscopic liver resections (LLR) but few studies have done a head-to-head comparison of the outcomes after anterolateral segment resections by the two techniques. Methods: A retrospective study was conducted of 3202 patients who underwent minimally invasive LR of the anterolateral liver segments at 26 international centres from 2005 to 2020. Two thousand six hundred and six cases met study criteria of which there were 358 RLR and 1868 LLR cases. Perioperative outcomes were compared between the two groups using a 1:3 Propensity Score Matched (PSM) and 1:1 Coarsened Exact Matched (CEM) analysis. Results: Patients matched after 1:3 PSM (261 RLR vs 783 LLR) and 1:1 CEM (296 RLR vs 296 LLR) revealed no significant differences in length of stay, readmission rates, morbidity, mortality, and involvement of or close oncological margins. RLR surgeries were associated with significantly less blood loss (50 mL vs 100 ml, P

Published
2022

24. Utility of the Iwate difficulty scoring system for laparoscopic right posterior sectionectomy: do surgical outcomes differ for tumors in segments VI and VII?

Author

Choi S. H., Chen K. -H., Syn N. L., Cipriani F., Cheung T. -T., Chiow A. K. H., Choi G. -H., Siow T. -F., Sucandy I., Marino M. V., Gastaca M., Chong C. C., Lee J. H., Ivanecz A., Mazzaferro V., Lopez-Ben S., Fondevila C., Rotellar F., Campos R. R., Efanov M., Kingham T. P., Sutcliffe R. P., Troisi R. I., Pratschke J., Wang X., D'Hondt M., Yong C. C., Levi Sandri G. B., Tang C. N., Ruzzenente A., Cherqui D., Ferrero A., Wakabayashi G., Scatton O., Aghayan D., Edwin B., Coelho F. F., Giuliante F., Liu R., Sijberden J., Abu Hilal M., Sugioka A., Long T. C. D., Fuks D., Aldrighetti L., Han H. -S., Goh B. K. P., Kang I., Jang J. Y., Chan C. -Y., D'Silva M., Schotte H., De Meyere C., Lai E., Krenzien F., Schmelzle M., Kadam P., Montalti R., Giglio M., Liu Q., Lee K. -F., Salimgereeva D., Alikhanov R., Lee L. -S., Prieto M., Lim C., Nghia P. P., Kojima M., Kato Y., Forchino F., Herman P., Kruger J. A. P., Saleh M., Pascual F., Dalla Valle B., Lopez-Lopez V., Casellas-Robert M., Giustizieri U., Citterio D., Mishima K., Fretland A. A., Ghotbi J., Ettorre G. M., Colasanti M., Guzman Y., Ardito F., Vani S., Wang H. -P., Choi, S. H., Chen, K. -H., Syn, N. L., Cipriani, F., Cheung, T. -T., Chiow, A. K. H., Choi, G. -H., Siow, T. -F., Sucandy, I., Marino, M. V., Gastaca, M., Chong, C. C., Lee, J. H., Ivanecz, A., Mazzaferro, V., Lopez-Ben, S., Fondevila, C., Rotellar, F., Campos, R. R., Efanov, M., Kingham, T. P., Sutcliffe, R. P., Troisi, R. I., Pratschke, J., Wang, X., D'Hondt, M., Yong, C. C., Levi Sandri, G. B., Tang, C. N., Ruzzenente, A., Cherqui, D., Ferrero, A., Wakabayashi, G., Scatton, O., Aghayan, D., Edwin, B., Coelho, F. F., Giuliante, F., Liu, R., Sijberden, J., Abu Hilal, M., Sugioka, A., Long, T. C. D., Fuks, D., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Kang, I., Jang, J. Y., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Lai, E., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Giglio, M., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Prieto, M., Lim, C., Nghia, P. P., Kojima, M., Kato, Y., Forchino, F., Herman, P., Kruger, J. A. P., Saleh, M., Pascual, F., Dalla Valle, B., Lopez-Lopez, V., Casellas-Robert, M., Giustizieri, U., Citterio, D., Mishima, K., Fretland, A. A., Ghotbi, J., Ettorre, G. M., Colasanti, M., Guzman, Y., Ardito, F., Vani, S., Wang, H. -P., Choi, Sung Hoon, Chen, Kuo-Hsin, Syn, Nicholas L, Cipriani, Federica, Cheung, Tan-To, Chiow, Adrian K H, Choi, Gi-Hong, Siow, Tiing-Foong, Sucandy, Iswanto, Marino, Marco V, Gastaca, Mikel, Chong, Charing C, Lee, Jae Hoon, Ivanecz, Arpad, Mazzaferro, Vincenzo, Lopez-Ben, Santiago, Fondevila, Constantino, Rotellar, Fernando, Campos, Ricardo Roble, Efanov, Mikhail, Kingham, T Peter, Sutcliffe, Robert P, Troisi, Roberto I, Pratschke, Johann, Wang, Xiaoying, D'Hondt, Mathieu, Yong, Chee Chien, Levi Sandri, Giovanni Battista, Tang, Chung Ngai, Ruzzenente, Andrea, Cherqui, Daniel, Ferrero, Alessandro, Wakabayashi, Go, Scatton, Olivier, Aghayan, Davit, Edwin, Bjørn, Coelho, Fabricio Ferreira, Giuliante, Felice, Liu, Rong, Sijberden, Jasper, Abu Hilal, Mohammad, Sugioka, Atsushi, Long, Tran Cong Duy, Fuks, David, Aldrighetti, Luca, Han, Ho-Seong, and Goh, Brian K P

Subjects
Carcinoma, Hepatocellular, Laparoscopic liver, Settore MED/18 - CHIRURGIA GENERALE, Operative Time, Liver Neoplasms, Carcinoma, Hepatocellular, Difficulty score, Length of Stay, Iwate, Laparoscopic hepatectomy, Right posterior sectionectomy, Treatment Outcome, Postoperative Complications, Humans, Hepatectomy, Surgery, Laparoscopy, Retrospective Studies
Abstract

Introduction: The Iwate Score (IS) have not been well-validated for specific procedures, especially for right posterior sectionectomy (RPS). In this study, the utility of the IS was determined for laparoscopic (L)RPS and the effect of tumor location on surgical outcomes was investigated. Methods: Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria. Baseline characteristics and perioperative outcomes of patients stratified based on the Iwate score were compared to determine whether a correlation with surgical difficulty existed. A 1:1 Mahalanobis distance matching was utilized to investigate the effect of tumor location on L-RPS outcomes. Results: The patients were stratified into 3 levels of difficulty (31 intermediate, 143 advanced, and 422 expert) based on the IS. When using a stepwise increase of the IS excluding the tumor location score, only Pringle’s maneuver was more frequently used in the higher surgical difficulty level (35.5%, 54.6%, and 65.2%, intermediate, advanced, and expert levels, respectively, Z = 3.34, p = 0.001). Other perioperative results were not associated with a statistical gradation toward higher difficulty level. 80 of 85 patients with a segment VI lesion and 511 patients with a segment VII lesion were matched 1:1. There were no significant differences in the perioperative outcomes of the two groups including open conversion, operating time, blood loss, intraoperative blood transfusion, postoperative stay, major morbidity, and mortality. Conclusion: Among patients undergoing L-RPS, the IS did not significantly correlate with most outcome measures associated with intraoperative difficulty and postoperative outcomes. Similarly, tumor location had no effect on L-RPS outcomes.

Published
2022

25. Comparison between the difficulty of laparoscopic limited liver resections of tumors located in segment 7 versus segment 8

Author

Efanov, M., Salimgereeva, D., Alikhanov, R., A. G. R., Wu, Geller, D., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., Belli, A., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Fondevila, C., Rotellar, F., Choi, G. -H., Robless Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Herman, P., Di Benedetto, F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Levi Sandri, G. B., Cherqui, D., Scatton, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Han, H. -S., Abu Hilal, M., Soubrane, O., Fuks, D., Aldrighetti, L., Edwin, B., Goh, B. K. P., Chan, C. -Y., Syn, N., D'Silva, M., Lee, B., Lim, C., Nghia, P. P., Gastaca, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Lee, L. S., Jang, J. Y., Kojima, M., Kato, Y., Ghotbi, J., Kruger, J. A. P., Coelho, F. F., Lopez-Lopez, V., Valle, B. D., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Wang, H. -P., Pascual, F., Saleh, M., Kadam, P., Tang, C. -N., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Graduate School, Surgery, CCA - Cancer Treatment and Quality of Life, Efanov, M., Salimgereeva, D., Alikhanov, R., Wu, A. G. R., Geller, D., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., Belli, A., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, F., Ruzzenente, A., Yong, C. -C., Fondevila, C., Rotellar, F., Choi, G. -H., Robless Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Herman, P., Di Benedetto, F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Levi Sandri, G. B., Cherqui, D., Scatton, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Han, H. -S., Abu Hilal, M., Soubrane, O., Fuks, D., Aldrighetti, L., Edwin, B., Goh, B. K. P., Chan, C. -Y., Syn, N., D'Silva, M., Lee, B., Lim, C., Nghia, P. P., Gastaca, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Lee, L. S., Jang, J. Y., Kojima, M., Kato, Y., Ghotbi, J., Kruger, J. A. P., Coelho, F. F., Lopez-Lopez, V., Valle, B. D., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Wang, H. -P., Pascual, F., Saleh, M., Kadam, P., Tang, C. -N., Ardito, F., Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Efanov, Mikhail, Salimgereeva, Diana, Alikhanov, Ruslan, Wu, Andrew G R, Geller, David, Cipriani, Federica, Aghayan, Davit L, Fretland, Asmund Avdem, Sijberden, Jasper, Belli, Andrea, Marino, Marco V, Mazzaferro, Vincenzo, Chiow, Adrian K H, Sucandy, Iswanto, Ivanecz, Arpad, Choi, Sung Hoon, Lee, Jae Hoon, Prieto, Mikel, Vivarelli, Marco, Giuliante, Felice, Ruzzenente, Andrea, Yong, Chee-Chien, Fondevila, Constantino, Rotellar, Fernando, Choi, Gi-Hong, Robless Campos, Ricardo, Wang, Xiaoying, Sutcliffe, Robert P, Pratschke, Johann, Lai, Eric, Chong, Charing C, D'Hondt, Mathieu, Monden, Kazuteru, Lopez-Ben, Santiago, Herman, Paulo, Di Benedetto, Fabrizio, Kingham, T Peter, Liu, Rong, Long, Tran Cong Duy, Ferrero, Alessandro, Levi Sandri, Giovanni Battista, Cherqui, Daniel, Scatton, Olivier, Wakabayashi, Go, Troisi, Roberto I, Cheung, Tan-To, Sugioka, Atsushi, Han, Ho-Seong, Abu Hilal, Mohammad, Soubrane, Olivier, Fuks, David, Aldrighetti, Luca, Edwin, Bjorn, and Goh, Brian K P

Subjects
hepatectomy, laparoscopy, liver resection, posterosuperior segments, risk score, Hepatology, Settore MED/18 - CHIRURGIA GENERALE, Surgery, posterosuperior segment
Abstract

Background: Presently, according to different difficulty scoring systems, there is no difference in complexity estimation of laparoscopic liver resection (LLR) of segments 7 and 8. However, there is no published data supporting this assumption. To date, no studies have compared the outcomes of laparoscopic parenchyma-sparing resection of the liver segments 7 and 8. Methods: A post hoc analysis of patients undergoing LLR of segments 7 and 8 in 46 centers between 2004 and 2020 was performed. 1:1 Propensity score matching (PSM) was used to compare isolated LLR of segments 7 and 8. Subset analyses were also performed to compare atypical resections and segmentectomies of 7 and 8. Results: A total of 2411 patients were identified, and 1691 patients met the inclusion criteria. Comparison after PSM between the entire cohort of segment 7 and segment 8 resections revealed inferior results for segment 7 resection in terms of increased blood loss, blood transfusions, and conversions to open surgery. Subset analyses of only atypical resections similarly demonstrated poorer outcomes for segment 7 in terms of increased blood loss, operation time, blood transfusions, and conversions to open surgery. Conversely, a subgroup analysis of segmentectomies after PSM found better outcomes for segment 7 in terms of a shorter operation time and hospital stay. Conclusion: Differences in the outcomes of segments 7 and 8 resections suggest a greater difficulty of laparoscopic atypical resection of segment 7 compared to segment 8, and greater difficulty of segmentectomy 8 compared to segmentectomy 7.

Published
2022

26. An international multicentre propensity score matched analysis comparing between robotic versus laparoscopic left lateral sectionectomy

Author

Chong Y., Prieto M., Gastaca M., Choi S. -H., Sucandy I., Chiow A. K. H., Marino M. V., Wang X., Efanov M., Schotte H., D'Hondt M., Choi G. -H., Krenzien F., Schmelzle M., Pratschke J., Kingham T. P., Giglio M., Troisi R., Lee J. H., Lai E. C., Tang C. N., Fuks D., D'Silva M., Han H. -S., Kadam P., Sutcliffe R. P., Lee K. -F., Chong C. C., Cheung T. -T., Liu Q., Liu R., Goh B. K. P., Chan C. -Y., De Meyere C., Salimgereeva D., Alikhanov R., Lee L. -S., Jang J. Y., Montalti R., Chong, Y., Prieto, M., Gastaca, M., Choi, S. -H., Sucandy, I., Chiow, A. K. H., Marino, M. V., Wang, X., Efanov, M., Schotte, H., D'Hondt, M., Choi, G. -H., Krenzien, F., Schmelzle, M., Pratschke, J., Kingham, T. P., Giglio, M., Troisi, R., Lee, J. H., Lai, E. C., Tang, C. N., Fuks, D., D'Silva, M., Han, H. -S., Kadam, P., Sutcliffe, R. P., Lee, K. -F., Chong, C. C., Cheung, T. -T., Liu, Q., Liu, R., Goh, B. K. P., Chan, C. -Y., De Meyere, C., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., and Montalti, R.

Subjects
Laparoscopic, Left lateral sectionectomy, Minimally invasive surgery, Robotic
Abstract

Background: Left lateral sectionectomy (LLS) is one of the most commonly performed minimally invasive liver resections. While laparoscopic (L)-LLS is a well-established technique, over traditional open resection, it remains controversial if robotic (R)-LLS provides any advantages of L-LLS. Methods: A post hoc analysis of 997 patients from 21 international centres undergoing L-LLS or R-LLS from 2006 to 2020 was conducted. A total of 886 cases (214 R-LLS, 672 L-LLS) met study criteria. 1:1 and 1:2 propensity score matched (PSM) comparison was performed between R-LLS & L-LLS. Further subset analysis by Iwate difficulty was also performed. Outcomes measured include operating time, blood loss, open conversion, readmission rates, morbidity and mortality. Results: Comparison between R-LLS and L-LLS after PSM 1:2 demonstrated statistically significantly lower open conversion rate in R-LLS than L-LLS (0.6% versus 5%, p = 0.009) and median blood loss was also statistically significantly lower in R-LLS at 50 (80) versus 100 (170) in L-LLS (p = 0.011) after PSM 1:1 although there was no difference in the blood transfusion rate. Pringle manoeuvre was also found to be used more frequently in R-LLS, with 53(24.8%) cases versus to 84(12.5%) L-LLS cases (p < 0.001). There was no significant difference in the other key perioperative outcomes such as operating time, length of stay, postoperative morbidity, major morbidity and 90-day mortality between both groups. Conclusion: R-LLS was associated with similar key perioperative outcomes compared to L-LLS. It was also associated with significantly lower blood loss and open conversion rates compared to L-LLS.

Published
2022

27. Impact of tumor size on the difficulty of laparoscopic left lateral sectionectomies

Author

Arizza, G., Russolillo, N., Ferrero, A., Syn, N. L., Cipriani, F., Aghayan, D., Marino, M. V., Memeo, R., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Vivarelli, M., Di Benedetto, F., Choi, S. -H., Lee, J. H., Park, J. O., Gastaca, M., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Robles-Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. N., Chong, C. C., D'Hondt, M., Yong, C. C., Ruzzenente, A., Herman, P., Kingham, T. P., Scatton, O., Liu, R., Levi Sandri, G. B., Soubrane, O., Mejia, A., Lopez-Ben, S., Monden, K., Wakabayashi, G., Cherqui, D., Troisi, R. I., Yin, M., Giuliante, Felice, Geller, D., Sugioka, A., Edwin, B., Cheung, T. -T., Long, T. C. D., Hilal, M. A., Fuks, D., Chen, K. -H., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Chan, C. -Y., Prieto, M., Meurs, J., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., K. K., Ng, Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Labadie, K. P., Kato, Y., Kojima, M., Fretland, A. A., Ghotbi, J., Coelho, F. F., Kruger, J. A. P., Lopez-Lopez, V., Magistri, P., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., D'Silva, M., Wang, H. -P., Saleh, M., Pascual, F., Suhool, A., Nghia, P. P., Lim, C., Liu, Q., Kadam, P., Dalla Valle, B., Lai, E. C., Conticchio, M., Giustizieri, U., Citterio, D., Chen, Z., Yu, S., Ardito, Francesco, Vani, S., Dogeas, E., Siow, T. F., Mocchegianni, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Arizza, G., Russolillo, N., Ferrero, A., Syn, N. L., Cipriani, F., Aghayan, D., Marino, M. V., Memeo, R., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Vivarelli, M., Di Benedetto, F., Choi, S. -H., Lee, J. H., Park, J. O., Gastaca, M., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Robles-Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. N., Chong, C. C., D'Hondt, M., Yong, C. C., Ruzzenente, A., Herman, P., Kingham, T. P., Scatton, O., Liu, R., Levi Sandri, G. B., Soubrane, O., Mejia, A., Lopez-Ben, S., Monden, K., Wakabayashi, G., Cherqui, D., Troisi, R. I., Yin, M., Giuliante, F., Geller, D., Sugioka, A., Edwin, B., Cheung, T. -T., Long, T. C. D., Hilal, M. A., Fuks, D., Chen, K. -H., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Chan, C. -Y., Prieto, M., Meurs, J., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Ng, K. K., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Labadie, K. P., Kato, Y., Kojima, M., Fretland, A. A., Ghotbi, J., Coelho, F. F., Kruger, J. A. P., Lopez-Lopez, V., Magistri, P., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., D'Silva, M., Wang, H. -P., Saleh, M., Pascual, F., Suhool, A., Nghia, P. P., Lim, C., Liu, Q., Kadam, P., Dalla Valle, B., Lai, E. C., Conticchio, M., Giustizieri, U., Citterio, D., Chen, Z., Yu, S., Ardito, F., Vani, S., Dogeas, E., Siow, T. F., Mocchegianni, F., Ettorre, G. M., Colasanti, M., and Guzman, Y.

Subjects
difficulty, laparoscopic hepatectomy, laparoscopic liver, left lateral sectionectomy, size, Hepatology, Settore MED/18 - CHIRURGIA GENERALE, Surgery
Abstract

Background: Tumor size (TS) represents a critical parameter in the risk assessment of laparoscopic liver resections (LLR). Moreover, TS has been rarely related to the extent of liver resection. The aim of this study was to study the relationship between tumor size and difficulty of laparoscopic left lateral sectionectomy (L-LLS). Methods: The impact of TS cutoffs was investigated by stratifying tumor size at each 10 mm-interval. The optimal cutoffs were chosen taking into consideration the number of endpoints which show a statistically significant split around the cut-points of interest and the magnitude of relative risk after correction for multiple risk factors. Results: A total of 1910 L-LLS were included. Overall, open conversion and intraoperative blood transfusion were 3.1 and 3.3%, respectively. The major morbidity rate was 2.7% and 90-days mortality 0.6%. Three optimal TS cutoffs were identified: 40-, 70-, and 100-mm. All the selected cutoffs showed a significant discriminative power for the prediction of open conversion, operative time, blood transfusion and need of Pringle maneuver. Moreover, 70- and 100-mm cutoffs were both discriminative for estimated blood loss and major complications. A stepwise increase in rates of open conversion rate (Z = 3.90, P

Published
2022

28. Defining Global Benchmarks for Laparoscopic Liver Resections: An International Multicenter Study

Author

Goh, B. K. P., Han, H. -S., Chen, K. -H., Chua, D. W., Chan, C. -Y., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., D'Silva, M., Siow, T. F., Kato, Y., Lim, C., Nghia, P. P., Herman, P., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Gastaca, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Chen, Z., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Campos, R. R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Coelho, F. F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Sandri, G. B. L., Saleh, M., Cherqui, D., Scatton, O., Soubrane, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Hilal, M. A., Fuks, D., Edwin, B., Aldrighetti, L., Syn, N., Prieto, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kojima, M., Ghotbi, J., Kruger, J. A. P., Lopez-Lopez, V., Valle, B. D., Casellas I Robert, M., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., Wang, H. -P., Pascual, F., Kadam, P., Tang, C. -N., Yu, S., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Goh, Brian K P, Han, Ho-Seong, Chen, Kuo-Hsin, Chua, Darren W, Chan, Chung-Yip, Cipriani, Federica, Aghayan, Davit L, Fretland, Asmund A, Sijberden, Jasper, D'Silva, Mizelle, Siow, Tiing Foong, Kato, Yutaro, Lim, Chetana, Nghia, Phan Phuoc, Herman, Paulo, Marino, Marco V, Mazzaferro, Vincenzo, Chiow, Adrian K H, Sucandy, Iswanto, Ivanecz, Arpad, Choi, Sung Hoon, Lee, Jae Hoon, Gastaca, Mikel, Vivarelli, Marco, Giuliante, Felice, Ruzzenente, Andrea, Yong, Chee-Chien, Yin, Mengqui, Chen, Zewei, Fondevila, Constantino, Efanov, Mikhail, Rotellar, Fernando, Choi, Gi-Hong, Campos, Ricardo R, Wang, Xiaoying, Sutcliffe, Robert P, Pratschke, Johann, Lai, Eric, Chong, Charing C, D'Hondt, Mathieu, Monden, Kazuteru, Lopez-Ben, Santiago, Coelho, Fabricio F, Kingham, Thomas Peter, Liu, Rong, Long, Tran Cong Duy, Ferrero, Alessandro, Sandri, Giovanni B Levi, Saleh, Mansour, Cherqui, Daniel, Scatton, Olivier, Soubrane, Olivier, Wakabayashi, Go, Troisi, Roberto I, Cheung, Tan-To, Sugioka, Atsushi, Hilal, Mohammad Abu, Fuks, David, Edwin, Bjørn, and Aldrighetti, Luca

Subjects
benchmark, hepatectomy, quality assessment, Settore MED/18 - CHIRURGIA GENERALE, minimally invasive, Surgery, laparoscopic liver resection, global
Abstract

To establish global benchmark outcomes indicators after laparoscopic liver resections (L-LR).There is limited published data to date on the best achievable outcomes after L-LR.This is a post hoc analysis of a multicenter database of 11,983 patients undergoing L-LR in 45 international centers in 4 continents between 2015 and 2020. Three specific procedures: left lateral sectionectomy (LLS), left hepatectomy (LH), and right hepatectomy (RH) were selected to represent the 3 difficulty levels of L-LR. Fifteen outcome indicators were selected to establish benchmark cutoffs.There were 3519 L-LR (LLS, LH, RH) of which 1258 L-LR (40.6%) cases performed in 34 benchmark expert centers qualified as low-risk benchmark cases. These included 659 LLS (52.4%), 306 LH (24.3%), and 293 RH (23.3%). The benchmark outcomes established for operation time, open conversion rate, blood loss ≥500 mL, blood transfusion rate, postoperative morbidity, major morbidity, and 90-day mortality after LLS, LH, and RH were 209.5, 302, and 426 minutes; 2.1%, 13.4%, and 13.0%; 3.2%, 20%, and 47.1%; 0%, 7.1%, and 10.5%; 11.1%, 20%, and 50%; 0%, 7.1%, and 20%; and 0%, 0%, and 0%, respectively.This study established the first global benchmark outcomes for L-LR in a large-scale international patient cohort. It provides an up-to-date reference regarding the "best achievable" results for L-LR for which centers adopting L-LR can use as a comparison to enable an objective assessment of performance gaps and learning curves.

Published
2022

30. Utility of the Iwate difficulty scoring system for laparoscopic right posterior sectionectomy: do surgical outcomes differ for tumors in segments VI and VII?

Author

Choi, S. H., Chen, K. -H., Syn, N. L., Cipriani, F., Cheung, T. -T., Chiow, A. K. H., Choi, G. -H., Siow, T. -F., Sucandy, I., Marino, M. V., Gastaca, M., Chong, C. C., Lee, J. H., Ivanecz, A., Mazzaferro, V., Lopez-Ben, S., Fondevila, C., Rotellar, F., Campos, R. R., Efanov, M., Kingham, T. P., Sutcliffe, R. P., Troisi, R. I., Pratschke, J., Wang, X., D'Hondt, M., Yong, C. C., Levi Sandri, G. B., Tang, C. N., Ruzzenente, A., Cherqui, D., Ferrero, A., Wakabayashi, G., Scatton, O., Aghayan, D., Edwin, B., Coelho, F. F., Giuliante, Felice, Liu, R., Sijberden, J., Abu Hilal, M., Sugioka, A., Long, T. C. D., Fuks, D., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Kang, I., Jang, J. Y., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Lai, E., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Giglio, M., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Prieto, M., Lim, C., Nghia, P. P., Kojima, M., Kato, Y., Forchino, F., Herman, P., Kruger, J. A. P., Saleh, M., Pascual, F., Dalla Valle, B., Lopez-Lopez, V., Casellas-Robert, M., Giustizieri, U., Citterio, D., Mishima, K., Fretland, A. A., Ghotbi, J., Ettorre, G. M., Colasanti, M., Guzman, Y., Ardito, Francesco, Vani, S., Wang, H. -P., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Choi, S. H., Chen, K. -H., Syn, N. L., Cipriani, F., Cheung, T. -T., Chiow, A. K. H., Choi, G. -H., Siow, T. -F., Sucandy, I., Marino, M. V., Gastaca, M., Chong, C. C., Lee, J. H., Ivanecz, A., Mazzaferro, V., Lopez-Ben, S., Fondevila, C., Rotellar, F., Campos, R. R., Efanov, M., Kingham, T. P., Sutcliffe, R. P., Troisi, R. I., Pratschke, J., Wang, X., D'Hondt, M., Yong, C. C., Levi Sandri, G. B., Tang, C. N., Ruzzenente, A., Cherqui, D., Ferrero, A., Wakabayashi, G., Scatton, O., Aghayan, D., Edwin, B., Coelho, F. F., Giuliante, Felice, Liu, R., Sijberden, J., Abu Hilal, M., Sugioka, A., Long, T. C. D., Fuks, D., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Kang, I., Jang, J. Y., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Lai, E., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Giglio, M., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Prieto, M., Lim, C., Nghia, P. P., Kojima, M., Kato, Y., Forchino, F., Herman, P., Kruger, J. A. P., Saleh, M., Pascual, F., Dalla Valle, B., Lopez-Lopez, V., Casellas-Robert, M., Giustizieri, U., Citterio, D., Mishima, K., Fretland, A. A., Ghotbi, J., Ettorre, G. M., Colasanti, M., Guzman, Y., Ardito, Francesco, Vani, S., Wang, H. -P., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Introduction: The Iwate Score (IS) have not been well-validated for specific procedures, especially for right posterior sectionectomy (RPS). In this study, the utility of the IS was determined for laparoscopic (L)RPS and the effect of tumor location on surgical outcomes was investigated. Methods: Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria. Baseline characteristics and perioperative outcomes of patients stratified based on the Iwate score were compared to determine whether a correlation with surgical difficulty existed. A 1:1 Mahalanobis distance matching was utilized to investigate the effect of tumor location on L-RPS outcomes. Results: The patients were stratified into 3 levels of difficulty (31 intermediate, 143 advanced, and 422 expert) based on the IS. When using a stepwise increase of the IS excluding the tumor location score, only Pringle’s maneuver was more frequently used in the higher surgical difficulty level (35.5%, 54.6%, and 65.2%, intermediate, advanced, and expert levels, respectively, Z = 3.34, p = 0.001). Other perioperative results were not associated with a statistical gradation toward higher difficulty level. 80 of 85 patients with a segment VI lesion and 511 patients with a segment VII lesion were matched 1:1. There were no significant differences in the perioperative outcomes of the two groups including open conversion, operating time, blood loss, intraoperative blood transfusion, postoperative stay, major morbidity, and mortality. Conclusion: Among patients undergoing L-RPS, the IS did not significantly correlate with most outcome measures associated with intraoperative difficulty and postoperative outcomes. Similarly, tumor location had no effect on L-RPS outcomes.

Published
2022

32. Recent Innovations & Daily Problems

Author

Tsai, Y., Ross, N., Niebuhr, H., Sailer, M., Köckerling, F., Sun, L., Shen, Y. M., Chen, J., Liu, S. J., Chen, F. Q., Yang, G. Y., Berney, C., Malouf, P., Suarez, D., Tavera, J. L., Ocadiz, J., Chen, T., Wang, J., Mancini, R., Pattaro, G., Ceci, F., Spaziani, E., Bansa, B., Lal, P., Sharma, R., Pradhan, G., Chander, J., Ramteke, V. K., Wijerathne, S., Agarwal, N., Liem, D., Lomanto, D., Warren, J., Cobb, W., Ewing, J., Carbonell, A., Guillaume, O., Holl, E., Park, J., Monforte, X., Redl, H., Petter-Puchner, A., Gruber-Blum, S., Teuschl, A., Yoshihara, E., Pottel, H., D’Hondt, M., Jadhav, P., Nagahama, T., Ando, M., Ami, K., Amagasa, H., Ganno, H., Arai, K., Kitamura, M., El-Hayek, K., Yoo, J., Phillips, M., Pauli, E., Bittner, J., Kroh, M., Garcia, D., Furtado, T., Alberti, L., Neto, C., Hubner, P., Alves, A., Oliveira, C., Vianna, J., Campolina, C., Dumanian, G., Dumanian, Z., Tulaimat, A., Chen, S., Liu, L. J., Guttadauro, A., Frassani, S., Macchini, D., Bertolini, A., Maternini, M., Gabrielli, F., Subramanian, V., Venditti, D., De Majo, A., Sena, G., Lisi, G., De Sanctis, F., Petrella, G., Porwal, A., Jadhav, M., Stein, M., Kaveggia, L., Clift, J., Noda, W., Niebuhr, H., Ross, N., Niebuhr, H., Ross, N., Niebuhr, H., Ross, N., Niebuhr, H., Ross, N., and Niebuhr, H.

Published
2015
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34. Outcome of Major Hepatectomy in Cirrhotic Patients: Does Surgical Approach Matter? A Propensity Score Matched Analysis

Author

Cacciaguerra, A. Benedetti, primary, Gorgec, B., additional, Lanari, J., additional, Cipriani, F., additional, Russolillo, N., additional, Mocchegiani, F., additional, Alseidi, A., additional, Ruzzenente, A., additional, Edwin, B., additional, D’Hondt, M., additional, Besselink, M., additional, Giuliante, F., additional, Fuks, D., additional, Rotellar, F., additional, López-Ben, S., additional, Ferrero, A., additional, Aldrighetti, L., additional, Cillo, U., additional, Vivarelli, M., additional, and Hilal, M. Abu, additional

Published
2022
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36. Clinical Added Value of MRI to CT in Patients Scheduled for Local Therapy of Colorectal Liver Metastases (CAMINO): An International Multicenter Prospective Diagnostic Accuracy Study

Author

Gorgec, B., primary, Hansen, I.S., additional, Kemmerich, G., additional, Syversveen, T., additional, Hilal, M Abu, additional, Bosscha, K., additional, Burgmans, M.C., additional, Edwin, B., additional, D'Hondt, M., additional, Gobardhan, P., additional, Gielkens, H., additional, Hartgrink, H.H., additional, Marsman, H.A., additional, Morone, M., additional, Kint, P.A.M., additional, Kok, N., additional, Kuhlmann, K., additional, Lips, D.J., additional, Peringa, J., additional, Willemssen, F., additional, Fretland, A.A., additional, Swijnenburg, R.J., additional, Verhoef, C., additional, Besselink, M.G., additional, and Stoker, J., additional

Published
2022
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39. Laparoscopic Versus Open Hemihepatectomy: The ORANGE II PLUS Multicenter Randomized Controlled Trial

Author

Fichtinger, R., primary, Aldrighetti, L., additional, Troisi, R., additional, Abu Hilal, M., additional, Sutcliffe, R., additional, Besselink, M., additional, Aroori, S., additional, Menon, K., additional, Edwin, B., additional, D'Hondt, M., additional, Lucidi, V., additional, Ulmer, T., additional, Diaz-Nieto, R., additional, Soonawalla, Z., additional, White, S., additional, Sergeant, G., additional, Ratti, F., additional, Olij, B., additional, Kümmerli, C., additional, Brandts, L., additional, Pugh, S., additional, Eminton, Z., additional, Van Breukelen, G., additional, Primrose, J., additional, and Van Dam, R., additional

Published
2022
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40. Comparison Between Minimally-Invasive Right Anterior and Right Posterior Sectionectomy versus Right Hepatectomy: An International Multicenter Propensity-Score Matched and Coarsened-Exact Matched Analysis of 1100 Patients

Author

Willems, E., primary, D'Hondt, M., additional, Kingham, P.T., additional, Fuks, D., additional, Choi, G.-H., additional, Syn, N., additional, Sucandy, I., additional, Marino, M.V., additional, Calvo, M. Prieto, additional, Chong, C.C.N., additional, Lee, J.-H., additional, Efanov, M., additional, Chiow, A.K., additional, Choi, S.-H., additional, Sutcliffe, R., additional, Troisi, R.I., additional, Pratschke, J., additional, Cheung, T.-T., additional, Wang, X.-Y., additional, Liu, R., additional, Tang, C.N., additional, Han, H.-S., additional, and Goh, B.K.P., additional

Published
2022
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42. Randomized Clinical Trial of Laparoscopic versus Open Hemihepatectomy within an Enhanced Recovery after Surgery Program (ORANGE-II-PLUS Study): A Quality of Life Analysis

Author

Olij, B., primary, Fichtinger, R., additional, Aldrghetti, L., additional, Troisi, R., additional, Hilal, M. Abu, additional, Sutcliffe, R., additional, Besselink, M., additional, Aroori, S., additional, Menon, K., additional, Edwin, B., additional, D'Hondt, M., additional, Lucidi, V., additional, Ulmer, T., additional, Diaz-Nieto, R., additional, Soonawalla, Z., additional, White, S., additional, Sergeant, G., additional, Ratti, F., additional, Kümmerli, C., additional, Brandts, L., additional, Pugh, S., additional, Eminton, Z., additional, Kimman, M., additional, Primrose, J., additional, and Van Dam, R., additional

Published
2022
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45. Bile Leakage after Laparoscopic and Open Liver Resection; Incidence and Clinical Impact: An International Multicenter Propensity Score-Matched Study of 13,379 Patients

Author

Gorgec, B., primary, Benedetti Cacciaguerra, A., additional, Cipriani, F., additional, Ratti, F., additional, Russolillo, N., additional, Lanari, J., additional, Al-Jarrah, R., additional, Aghayan, D., additional, Primrose, J.N., additional, Giuliante, F., additional, D’Hondt, M., additional, Rotellar, F., additional, Fuks, D., additional, Lopez-Ben, S., additional, Vivarelli, M., additional, Edwin, B., additional, Cillo, U., additional, Ferrero, A., additional, Aldrighetti, L.A., additional, Besselink, M.G., additional, and Abu Hilal, M., additional

Published
2022
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46. Clinical added value of MRI to CT in patients scheduled for local therapy of colorectal liver metastases (CAMINO)

Author

Görgec, B., Hansen, I., Kemmerich, G., Syversveen, T., Abu Hilal, M., Belt, E. J. T., Bisschops, R. H. C., Bollen, T. L., Bosscha, K., Burgmans, M. C., Cappendijk, V., de Boer, M. T., D’Hondt, M., Edwin, B., Gielkens, H., Grünhagen, D. J., Gillardin, P., Gobardhan, P. D., Hartgrink, H. H., Horsthuis, K., Kok, N. F. M., Kint, P. A. M., Kruimer, J. W. H., Leclercq, W. K. G., Lips, D. J., Lutin, B., Maas, M., Marsman, H. A., Morone, M., Pennings, J. P., Peringa, J., te Riele, W. W., Vermaas, M., Wicherts, D., Willemssen, F. E. J. A., Zonderhuis, B. M., Bossuyt, P. M. M., Swijnenburg, R. J., Fretland, A., Verhoef, C., Besselink, M. G., Stoker, J., Bnà, C., de Meyere, C., Draaisma, W. A., Gerhards, M. F., Imani, F., Kuhlmann, K. F. D., Liem, M. S. L., Meyer, Y., Surgery, Radiology & Nuclear Medicine, Graduate School, Radiology and Nuclear Medicine, AMS - Rehabilitation & Development, AMS - Sports, Amsterdam Gastroenterology Endocrinology Metabolism, Epidemiology and Data Science, APH - Methodology, APH - Personalized Medicine, CCA - Imaging and biomarkers, CCA - Cancer Treatment and Quality of Life, Radiology and nuclear medicine, Pathology, Obstetrics and gynaecology, CCA - Cancer Treatment and quality of life, AGEM - Re-generation and cancer of the digestive system, and VU University medical center

Subjects
Gadolinium DTPA, Cancer Research, Colorectal cancer, Gadoxetic acid, Contrast Media, Diagnostic accuracy, Multimodal Imaging, Liver MRI, Study Protocol, Liver metastases, Prospective Studies, FDG-PET, RC254-282, OUTCOMES, medicine.diagnostic_test, Minimal clinically important difference, Liver Neoplasms, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Magnetic Resonance Imaging, Oncology, SURVIVAL, Radiology, Colorectal Neoplasms, Life Sciences & Biomedicine, medicine.drug, Adult, medicine.medical_specialty, STRATEGIES, HEPATIC RESECTION, SDG 3 - Good Health and Well-being, Genetics, medicine, Humans, In patient, CANCER PATIENTS, RADIOFREQUENCY ABLATION, Liver surgery, RECURRENCE, Protocol (science), Science & Technology, business.industry, Abdominal CT scan, Magnetic resonance imaging, Diffusion weighted imaging, PERFORMANCE, medicine.disease, Thermal ablation, Colorectal liver metastases, CONTRAST-ENHANCED CT, Tomography, X-Ray Computed, business, Diffusion MRI
Abstract

Background Abdominal computed tomography (CT) is the standard imaging method for patients with suspected colorectal liver metastases (CRLM) in the diagnostic workup for surgery or thermal ablation. Diffusion-weighted and gadoxetic-acid-enhanced magnetic resonance imaging (MRI) of the liver is increasingly used to improve the detection rate and characterization of liver lesions. MRI is superior in detection and characterization of CRLM as compared to CT. However, it is unknown how MRI actually impacts patient management. The primary aim of the CAMINO study is to evaluate whether MRI has sufficient clinical added value to be routinely added to CT in the staging of CRLM. The secondary objective is to identify subgroups who benefit the most from additional MRI. Methods In this international multicentre prospective incremental diagnostic accuracy study, 298 patients with primary or recurrent CRLM scheduled for curative liver resection or thermal ablation based on CT staging will be enrolled from 17 centres across the Netherlands, Belgium, Norway, and Italy. All study participants will undergo CT and diffusion-weighted and gadoxetic-acid enhanced MRI prior to local therapy. The local multidisciplinary team will provide two local therapy plans: first, based on CT-staging and second, based on both CT and MRI. The primary outcome measure is the proportion of clinically significant CRLM (CS-CRLM) detected by MRI not visible on CT. CS-CRLM are defined as liver lesions leading to a change in local therapeutical management. If MRI detects new CRLM in segments which would have been resected in the original operative plan, these are not considered CS-CRLM. It is hypothesized that MRI will lead to the detection of CS-CRLM in ≥10% of patients which is considered the minimal clinically important difference. Furthermore, a prediction model will be developed using multivariable logistic regression modelling to evaluate the predictive value of patient, tumor and procedural variables on finding CS-CRLM on MRI. Discussion The CAMINO study will clarify the clinical added value of MRI to CT in patients with CRLM scheduled for local therapy. This study will provide the evidence required for the implementation of additional MRI in the routine work-up of patients with primary and recurrent CRLM for local therapy. Trial registration The CAMINO study was registered in the Netherlands National Trial Register under number NL8039 on September 20th 2019.

Published
2021

48. Transition from laparoscopic to robotic liver surgery: clinical outcomes, learning curve effect, and cost-effectiveness.

Author

D'Hondt, M., Devooght, A., Willems, E., Wicherts, D., De Meyere, C., Parmentier, I., Provoost, A., Pottel, H., and Verslype, C.

Abstract

The reproducibility of the implementation of robotic liver surgery (RLS) is still debated. The aim of the present study is to evaluate short-term outcomes and cost differences during the implementation of RLS, performed by an early adopter in laparoscopic liver surgery (LLS). Patients undergoing RLS between February 2020 and May 2021 were included. Short-term outcomes of the robotic group (RG) were compared to the "Initial Phase" group (IP) of 120 LLS cases and the 120 most recent laparoscopic cases or "Mastery Phase" group (MP). A cost analysis per procedure for the three groups was performed. Seventy-one patients underwent RLS during the study period. Median operative time in the RG was comparable to the IP, but significantly shorter in the MP (140 vs 138 vs 120 min, p < 0.001). Median intraoperative blood loss in the RG was lower than in both laparoscopic groups (40 ml [20–90 ml] vs 150 ml [50–250 ml] vs 80 ml [30–150 ml], p < 0.001). Median hospital stay in the RG was significantly shorter than the IP group (p < 0.001). There were no significant differences in postoperative complication, conversion, or readmission rates. Procedural cost analysis was in favor of robotic surgery (€5008) compared to the IP (€ 6913) and the MP (€6099). Surgeons with sufficient experience in LLS can rapidly overcome the learning curve for RLS. In our experience, the short-term outcomes of the implementation phase of RLS are similar to the mastery phase of LLS. The total average cost per procedure is lower for RLS compared to LLS. [ABSTRACT FROM AUTHOR]

Published
2023
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50. 384O Laparoscopic versus open hemihepatectomy: The ORANGE II PLUS multicenter randomized controlled trial

Author

Fichtinger, R.S., primary, Aldrighetti, L., additional, Troisi, R., additional, Abu Hilal, M., additional, Sutcliffe, R., additional, Besselink, M., additional, Aroori, S., additional, Menon, K., additional, Edwin, B., additional, D'Hondt, M., additional, Lucidi, V., additional, Ulmer, F., additional, Díaz-Nieto, R., additional, Ratti, F., additional, Kümmerli, C., additional, Brandts, L., additional, Pugh, S., additional, Eminton, Z., additional, Primrose, J., additional, and van Dam, R., additional

Published
2021
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