Predictive ability of preoperative CT scan for the intraoperative difficulty and postoperative outcomes of laparoscopic liver resection.

Background: The surgical difficulty and postoperative outcomes of laparoscopic liver resection (LLR) are related to the size of the cut liver surface. This study assessed whether the estimated parenchymal transection surface area could predict intraoperative difficulty and postoperative outcomes.

Methods: LLRs performed between 2008 and 2018, for whom a preoperative CT scan was available for 3D review, were included in the study. The area of scheduled parenchymal transection was measured on the preoperative CT scan and cut-off values that could predict intraoperative difficulty were analyzed.

Results: 152 patients who underwent left lateral sectionectomy (n = 27, median estimated area 30.1 cm [range 16.6-65.9]), left/right hepatectomy (n = 17 and n = 70, 76.8 cm [range 43.9-150.9] and 72.2 cm [range 39.4-124.9], respectively), right posterior sectionectomy (n = 7, 113.3 cm [range 102.1-136.3]), central hepatectomy (n = 11, 109.1 cm [range 66.1-186.1]) and extended left/right hepatectomy (n = 6 and n = 14, 115.3 cm [range 92.9-128.9] and 50.7 cm [range 13.3-74.9], respectively) were included. An estimated parenchymal transection surface area ≥ 100 cm was associated with significant increase in operative time (AUC 0.81, 95% CI [0.70, 0.93], p < 0.001) and estimated blood loss (AUC 0.92, 95% CI [0.86, 0.97], p < 0.001), as well as a higher conversion rate (22.2% vs. 4.0%, p < 0.001). Overall (p = 0.017) and major morbidity (p = 0.003), biliary leakage (p < 0.001) and pulmonary complications (p < 0.001) were significantly higher in patients with an estimated parenchymal transection surface area ≥ 100 cm.

Conclusions: An estimated parenchymal transection surface area ≥ 100 cm is a relevant indicator of surgical difficulty and postoperative complications in LLR.