Resection type is a predictor of postoperative complications in laparoscopic partial liver resection

Background Partial laparoscopic liver resection (LLR) is a procedure that can have varying levels of surgical difficulty depending on the tumor status and procedure. Therefore, we aimed to evaluate the surgical outcomes of partial LLR using a new resection classification system. Methods From January 2009 to May 2021, 156 patients underwent LLR; of them, 87 patients who underwent pure partial LLR were included in this study. They were classified according to the IWATE criteria as the low ( n = 56) and intermediate ( n = 31) difficulty groups and reclassified according to the resection type as the edge (ER, n = 45), bowl-shaped (BSR, n = 27), and dome-shaped resection (DSR, n = 15) groups. The following surgical outcomes were comparatively analyzed among the groups: intraoperative blood loss, the operation time, and complication rates. Preoperative risk factors for intraoperative blood transfusion and complications were evaluated. Results In the IWATE criteria-based analysis, the intermediate-difficulty group had significantly higher intraoperative blood loss ( p = 0.005), operation time ( p = 0.005), and Clavien–Dindo (CD) grade-based complication rates (CD grade 2 or higher, p = 0.03) than the low-difficulty group. When analyzing the resection type, the CD grade-based complication rate ( p = 0.013) and surgical site infection (SSI, p = 0.005) were significantly higher and the postoperative hospitalization was significantly longer ( p = 0.028) in the bowl-shaped resection (BSR) group than in the edge- (ER) and dome-shaped resection (DSR) groups. The tumor size ( p = 0.011) and IWATE criteria score ( p = 0.006) were independent risk factors for intraoperative blood transfusion in the multivariate analysis. The tumor depth ( p = 0.011) and BSR ( p = 0.002) were independent risk factors for complications of CD grade 2 or higher in the multivariate analysis. BSR was an independent risk factor for SSI in the multivariate analysis ( p = 0.017). Conclusions Resection type could predict the rate of postoperative complications, while the IWATE criteria could predict the intraoperative surgical difficulty.