{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:51:21Z","timestamp":1783659081551,"version":"3.55.0"},"reference-count":35,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T00:00:00Z","timestamp":1680048000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The aim of this multicentric study was to investigate the impact of tumor location and size on the difficulty of Laparoscopic\u2010Left Hepatectomy (L\u2010LH).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients who underwent L\u2010LH performed across 46 centers from 2004 to 2020 were analyzed. Of 1236\u2009L\u2010LH, 770 patients met the study criteria. Baseline clinical and surgical characteristics with a potential impact on LLR were included in a multi\u2010label conditional interference tree. Tumor size cut\u2010off was algorithmically determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients were stratified into 3 groups based on tumor location and dimension: 457 in antero\u2010lateral location (Group 1), 144 in postero\u2010superior segment (4a) with tumor size \u226440\u2009mm (Group 2), and 169 in postero\u2010superior segment (4a) with tumor size &gt;40\u2009mm (Group 3). Patients in the Group 3 had higher conversion rate (7.0% vs. 7.6% vs. 13.0%, <jats:italic>p<\/jats:italic>\u2010value .048), longer operating time (median, 240\u2009min vs. 285\u2009min vs. 286\u2009min, <jats:italic>p<\/jats:italic>\u2010value &lt;.001), greater blood loss (median, 150\u2009mL vs. 200\u2009mL vs. 250\u2009mL, <jats:italic>p<\/jats:italic>\u2010value &lt;.001) and higher intraoperative blood transfusion rate (5.7% vs. 5.6% vs. 11.3%, <jats:italic>p<\/jats:italic>\u2010value .039). Pringle's maneuver was also utilized more frequently in Group 3 (66.7%), compared to Group 1 (53.2%) and Group 2 (51.8%) (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.006). There were no significant differences in postoperative stay, major morbidity, and mortality between the three groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>L\u2010LH for tumors that are &gt;40\u2009mm in diameter and located in PS Segment 4a are associated with the highest degree of technical difficulty. However, post\u2010operative outcomes were not different from L\u2010LH of smaller tumors located in PS segments, or tumors located in the antero\u2010lateral segments.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jhbp.1323","type":"journal-article","created":{"date-parts":[[2023,3,6]],"date-time":"2023-03-06T02:58:46Z","timestamp":1678071526000},"page":"1098-1110","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Sub\u2010classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes"],"prefix":"10.1002","volume":"30","author":[{"given":"Andrea","family":"Ruzzenente","sequence":"first","affiliation":[{"name":"General and Hepatobiliary Surgery, Department of Surgery, Dentistry Gynecology and Pediatrics University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo Dalla","family":"Valle","sequence":"additional","affiliation":[{"name":"General and Hepatobiliary Surgery, Department of Surgery, Dentistry Gynecology and Pediatrics University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Poletto","sequence":"additional","affiliation":[{"name":"General and Hepatobiliary Surgery, Department of Surgery, Dentistry Gynecology and Pediatrics University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6343-176X","authenticated-orcid":false,"given":"Nicholas L.","family":"Syn","sequence":"additional","affiliation":[{"name":"Department of Hepatopancreatobiliary and Transplant Surgery Singapore General Hospital\/ National Cancer Centre Singapore and Ministry of Health Holdings  Singapore 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