{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T19:42:32Z","timestamp":1787686952122,"version":"build-2784847793"},"reference-count":32,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,15]],"date-time":"2024-01-15T00:00:00Z","timestamp":1705276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Post-hepatectomy liver failure (PHLF) represents a major cause of morbidity and mortality after liver resection. The factors related to PHLF are represented not only by the volume and function of the future liver remnant but also by the severity of portal hypertension. The aim of this study was to assess whether the preservation of the round ligament (RL) may mitigate portal hypertension, thus decreasing the risk of PHLF and ascites in cirrhotic patients while undergoing minimally invasive liver surgery (MILS). All the cirrhotic patients who underwent MILS for HCC from 2016 to 2021 in two international tertiary referral centers were retrospectively analyzed, comparing cases with the RL preserved vs. those with the RL divided. Only patients with cirrhosis \u2265 Child A6, portal hypertension, and ICG-R15 &gt; 10% were included. Main postoperative outcomes were compared, and the risk factors for postoperative ascites (severe PHLF, grade B\/C) were investigated through a logistic regression. After the application of the selection criteria, a total of 130 MILS patients were identified, with 86 patients with the RL preserved and 44 with the RL divided. The RL-preserved group showed lower incidences of severe PHLF (7.0% vs. 20.5%, p = 0.023) and ascites (5.8% vs. 18.2%, p = 0.026) in comparison with the RL-divided group. After uni\/multivariate analysis, the risk factors related to postoperative ascites were RL division and platelets &lt; 92 \u00d7 103\/\u00b5L, calculated with ROC analysis. The preservation of the round ligament during MILS may mitigate portal hypertension, preventing PHLF and ascites in cirrhotic patients with borderline liver function.<\/jats:p>","DOI":"10.3390\/cancers16020364","type":"journal-article","created":{"date-parts":[[2024,1,15]],"date-time":"2024-01-15T04:54:38Z","timestamp":1705294478000},"page":"364","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Prevention of Post-Hepatectomy Liver Failure in Cirrhotic Patients Undergoing Minimally Invasive Liver Surgery for HCC: Has the Round Ligament to Be Preserved?"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8982-2163","authenticated-orcid":false,"given":"Marco","family":"Vivarelli","sequence":"first","affiliation":[{"name":"Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Mocchegiani","sequence":"additional","affiliation":[{"name":"Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taiga","family":"Wakabayashi","sequence":"additional","affiliation":[{"name":"Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Gaudenzi","sequence":"additional","affiliation":[{"name":"Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5477-3346","authenticated-orcid":false,"given":"Daniele","family":"Nicolini","sequence":"additional","affiliation":[{"name":"Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malek A.","family":"Al-Omari","sequence":"additional","affiliation":[{"name":"Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grazia","family":"Conte","sequence":"additional","affiliation":[{"name":"Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5544-9468","authenticated-orcid":false,"given":"Alessandra","family":"Borgheresi","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital \u201cAzienda Ospedaliera Universitaria delle Marche\u201d, 60126 Ancona, Italy"},{"name":"Department of Clinical, Special and Dental Sciences, Universit\u00e0 Politecnica delle Marche, 60121 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0693-8257","authenticated-orcid":false,"given":"Andrea","family":"Agostini","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital \u201cAzienda Ospedaliera Universitaria delle Marche\u201d, 60126 Ancona, Italy"},{"name":"Department of Clinical, Special and Dental Sciences, Universit\u00e0 Politecnica delle Marche, 60121 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Rossi","sequence":"additional","affiliation":[{"name":"Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiki","family":"Fujiyama","sequence":"additional","affiliation":[{"name":"Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Giovagnoni","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital \u201cAzienda Ospedaliera Universitaria delle Marche\u201d, 60126 Ancona, Italy"},{"name":"Department of Clinical, Special and Dental Sciences, Universit\u00e0 Politecnica delle Marche, 60121 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Go","family":"Wakabayashi","sequence":"additional","affiliation":[{"name":"Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6886-8138","authenticated-orcid":false,"given":"Andrea","family":"Benedetti Cacciaguerra","sequence":"additional","affiliation":[{"name":"Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.surg.2010.10.001","article-title":"Posthepatectomy liver failure: A definition and grading by the International Study Group of 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Soc."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/2\/364\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:47:00Z","timestamp":1760104020000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/2\/364"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,15]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["cancers16020364"],"URL":"https:\/\/doi.org\/10.3390\/cancers16020364","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,15]]}}}