Paramin Muangkaew1,2, Jai Young Cho3, Ho-Seong Han1, Yoo-Seok Yoon1, YoungRok Choi1, Jae Yool Jang1, Hanlim Choi1, Jae Seong Jang1, Seong Uk Kwon1. 1. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea. 2. Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 3. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea. jychogs@gmail.com.
Abstract
BACKGROUND: A classification system for defining the complexity of hepatectomy according to its technical difficulty was recently proposed as a consensus of a panel of experts. We validated this classification system for a prospective liver resection cohort in patients with hepatocellular carcinoma (HCC). METHOD: The complexity classification separated liver resections into three categories of complexity (low, medium, or high). We retrospectively reviewed 150 open hepatectomies between 1 March 2004 and 30 November 2013 in patients with HCC, and compared the perioperative outcomes according to the complexity classification. RESULTS: No differences in patient demographics or pathologic findings were observed among the three groups according to the complexity classification, which effectively differentiated the three groups in terms of intraoperative findings and short-term outcomes. The mean estimated blood loss (p = 0.001), rate of blood transfusion (p < 0.001), and mean operation time (p < 0.001) were significantly different among the three groups. The rates of overall and major complications (p = 0.026 and 0.005, respectively) were significantly greater in the high-complexity group. Multivariate analysis showed that the complexity classification was independently associated with major complications (odds ratio 4.73; p = 0.040); however, overall patient survival (p = 0.139) and disease-free survival (p = 0.076) were not significantly different among the three groups. CONCLUSION: The complexity classification effectively differentiated intraoperative and short-term outcomes, and was independently associated with major complications after hepatectomy in patients with HCC.
BACKGROUND: A classification system for defining the complexity of hepatectomy according to its technical difficulty was recently proposed as a consensus of a panel of experts. We validated this classification system for a prospective liver resection cohort in patients with hepatocellular carcinoma (HCC). METHOD: The complexity classification separated liver resections into three categories of complexity (low, medium, or high). We retrospectively reviewed 150 open hepatectomies between 1 March 2004 and 30 November 2013 in patients with HCC, and compared the perioperative outcomes according to the complexity classification. RESULTS: No differences in patient demographics or pathologic findings were observed among the three groups according to the complexity classification, which effectively differentiated the three groups in terms of intraoperative findings and short-term outcomes. The mean estimated blood loss (p = 0.001), rate of blood transfusion (p < 0.001), and mean operation time (p < 0.001) were significantly different among the three groups. The rates of overall and major complications (p = 0.026 and 0.005, respectively) were significantly greater in the high-complexity group. Multivariate analysis showed that the complexity classification was independently associated with major complications (odds ratio 4.73; p = 0.040); however, overall patient survival (p = 0.139) and disease-free survival (p = 0.076) were not significantly different among the three groups. CONCLUSION: The complexity classification effectively differentiated intraoperative and short-term outcomes, and was independently associated with major complications after hepatectomy in patients with HCC.
Authors: Ser Yee Lee; Brian K P Goh; Gholami Sepideh; John C Allen; Ryan P Merkow; Jin Yao Teo; Deepa Chandra; Ye Xin Koh; Ek Khoon Tan; Juinn Haur Kam; Peng Chung Cheow; Pierce K H Chow; London L P J Ooi; Alexander Y F Chung; Michael I D'Angelica; William R Jarnagin; T Peter Kingham; Chung Yip Chan Journal: J Gastrointest Surg Date: 2018-11-12 Impact factor: 3.452