Shogo Tanaka1, Shoji Kubo2, Akishige Kanazawa3, Yutaka Takeda4, Fumitoshi Hirokawa5, Hiroyuki Nitta6, Takayoshi Nakajima7, Takashi Kaizu8, Hironori Kaneko9, Go Wakabayashi10. 1. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. Electronic address: m8827074@msic.med.osaka-cu.ac.jp. 2. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. 3. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City General Hospital, Osaka, Japan. 4. Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan. 5. Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan. 6. Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan. 7. Department of Surgery, Meiwa Hospital, Nishinomiya, Japan. 8. Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan. 9. Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan. 10. Department of Surgery, Ageo Central General Hospital, Ageo, Japan.
Abstract
BACKGROUND: Laparoscopic liver resection (LLR) is widely used for hepatic disease treatment. Preoperative prediction of operative difficulty can be beneficial as a roadmap for surgeons advancing from simple to highly technical LLR. We performed a multicenter analysis to investigate a "difficulty scoring system" for predicting the difficulty of LLR. STUDY DESIGN: The proposed "difficulty scoring system" includes 3 difficulty levels based on 5 factors. The system was validated in a cohort of 2,199 patients who underwent LLR at 74 Japanese centers between 2010 and 2014; the difficulty level was rated as low (n = 965), intermediate (n = 891), and high (n = 343). Operative parameters, postoperative complications, and outcomes were compared according to the difficulty levels. RESULTS: The median operation time and blood loss were 258 minutes (range 30 to 1,275 minutes) and 75 mL (range 0 to 7,798 mL), respectively. The overall conversion rate was 5.0% (n = 110). The incidences of postoperative complications, liver failure, and in-hospital death were 5.3% (n = 116), 1.5% (n = 32), and 0.5% (n = 12), respectively. Median hospital stay was 9 days (range 1 to 189 days). Conversion rate, operation time, and blood loss showed a direct correlation with the difficulty level. A strong correlation was observed among the difficulty level, incidence of postoperative complications, and hospital stay. Incidence of postoperative liver failure and in-hospital death in the high difficulty group was higher than that in the low difficulty group. CONCLUSIONS: Preoperative evaluation with the "difficulty scoring system" predicted the difficulty of the operation and the postoperative outcomes of LLR. In the beginning of LLR training, surgeons should start with low difficulty-level operations.
BACKGROUND: Laparoscopic liver resection (LLR) is widely used for hepatic disease treatment. Preoperative prediction of operative difficulty can be beneficial as a roadmap for surgeons advancing from simple to highly technical LLR. We performed a multicenter analysis to investigate a "difficulty scoring system" for predicting the difficulty of LLR. STUDY DESIGN: The proposed "difficulty scoring system" includes 3 difficulty levels based on 5 factors. The system was validated in a cohort of 2,199 patients who underwent LLR at 74 Japanese centers between 2010 and 2014; the difficulty level was rated as low (n = 965), intermediate (n = 891), and high (n = 343). Operative parameters, postoperative complications, and outcomes were compared according to the difficulty levels. RESULTS: The median operation time and blood loss were 258 minutes (range 30 to 1,275 minutes) and 75 mL (range 0 to 7,798 mL), respectively. The overall conversion rate was 5.0% (n = 110). The incidences of postoperative complications, liver failure, and in-hospital death were 5.3% (n = 116), 1.5% (n = 32), and 0.5% (n = 12), respectively. Median hospital stay was 9 days (range 1 to 189 days). Conversion rate, operation time, and blood loss showed a direct correlation with the difficulty level. A strong correlation was observed among the difficulty level, incidence of postoperative complications, and hospital stay. Incidence of postoperative liver failure and in-hospital death in the high difficulty group was higher than that in the low difficulty group. CONCLUSIONS: Preoperative evaluation with the "difficulty scoring system" predicted the difficulty of the operation and the postoperative outcomes of LLR. In the beginning of LLR training, surgeons should start with low difficulty-level operations.
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
Authors: Charing C N Chong; H T Lok; Andrew K Y Fung; Anthony K W Fong; Y S Cheung; John Wong; K F Lee; Paul B S Lai Journal: Surg Endosc Date: 2019-07-16 Impact factor: 4.584