Takao Ohtsuka1, Daisuke Ban2, Yoshiharu Nakamura3, Yuichi Nagakawa4, Minoru Tanabe2, Yoshitaka Gotoh1, Vittoria Vanessa D M Velasquez1, Kohei Nakata1, Yatsuka Sahara4, Kyoichi Takaori5, Goro Honda6, Takeyuki Misawa7, Manabu Kawai8, Hiroki Yamaue8, Takanori Morikawa9, Tamotsu Kuroki10, Yiping Mou11, Woo-Jung Lee12, Shailesh V Shrikhande13, Chung Ngai Tang14, Claudius Conrad15, Ho-Seong Han16, Chinnusamy Palanivelu17, Horacio J Asbun18, David A Kooby19, Go Wakabayashi20, Tadahiro Takada21, Masakazu Yamamoto22, Masafumi Nakamura1. 1. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 2. Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan. 3. Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan. 4. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan. 5. Division of Hepatobiliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan. 6. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. 7. Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan. 8. Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan. 9. Department of Surgery, Tohoku University, Sendai, Japan. 10. Department of Surgery, National Hospital Nagasaki Medical Center, Nagasaki, Japan. 11. Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China. 12. Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, South Korea. 13. Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Mumbai, India. 14. Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China. 15. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 16. Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea. 17. Division of Gastrointestinal Surgery and Minimal Access Surgery, GEM Hospital and Research Centre, Coimbatore, India. 18. Department of Surgery, Mayo Clinic, Jacksonville, FL, USA. 19. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. 20. Department of Surgery, Ageo Central General Hospital, Ageo, Japan. 21. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. 22. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
Abstract
BACKGROUND: Several factors affect the level of difficulty of laparoscopic distal pancreatectomy (LDP). The purpose of this study was to develop a difficulty scoring (DS) system to quantify the degree of difficulty in LDP. METHODS: We collected clinical data for 80 patients who underwent LDP. A 10-level difficulty index was developed and subcategorized into a three-level difficulty index; 1-3 as low, 4-6 as intermediate, and 7-10 as high index. The automatic linear modeling (LINEAR) statistical tool was used to identify factors that significantly increase level of difficulty in LDP. RESULTS: The operator's 10-level DS concordance between the 10-level DS by the reviewers, LINEAR index DS, and clinical index DS systems were analyzed, and the weighted Cohen's kappa statistic were at 0.869, 0.729, and 0.648, respectively, showing good to excellent inter-rater agreement. We identified five factors significantly affecting level of difficulty in LDP; type of operation, resection line, proximity of tumor to major vessel, tumor extension to peripancreatic tissue, and left-sided portal hypertension/splenomegaly. CONCLUSIONS: This novel DS for LDP adequately quantified the degree of difficulty, and can be useful for selecting patients for LDP, in conjunction with fitness for surgery and prognosis.
BACKGROUND: Several factors affect the level of difficulty of laparoscopic distal pancreatectomy (LDP). The purpose of this study was to develop a difficulty scoring (DS) system to quantify the degree of difficulty in LDP. METHODS: We collected clinical data for 80 patients who underwent LDP. A 10-level difficulty index was developed and subcategorized into a three-level difficulty index; 1-3 as low, 4-6 as intermediate, and 7-10 as high index. The automatic linear modeling (LINEAR) statistical tool was used to identify factors that significantly increase level of difficulty in LDP. RESULTS: The operator's 10-level DS concordance between the 10-level DS by the reviewers, LINEAR index DS, and clinical index DS systems were analyzed, and the weighted Cohen's kappa statistic were at 0.869, 0.729, and 0.648, respectively, showing good to excellent inter-rater agreement. We identified five factors significantly affecting level of difficulty in LDP; type of operation, resection line, proximity of tumor to major vessel, tumor extension to peripancreatic tissue, and left-sided portal hypertension/splenomegaly. CONCLUSIONS: This novel DS for LDP adequately quantified the degree of difficulty, and can be useful for selecting patients for LDP, in conjunction with fitness for surgery and prognosis.
Authors: Shi Qing Lee; Tousif Kabir; Ye-Xin Koh; Jin-Yao Teo; Ser-Yee Lee; Juinn-Huar Kam; Peng-Chung Cheow; Prema Raj Jeyaraj; Pierce K H Chow; London L Ooi; Alexander Y F Chung; Chung-Yip Chan; Brian K P Goh Journal: Ann Hepatobiliary Pancreat Surg Date: 2020-08-31
Authors: Riccardo Casadei; Claudio Ricci; Carlo Ingaldi; Laura Alberici; Maria Chiara Vaccaro; Elisa Galasso; Francesco Minni Journal: World J Surg Date: 2020-10-15 Impact factor: 3.352