Shogo Tanaka1, Yoshikuni Kawaguchi2, Shoji Kubo3, Akishige Kanazawa4, Yutaka Takeda5, Fumitoshi Hirokawa6, Hiroyuki Nitta7, Takayoshi Nakajima8, Takashi Kaizu9, Masaki Kaibori10, Toru Kojima11, Yuichiro Otsuka12, David Fuks13, Kiyoshi Hasegawa14, Norihiro Kokudo14, Hironori Kaneko12, Brice Gayet13, Go Wakabayashi15. 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 Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France; Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. Electronic address: yokawaguchi-tky@umin.ac.jp. 3. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. 4. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City General Hospital, Osaka, Japan. 5. Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan. 6. Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan. 7. Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan. 8. Department of Surgery, Meiwa Hospital, Nishinomiya, Japan. 9. Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan. 10. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Japan. 11. Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan. 12. Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan. 13. Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France. 14. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 15. Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Japan.
Abstract
BACKGROUND: The original difficulty scoring system was revised after discussion at the 2nd International Consensus Conference on Laparoscopic Liver Resection held in Morioka (Iwate Prefecture) in Japan and renamed the IWATE criteria (a 4-level classification system involving 6 preoperative factors). We used Japanese and French cohorts to validate the IWATE criteria by evaluating their association with the procedure-based difficulty classification proposed by the Institut Mutualiste Montsouris. METHOD: Patients who had undergone laparoscopic liver resection at multiple Japanese multi-institutions or the Institut Mutualiste Montsouris were assigned to the multiple Japanese multi-institution (n = 1,867) or Institut Mutualiste Montsouris cohort (n = 433). We analyzed clinical characteristics and outcomes according to the 4-level IWATE criteria difficulties (low, intermediate, advanced, and expert) and evaluated their association with 11 laparoscopic liver resection procedures in the Institut Mutualiste Montsouris classification (low, intermediate, and high levels). RESULTS: We found significant differences in age, surgical indications, and the 4-level IWATE criteria difficulties between the cohorts (all, P < .001). Operation time and blood loss were significantly different among the 4-level difficulties in both cohorts (all, P < .001). The rates of conversion, postoperative complications, liver failure, and in-hospital deaths also increased significantly with increasing difficulty (all, P < .001). The IWATE criteria classified the three low-level Institut Mutualiste Montsouris procedures in the low-to-intermediate levels, the two intermediate-level procedures in the intermediate-to-advanced levels, and the six high-level procedures in the advanced-to-expert levels. CONCLUSION: We observed associations between the IWATE criteria and intraoperative and postoperative outcomes in the Japanese multi-institution and Institut Mutualiste Montsouris cohorts and thus validated the IWATE system.
BACKGROUND: The original difficulty scoring system was revised after discussion at the 2nd International Consensus Conference on Laparoscopic Liver Resection held in Morioka (Iwate Prefecture) in Japan and renamed the IWATE criteria (a 4-level classification system involving 6 preoperative factors). We used Japanese and French cohorts to validate the IWATE criteria by evaluating their association with the procedure-based difficulty classification proposed by the Institut Mutualiste Montsouris. METHOD:Patients who had undergone laparoscopic liver resection at multiple Japanese multi-institutions or the Institut Mutualiste Montsouris were assigned to the multiple Japanese multi-institution (n = 1,867) or Institut Mutualiste Montsouris cohort (n = 433). We analyzed clinical characteristics and outcomes according to the 4-level IWATE criteria difficulties (low, intermediate, advanced, and expert) and evaluated their association with 11 laparoscopic liver resection procedures in the Institut Mutualiste Montsouris classification (low, intermediate, and high levels). RESULTS: We found significant differences in age, surgical indications, and the 4-level IWATE criteria difficulties between the cohorts (all, P < .001). Operation time and blood loss were significantly different among the 4-level difficulties in both cohorts (all, P < .001). The rates of conversion, postoperative complications, liver failure, and in-hospital deaths also increased significantly with increasing difficulty (all, P < .001). The IWATE criteria classified the three low-level Institut Mutualiste Montsouris procedures in the low-to-intermediate levels, the two intermediate-level procedures in the intermediate-to-advanced levels, and the six high-level procedures in the advanced-to-expert levels. CONCLUSION: We observed associations between the IWATE criteria and intraoperative and postoperative outcomes in the Japanese multi-institution and Institut Mutualiste Montsouris cohorts and thus validated the IWATE system.
Authors: Yvette Chong; Ye-Xin Koh; Jin-Yao Teo; Peng-Chung Cheow; Pierce K Chow; Alexander Y Chung; Chung-Yip Chan; Brian K P Goh Journal: Surg Endosc Date: 2021-02-10 Impact factor: 4.584
Authors: Kevin P Labadie; David J Droullard; Alex W Lois; Sara K Daniel; Kathryn E McNevin; Jaqueline Valdez Gonzalez; Yongwoo D Seo; Kevin M Sullivan; Kyle S Bilodeau; Lindsay K Dickerson; Alan F Utria; John Calhoun; Venu G Pillarisetty; Jonathan G Sham; Raymond S Yeung; James O Park Journal: Surg Endosc Date: 2021-02-19 Impact factor: 4.584