Validation of the Iwate scoring system for the stratification of laparoscopic liver resections: An international multicenter study.
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Peng Yufu, Liu Fei, Li Bo, Wei Yonggang, Tan Hwee-Leong, Syn Nicholas L, Fuks David, Soubrane Olivier, Dokmak Safi, Gruttadauria Salvatore, Zimmitti Giuseppe, Jaber Bashar, Cipriani Federica, Kato Yutaro, Scatton Olivier, Herman Paulo, Aghayan Davit L, Marino Marco V, Croner Roland S, Mazzaferro Vincenzo, Chiow Adrian K H, Sucandy Iswanto, Ivanecz Arpad, Choi Sung Hoon, Lee Jae Hoon, Prieto Mikel, Vivarelli Marco, Giuliante Felice, Ruzzenente Andrea, Yong Chee-Chien, Yin Mengqiu, Fondevila Constantino, Efanov Mikhail, Morise Zenichi, Di Benedetto Fabrizio, Brustia Raffaele, Dalla Valle Raffaele, Boggi Ugo, Geller David, Belli Andrea, Memeo Riccardo, Mejia Alejandro, Park James O, Rotellar Fernando, Choi Gi-Hong, Robles-Campos Ricardo, Hasegawa Kiyoshi, Wang Xiaoying, Sutcliffe Robert P, Pratschke Johann, Lai Eric C H, Chong Charing C N, D'Hondt Mathieu, Monden Kazuteru, Lopez-Ben Santiago, Kingham T Peter, Liu Rong, Ferrero Alessandro, Ettorre Giuseppe Maria, Cherqui Daniel, Liang Xiao, Mishima Kohei, Wakabayashi Go, Troisi Roberto I, Cheung Tan-To, Sugimoto Motokazu, Sugioka Atsushi, Han Ho-Seong, Duy Long Tran Cong, Abu Hilal Mohammad, Zhang Wanguang, Chen Kuo-Hsin, Aldrighetti Luca, Edwin Bjorn, Goh Brian K P, International robotic and laparoscopic liver resection study group investigators
Аннотация
METHODS: A retrospective cohort study of 22,252 patients undergoing LLR across 64 centers worldwide between 2005 and 2021 was performed. Baseline characteristics and perioperative outcomes were analyzed across the four difficulty levels and 12-point difficulty index of the Iwate DSS.
RESULTS: A total of 14,759 patients met the inclusion criteria. The main indications for LLR were hepatocellular carcinoma/intrahepatic cholangiocarcinoma (52.8 %), and metastatic tumors liver (26.5 %). In terms of underlying liver pathology, 5127 patients (34.8 %) had liver cirrhosis, and 1214 patients (8.3 %) had portal hypertension. Intraoperative outcomes (operation time, blood loss, blood transfusion, use of Pringles maneuver and open conversion) and postoperative outcomes (length of stay, morbidity, major complications, and 90-day mortality) significantly increased with stepwise increases across the four difficulty levels (P < 0.001) and 12-point difficulty index (P < 0.001). These trends remained significant following adjustment for baseline characteristics (P < 0.001).
CONCLUSION: The Iwate DSS 12-point difficulty index and four difficulty levels correlated well with LLR difficulty as determined by key surrogate perioperative measures.