Utility of the Iwate Difficulty Scoring System for the Stratification of Laparoscopic Right Hepatectomies: An International Multicenter Study.
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Sugimoto Motokazu, Zhao Yun, Gotohda Naoto, Tan Hwee-Leong, Koh Ye-Xin, Aghayan Davit L, Yao Cheng, Ishizawa Takeashi, Ratti Francesca, Zhang Wanguang, Scatton Olivier, Coelho Fabricio Ferreira, Dokmak Safi, 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, Hasegawa Kiyoshi, Croner Roland S, Gruttadauria Salvatore, Hawksworth Jason, Park James O, Rotellar Fernando, Choi Gi-Hong, Robles-Campos Ricardo, Wang Xiaoying, Sutcliffe Robert P, Pratschke Johann, Tang Chung-Ngai, Chong Charing C N, D'Hondt Mathieu, Monden Kazuteru, Lopez-Ben Santiago, Kingham T Peter, Ferrero Alessandro, Ettorre Giuseppe Maria, Cherqui Daniel, Liang Xiao, Swijnenburg Rutger-Jan, Wakabayashi Go, Troisi Roberto I, Cheung Tan-To, Sugioka Atsushi, Ueno Masaki, Joliat Gaetan-Romain, Schmelzle Moritz, Hatano Etsuro, Mejia Alejandro, Marino Marco V, Cillo Umberto, Zhu Chengzhan, Yong Zha, Millet Guillaume, Torzilli Guido, Yu Decai, Long Tran Cong Duy, Peng Yufu, Wei Yonggang, Liu Rong, Han Ho-Seong, Soubrane Olivier, Fuks David, Chen Kuo-Hsin, Abu Hilal Mohammad, Aldrighetti Luca, Edwin Bjørn, Goh Brian K P, International Robotic and Laparoscopic Liver Resection Study Group Investigators
Аннотация
METHODS: This international, multicenter study included 1732 patients who underwent L-RH at 78 centers between 2005 and 2023. Baseline clinicopathological characteristics and surgical outcomes were collected and analyzed based on I-DSS grades. Multivariable analyses were performed to adjust for potential confounders.
RESULTS: Patients were categorized into three I-DSS grades: intermediate (n = 13), advanced (n = 355), and expert (n = 1364). Unadjusted analysis showed that higher I-DSS grades were associated with shorter operation time and increased morbidity. However, after adjustment for baseline factors, no significant differences were observed across I-DSS grades in terms of intra- and postoperative outcomes, including operation time, blood loss, transfusion, morbidity, mortality, and surgical margin positivity.
CONCLUSIONS: The I-DSS has limited ability to stratify technical difficulty in L-RH. Future studies should be undertaken to develop a new difficulty classification system tailored specifically to specific procedures such as L-RH.