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Linn YL, Wu AG, Han HS, Liu R, Chen KH, Fuks D, Soubrane O, Cherqui D, Geller D, Cheung TT, Edwin B, Aldrighetti L, Abu Hilal M, Troisi RI, Wakabayashi G, Goh BKP. Systematic review and meta-analysis of difficulty scoring systems for laparoscopic and robotic liver resections. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:36-59. [PMID: 35780493 DOI: 10.1002/jhbp.1211] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/31/2022] [Accepted: 06/24/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The ability to stratify the difficulty of minimally invasive liver resection (MILR) allows surgeons at different phases of the learning curve to tackle cases of appropriate difficulty safely. Several difficulty scoring systems (DSS) have been formulated which attempt to accurately stratify this difficulty. The present study aims to review the literature pertaining to the existing DSS for MILR. METHODS We performed a systematic review and metanalysis of the literature reporting on the formulation, supporting data, and comparison of DSS for MILR. RESULTS A total of 11 studies were identified which reported on the formulation of unique DSS for MILR. Five of these (Ban, Iwate, Hasegawa, Institut Mutaliste Montsouris [IMM], and Southampton DSS) were externally validated and shown to predict difficulty of MILR via a range of outcome measures. The Ban DSS was supported by pooled data from 10 studies (9 LLR, 1 RLR), Iwate by 10 studies (8 LLR, 2 RLR), Hasegawa by four studies (all LLR), IMM by eight studies (all LLR), and Southampton by five studies (all LLR). There was no clear superior DSS. CONCLUSION The existing DSS were all effective in predicting difficulty of MILR. Present studies comparing between DSS have not established a clear superior system, and the five main DSS have been found to be predictive of difficulty in LLR and two of these in RLR.
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Affiliation(s)
- Yun-Le Linn
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore City, Singapore
| | - Andrew G Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, Korea
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Kuo-Hsin Chen
- Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France
| | - Olivier Soubrane
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France
| | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France
| | - David Geller
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tan-To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Bjørn Edwin
- The Intervention Centre, Departmet for HPB Surgery, Oslo University Hospital, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Mohammad Abu Hilal
- Department of Surgery, University Hospital Southampton, Southampton, UK.,Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Roberto I Troisi
- Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital Naples, Naples, Italy
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital/ National Cancer Centre Singapore and Duke-National University of Singapore Medical School, Singapore City, Singapore
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Haney CM, Studier-Fischer A, Probst P, Fan C, Müller PC, Golriz M, Diener MK, Hackert T, Müller-Stich BP, Mehrabi A, Nickel F. A systematic review and meta-analysis of randomized controlled trials comparing laparoscopic and open liver resection. HPB (Oxford) 2021; 23:1467-1481. [PMID: 33820689 DOI: 10.1016/j.hpb.2021.03.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND/PURPOSE The dissemination of laparoscopic liver resection (LLR) has been based on non-randomized studies and reviews of these. Aim of this study was to evaluate if the randomized evidence comparing LLR to open liver resection (OLR) supports these findings. METHODS A prospectively registered (reviewregistry866) systematic review and meta-analysis following Cochrane and PRISMA guidelines comparing LLR to OLR for benign and malignant diseases was performed via Medline, Web of Science, CENTRAL up to 31.12.2020. The main outcome was postoperative complications. Risk of bias was assessed with the Cochrane Risk of Bias tool 2.0, certainty of evidence was assessed using the GRADE approach. RESULTS The search yielded 2080 results. 13 RCTs assessing mostly minor liver resections with 1457 patients were included. There were reduced odds of experiencing any complication (Odds ratio (OR) [95% confidence interval (CI)]: 0·42 [0·30, 0·58]) and severe complications (OR[CI]: 0·51 [0·31, 0·84]) for patients undergoing LLR. LOS was shorter (Mean difference (MD) [CI]: -2·90 [-3·88, -1·92] days), blood loss was lower (MD: [CI]: -115·41 [-146·08, -84·75] ml), and functional recovery was better for LLR. All other outcomes showed no significant differences. CONCLUSIONS LLR shows significant postoperative benefits. RCTs assessing long-term outcomes and major resections are needed.
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Affiliation(s)
- Caelán M Haney
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Alexander Studier-Fischer
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Pascal Probst
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Study Center of the German Surgical Society, Im Neuenheimer Feld 130, 69120 Heidelberg, Germany
| | - Carolyn Fan
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Philip C Müller
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Mohammad Golriz
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Markus K Diener
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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Ivanecz A, Plahuta I, Magdalenić T, Ilijevec B, Mencinger M, Peruš I, Potrč S. Evaluation of the Iwate Model for Predicting the Difficulty of Laparoscopic Liver Resection: Does Tumor Size Matter? J Gastrointest Surg 2021; 25:1451-1460. [PMID: 32495139 DOI: 10.1007/s11605-020-04657-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/13/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND This study aimed to externally validate the Iwate scoring model and its prognostic value for predicting the risks of intra- and postoperative complications of laparoscopic liver resection. METHODS Consecutive patients who underwent pure laparoscopic liver resection between 2008 and 2019 at a single tertiary center were included. The Iwate scores were calculated according to the original proposition (four difficulty levels based on six indices). Intra- and postoperative complications were compared across difficulty levels. Fitting the obtained data to the cumulative density function of the Weibull distribution and a linear function provided the mean risk curves for intra- and postoperative complications, respectively. RESULTS The difficulty levels of 142 laparoscopic liver resections were scored as low, intermediate, advanced, and expert level in 41 (28.9%), 53 (37.3%), 32 (22.5%), and 16 (11.3%) patients, respectively. Intraoperative complications were detected in 26 (18.3%) patients and its rates (2.4%, 7.5%, 34.3%, and 62.5%) increased gradually with statistically significant values among difficulty levels (P ˂ 0.001). Major postoperative complications occurred in 21 (14.8%) patients and its rates (4.8%, 5.6%, 28.1%, 43.7%; P ˂ 0.001) showed the same trend as for intraoperative complications. Then, the mean risk curves of both complications were obtained. Due to outliers, a new threshold for a tumor size index was proposed at 38 mm. The repeated analysis showed improved results. CONCLUSIONS The Iwate scoring model predicts the probability of complications across difficulty levels. Our proposed tumor size threshold (38 mm) improves the quality of the prediction. The model is upgraded by a probability of complications for every difficulty score.
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Affiliation(s)
- Arpad Ivanecz
- Department of Abdominal and General Surgery, University Medical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
| | - Irena Plahuta
- Department of Abdominal and General Surgery, University Medical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia
| | - Tomislav Magdalenić
- Department of Abdominal and General Surgery, University Medical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia
| | - Bojan Ilijevec
- Department of Abdominal and General Surgery, University Medical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia
| | - Matej Mencinger
- Faculty of Civil Engineering, Transportation Engineering and Architecture, University of Maribor, Smetanova ulica 17, 2000, Maribor, Slovenia.,Center of Applied Mathematics and Theoretical Physics, University of Maribor, Mladinska 3, 2000, Maribor, Slovenia.,Institute of Mathematics, Physics and Mechanics, Jadranska 19, 1000, Ljubljana, Slovenia
| | - Iztok Peruš
- Faculty of Civil Engineering, Transportation Engineering and Architecture, University of Maribor, Smetanova ulica 17, 2000, Maribor, Slovenia.,Faculty of Natural Science and Engineering, University of Ljubljana, Aškerčeva cesta 12, 1000, Ljubljana, Slovenia
| | - Stojan Potrč
- Department of Abdominal and General Surgery, University Medical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia
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Ivanecz A, Plahuta I, Magdalenić T, Mencinger M, Peruš I, Potrč S, Krebs B. The external validation of a difficulty scoring system for predicting the risk of intraoperative complications during laparoscopic liver resection. BMC Surg 2019; 19:179. [PMID: 31775813 PMCID: PMC6882247 DOI: 10.1186/s12893-019-0645-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This study aimed to externally validate and upgrade the recent difficulty scoring system (DSS) proposed by Halls et al. to predict intraoperative complications (IOC) during laparoscopic liver resection (LLR). METHODS The DSS was validated in a cohort of 128 consecutive patients undergoing pure LLRs between 2008 and 2019 at a single tertiary referral center. The validated DSS includes four difficulty levels based on five risk factors (neoadjuvant chemotherapy, previous open liver resection, lesion type, lesion size and classification of resection). As established by the validated DSS, IOC was defined as excessive blood loss (> 775 mL), conversion to an open approach and unintentional damage to surrounding structures. Additionally, intra- and postoperative outcomes were compared according to the difficulty levels with usual statistic methods. The same five risk factors were used for validation done by linear and advanced nonlinear (artificial neural network) models. The study was supported by mathematical computations to obtain a mean risk curve predicting the probability of IOC for every difficulty score. RESULTS The difficulty level of LLR was rated as low, moderate, high and extremely high in 36 (28.1%), 63 (49.2%), 27 (21.1%) and 2 (1.6%) patients, respectively. IOC was present in 23 (17.9%) patients. Blood loss of >775 mL occurred in 8 (6.2%) patients. Conversion to open approach was required in 18 (14.0%) patients. No patients suffered from unintentional damage to surrounding structures. Rates of IOC (0, 9.5, 55.5 and 100%) increased gradually with statistically significant value among difficulty levels (P < 0.001). The relations between the difficulty level, need for transfusion, operative time, hepatic pedicle clamping, and major postoperative morbidity were statistically significant (P < 0.05). Linear and nonlinear validation models showed a strong correlation (correlation coefficients 0.914 and 0.948, respectively) with the validated DSS. The Weibull cumulative distribution function was used for predicting the mean risk probability curve of IOC. CONCLUSION This external validation proved this DSS based on patient's, tumor and surgical factors enables us to estimate the risk of intra- and postoperative complications. A surgeon should be aware of an increased risk of complications before starting with more complex procedures.
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Affiliation(s)
- Arpad Ivanecz
- Department of Abdominal and General Surgery, University Medical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
| | - Irena Plahuta
- Department of Abdominal and General Surgery, University Medical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia
| | - Tomislav Magdalenić
- Department of Abdominal and General Surgery, University Medical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia
| | - Matej Mencinger
- Faculty of Civil Engineering, Transportation Engineering and Architecture, University of Maribor, Smetanova ulica 17, 2000, Maribor, Slovenia
- Center of Applied Mathematics and Theoretical Physics, University of Maribor, Mladinska 3, 2000, Maribor, Slovenia
- Institute of Mathematics, Physics and Mechanics, Jadranska 19, 1000, Ljubljana, Slovenia
| | - Iztok Peruš
- Faculty of Civil Engineering, Transportation Engineering and Architecture, University of Maribor, Smetanova ulica 17, 2000, Maribor, Slovenia
- Faculty of Natural Science and Engineering, University of Ljubljana, Aškerčeva cesta 12, 1000, Ljubljana, Slovenia
| | - Stojan Potrč
- Department of Abdominal and General Surgery, University Medical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia
| | - Bojan Krebs
- Department of Abdominal and General Surgery, University Medical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia
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