Detailed Abstract
[Poster Presentation 13 - Liver (Liver Disease/Surgery)]
[LV PP 13-S7] Validation of the Institute Mutualiste Montsouris System for the Stratification of Laparoscopic Liver Resections: an International Multicenter Study.
Hwee Leong TAN 1, Nicholas L. SYN 2, Brian K. P. GOH 1, International Robotic And Laparoscopic Liver Resection Study Group Investigators - 3
1 Department of Hepatopancreatobiliary And Transplant Surgery, Singapore General Hospital, SINGAPORE, 2 Ministry of Health Holdings Pte Ltd, Ministry of Health Holdings Pte Ltd, SINGAPORE, 3 International Robotic And Laparoscopic Liver Resection Study Group Investigators, International Robotic And Laparoscopic Liver Resection Study Group Investigators, SINGAPORE
Background : The Institut Mutualiste Montsouris (IMM) difficulty scoring system (DSS) has been extensively validated for laparoscopic liver resection (LLR). To address current limitations in the studies validating it, we performed an international multicenter study to validate the IMM DSS across both its three difficulty levels and 11 procedure types.
Methods : A retrospective cohort study of all patients undergoing LLR across 64 centers worldwide between 2005 and 2021 was performed. Baseline characteristics and perioperative outcomes were analyzed across the three difficulty levels and 11 procedure types of the IMM DSS.
Results : A total of 14765 patients were included in our final analysis. The main indications for LLR in our study was hepatocellular carcinoma or intrahepatic cholangiocarcinoma (n=7781, 52.7%) followed by liver metastasectomy (n=3911, 26.5%). In terms of underlying liver pathology, 5127 (34.7%) cases had cirrhosis, and 1214 (8.3%) had portal hypertension. Perioperative outcomes including operative time, open conversion rate, intraoperative blood loss, need for intraoperative blood transfusion, need for Pringle’s application, length of stay, postoperative morbidity, major postoperative morbidity and 90-day mortality all demonstrated a significant increasing trend with increasing IMM DSS difficulty level (P〈0.001). These trends remained significant following adjustment for baseline characteristics (P〈0.001). Notably, when examining the 11 LLR procedure types, all procedures within each IMM difficulty level were individually higher that all procedures in the preceding difficulty level for operative time, blood loss, length of stay, postoperative morbidity and major postoperative morbidity.
Conclusions : The IMM DSS three difficulty levels correlate well with LLR difficulty as determined by key surrogate perioperative measures.
Methods : A retrospective cohort study of all patients undergoing LLR across 64 centers worldwide between 2005 and 2021 was performed. Baseline characteristics and perioperative outcomes were analyzed across the three difficulty levels and 11 procedure types of the IMM DSS.
Results : A total of 14765 patients were included in our final analysis. The main indications for LLR in our study was hepatocellular carcinoma or intrahepatic cholangiocarcinoma (n=7781, 52.7%) followed by liver metastasectomy (n=3911, 26.5%). In terms of underlying liver pathology, 5127 (34.7%) cases had cirrhosis, and 1214 (8.3%) had portal hypertension. Perioperative outcomes including operative time, open conversion rate, intraoperative blood loss, need for intraoperative blood transfusion, need for Pringle’s application, length of stay, postoperative morbidity, major postoperative morbidity and 90-day mortality all demonstrated a significant increasing trend with increasing IMM DSS difficulty level (P〈0.001). These trends remained significant following adjustment for baseline characteristics (P〈0.001). Notably, when examining the 11 LLR procedure types, all procedures within each IMM difficulty level were individually higher that all procedures in the preceding difficulty level for operative time, blood loss, length of stay, postoperative morbidity and major postoperative morbidity.
Conclusions : The IMM DSS three difficulty levels correlate well with LLR difficulty as determined by key surrogate perioperative measures.
SESSION
Poster Presentation 13
Zone G 3/22/2024 2:50 PM - 3:40 PM