Detailed Abstract
[E-poster - Liver (Liver Disease/Surgery)]
[EP 013] Validation of the Iwate Scoring 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 Iwate difficulty scoring system (DSS) is one of the most widely validated DSS for laparoscopic liver resection (LLR). To address current limitations in the studies validating the Iwate DSS, we performed an international multicenter study to validate the Iwate DSS across both its four difficulty levels and 12-point difficulty index.
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 four difficulty levels and 12-point difficulty index of the Iwate DSS.
Results : A total of 14759 patients were included in our final analysis. The main indications for LLR were hepatocellular carcinoma and intrahepatic cholangiocarcinoma (52.8%), and liver metastatic tumors (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).
Conclusions : The Iwate DSS 12-point difficulty index and four 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 four difficulty levels and 12-point difficulty index of the Iwate DSS.
Results : A total of 14759 patients were included in our final analysis. The main indications for LLR were hepatocellular carcinoma and intrahepatic cholangiocarcinoma (52.8%), and liver metastatic tumors (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).
Conclusions : The Iwate DSS 12-point difficulty index and four difficulty levels correlate well with LLR difficulty as determined by key surrogate perioperative measures.
SESSION
E-poster
E-Session 03/21 ALL DAY