External validation of different difficulty scoring systems of laparoscopic liver resection for hepatocellular carcinoma,Surgical Endoscopy

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External validation of different difficulty scoring systems of laparoscopic liver resection for hepatocellular carcinoma
Surgical Endoscopy ( IF 2.4 ) Pub Date : 2021-08-18 , DOI: 10.1007/s00464-021-08687-5
Haiping Lin _{1,

2} , Yang Bai ₁ , Mengqiu Yin _{1,

2} , Zewei Chen _{1,

2} , Shian Yu ₂

Affiliation

Background

Several difficulty scoring systems (DSSs) have been proposed for evaluating difficulty of laparoscopic liver resection (LLR) and no study has validated their performance in a hepatocellular carcinoma (HCC)-only cohort at the same time.

Methods

All cases with HCC that underwent LLR from January 2015 to December 2020 in our center were retrospectively collected. Performance of the IWATE-DSS, Halls-DSS, Hasegawa-DSS, and Kawaguchi-DSS in predicting perioperative outcomes was evaluated. Subgroup analyses were conducted to compare perioperative outcomes between surgeons on the learning curve and surgeons that have gone through the learning curve.

Results

For all four DSSs, there were significant distributions of applying bleeding control, surgical time, estimated blood loss, postoperative major complications, and postoperative hospital stay among different groups of each DSS (P all < 0.05). Conversion to laparotomy or not was significantly distributed in different groups of the IWATE-DSS (P = 0.006) and Halls-DSS (P = 0.022), while it was not in the Hasegawa-DSS (P = 0.056) and Kawaguchi-DSS (P = 0.183). Trend tests showed that the conversion rates increased with higher DSS points in the IWATE-DSS (P < 0.001) and the Kawaguchi-DSS (P = 0.021), while not in the Halls-DSS (P = 0.064) and the Hasegawa-DSS (P = 0.068). In the medium and advanced/expert difficulty-level subgroups defined by the IWATE-DSS, there were larger estimated blood loss (P in medium-difficulty group = 0.009; P in the advanced/expert difficulty group = 0.004) and longer postoperative hospital stay (P in the medium-difficulty group = 0.012; P in the advanced/expert group = 0.035) in the learner-performed cases.

Conclusions

All DSSs performed well in predicting applying bleeding control, surgical time, estimated blood loss, postoperative major complications, and postoperative hospital stay, while only the IWATE-DSS was able to predict whether conversion to laparotomy or not for HCC patients underwent LLR. The IWATE-DSS was also able to help surgeons on the LLR learning curve choose cases and guide clinical practices.

中文翻译：

腹腔镜肝癌肝切除术不同难度评分系统的外部验证

背景

已经提出了几种难度评分系统 (DSS) 来评估腹腔镜肝切除术 (LLR) 的难度，并且没有研究同时验证它们在仅肝细胞癌 (HCC) 队列中的性能。

方法

回顾性收集2015年1月至2020年12月在我中心接受LLR的所有HCC病例。评估了 IWATE-DSS、Halls-DSS、Hasegawa-DSS 和 Kawaguchi-DSS 在预测围手术期结果方面的表现。进行亚组分析以比较学习曲线上的外科医生和已经通过学习曲线的外科医生之间的围手术期结果。

结果

4 种 DSS 的止血应用、手术时间、估计失血量、术后主要并发症、术后住院时间在各 DSS 不同组间分布均有统计学意义（P均 < 0.05）。IWATE-DSS ( P = 0.006) 和 Halls-DSS ( P = 0.022)不同组间是否中转开腹显着分布，而长谷川-DSS ( P = 0.056) 和 Kawaguchi-DSS ( P = 0.183）。趋势测试表明，在 IWATE-DSS ( P < 0.001) 和 Kawaguchi-DSS ( P = 0.021) 中，转化率随着 DSS 点数的增加而增加，而在 Halls-DSS 中则不然 ( P = 0.064) 和长谷川-DSS ( P = 0.068)。在 IWATE-DSS 定义的中等和高级/专家难度级别亚组中，估计失血量更大（中等难度组 P = 0.009；高级/专家难度组P = 0.004）和术后住院时间更长（中等难度组中的 P = 0.012；高级/专家组中的 P = 0.035）在学习者执行的案例中。