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

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Abstract

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.

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Acknowledgements

None.

Funding

The study was supported by the key program of the Jinhua Municipal Science & Technology Bureau (2018-3-001a), the key program of the Zhejiang medical and health science & technology Project (2018244976) and the Research Project of Zhejiang Provincial Public Welfare Fund Project in the Field of Social Development (No. LGF20H160028).

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Authors and Affiliations

  1. Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China

    Haiping Lin, Yang Bai, Mengqiu Yin & Zewei Chen

  2. Department of Hepatobiliary Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, China

    Haiping Lin, Mengqiu Yin, Zewei Chen & Shian Yu

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  1. Haiping Lin
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  2. Yang Bai
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Correspondence to Shian Yu.

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Haiping Lin, Yang Bai, Mengqiu Yin, Zewei Chen, and Shian Yu have no conflicts of interest or financial ties to disclose.

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Appendix

Appendix

See Tables 8, 9, 10, 11, 12 and 13.

Table 8 Parameters and assigned indexes in the IWATE-DSS
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Table 9 Parameters and assigned indexes in the Halls-DSS
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Table 10 Types and levels in the Kawaguchi-DSS
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Table 11 Parameters and assigned scores in the Hasegawa-DSS
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Table 12 Baseline characteristics and tumor-related factors of the learner-performed and expert-performed cases
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Table 13 Intraoperative and postoperative outcomes between learner-performed cases and expert-performed cases after PSM
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Lin, H., Bai, Y., Yin, M. et al. External validation of different difficulty scoring systems of laparoscopic liver resection for hepatocellular carcinoma. Surg Endosc 36, 3732–3749 (2022). https://doi.org/10.1007/s00464-021-08687-5

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  • DOI: https://doi.org/10.1007/s00464-021-08687-5

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