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A novel model for prediction of pure laparoscopic liver resection surgical difficulty

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Abstract

Background

Extending the clinical indications for laparoscopic liver resection (LLR) should be carefully considered based on a surgeon’s experience and skill. However, objective indexes to help surgeons assess the estimated difficulty of LLR are scarce. The aim of our study was to develop the first objective numerical rating scale to predict the surgical difficulty of various LLR procedures.

Methods

We performed a retrospective review of the operative outcomes of 187 patients who underwent a pure LLR. First, the value of preoperative factors for predicting surgical time was evaluated by multivariate linear regression analyses, and a scoring system was constructed. Next, the integrity of our predictive linear model was evaluated against the documented operative outcomes for patients forming our study group.

Results

Four predictive factors were identified and scored based on the weighted contribution of each factor predicting surgical time: extent of resection (scored 0, 2, or 3); location of tumor (scored 0, 1, or 2); obesity (scored 0 or 1); and platelet count (scored 0 or 1). The scores were summed to classify surgical difficulty into three levels: low (total score ≤1); medium (total score 2–3); and high (total score ≥4). Operative outcomes, including surgical time, volume of blood loss, length of hospital stay, and rate of morbidity, were significantly different between the three surgical difficulty levels.

Conclusion

Our novel model will be useful for surgeons to predict the difficulty of an LLR procedure relative to their own experience and skill.

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References

  1. Cherqui D (2015) Laparoscopic liver resection: a new paradigm in the management of hepatocellular carcinoma? J Hepatol 63:540–542

    Article  PubMed  Google Scholar 

  2. Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schon MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629

    PubMed  Google Scholar 

  3. Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830

    Article  PubMed  Google Scholar 

  4. Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G (2016) Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg 263:761–777

    Article  PubMed  Google Scholar 

  5. Beppu T, Wakabayashi G, Hasegawa K, Gotohda N, Mizuguchi T, Takahashi Y, Hirokawa F, Taniai N, Watanabe M, Katou M, Nagano H, Honda G, Baba H, Kokudo N, Konishi M, Hirata K, Yamamoto M, Uchiyama K, Uchida E, Kusachi S, Kubota K, Mori M, Takahashi K, Kikuchi K, Miyata H, Takahara T, Nakamura M, Kaneko H, Yamaue H, Miyazaki M, Takada T (2015) Long-term and perioperative outcomes of laparoscopic versus open liver resection for colorectal liver metastases with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Sci 22:711–720

    Article  Google Scholar 

  6. Takahara T, Wakabayashi G, Beppu T, Aihara A, Hasegawa K, Gotohda N, Hatano E, Tanahashi Y, Mizuguchi T, Kamiyama T, Ikeda T, Tanaka S, Taniai N, Baba H, Tanabe M, Kokudo N, Konishi M, Uemoto S, Sugioka A, Hirata K, Taketomi A, Maehara Y, Kubo S, Uchida E, Miyata H, Nakamura M, Kaneko H, Yamaue H, Miyazaki M, Takada T (2015) Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci 22:721–727

    Article  PubMed  Google Scholar 

  7. Cauchy F, Fuks D, Nomi T, Dokmak S, Scatton O, Schwarz L, Barbier L, Belghiti J, Soubrane O, Gayet B (2016) Benefits of laparoscopy in elderly patients requiring major liver resection. J Am Coll Surg 222(174–184):e110

    Google Scholar 

  8. Han HS, Shehta A, Ahn S, Yoon YS, Cho JY, Choi Y (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma: case-matched study with propensity score matching. J Hepatol 63:643–650

    Article  PubMed  Google Scholar 

  9. Hasegawa Y, Nitta H, Sasaki A, Takahara T, Itabashi H, Katagiri H, Otsuka K, Nishizuka S, Wakabayashi G (2015) Long-term outcomes of laparoscopic versus open liver resection for liver metastases from colorectal cancer: a comparative analysis of 168 consecutive cases at a single center. Surgery 157:1065–1072

    Article  PubMed  Google Scholar 

  10. Hibi T, Cherqui D, Geller DA, Itano O, Kitagawa Y, Wakabayashi G (2016) Expanding indications and regional diversity in laparoscopic liver resection unveiled by the International Survey on Technical Aspects of Laparoscopic Liver Resection (INSTALL) study. Surg Endosc 30:2975–2983

    Article  PubMed  Google Scholar 

  11. Lee MK 4th, Gao F, Strasberg SM (2016) Completion of a liver surgery complexity score and classification based on an international survey of experts. J Am Coll Surg 223:332–342

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kawaguchi Y, Nomi T, Fuks D, Mal F, Kokudo N, Gayet B (2016) Hemorrhage control for laparoscopic hepatectomy: technical details and predictive factors for intraoperative blood loss. Surg Endosc 30:2543–2551

    Article  PubMed  Google Scholar 

  13. Vigano L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D (2009) The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg 250:772–782

    Article  PubMed  Google Scholar 

  14. Hasegawa Y, Nitta H, Takahara T, Katagiri H, Baba S, Takeda D, Makabe K, Wakabayashi G, Sasaki A (2017) Safely extending the indications of laparoscopic liver resection: when should we start laparoscopic major hepatectomy? Surg Endosc 31:309–316

    Article  PubMed  Google Scholar 

  15. Lin CW, Tsai TJ, Cheng TY, Wei HK, Hung CF, Chen YY, Chen CM (2016) The learning curve of laparoscopic liver resection after the Louisville statement 2008: will it be more effective and smooth? Surg Endosc 30:2895–2903

    Article  PubMed  Google Scholar 

  16. Troisi RI, Montalti R, Van Limmen JG, Cavaniglia D, Reyntjens K, Rogiers X, De Hemptinne B (2014) Risk factors and management of conversions to an open approach in laparoscopic liver resection: analysis of 265 consecutive cases. HPB (Oxford) 16:75–82

    Article  Google Scholar 

  17. Cho JY, Han HS, Yoon YS, Shin SH (2008) Experiences of laparoscopic liver resection including lesions in the posterosuperior segments of the liver. Surg Endosc 22:2344–2349

    Article  PubMed  Google Scholar 

  18. Cauchy F, Fuks D, Nomi T, Schwarz L, Barbier L, Dokmak S, Scatton O, Belghiti J, Soubrane O, Gayet B (2015) Risk factors and consequences of conversion in laparoscopic major liver resection. Br J Surg 102:785–795

    Article  CAS  PubMed  Google Scholar 

  19. Yu X, Yu H, Fang X (2016) The impact of body mass index on short-term surgical outcomes after laparoscopic hepatectomy, a retrospective study. BMC Anesthesiol 16:29

    Article  PubMed  PubMed Central  Google Scholar 

  20. Cauchy F, Fuks D, Nomi T, Schwarz L, Belgaumkar A, Scatton O, Soubrane O, Gayet B (2016) Incidence, risk factors and consequences of bile leakage following laparoscopic major hepatectomy. Surg Endosc 30:3709–3719

    Article  PubMed  Google Scholar 

  21. Cai X, Li Z, Zhang Y, Yu H, Liang X, Jin R, Luo F (2014) Laparoscopic liver resection and the learning curve: a 14-year, single-center experience. Surg Endosc 28:1334–1341

    Article  PubMed  Google Scholar 

  22. Nomi T, Fuks D, Kawaguchi Y, Mal F, Nakajima Y, Gayet B (2015) Learning curve for laparoscopic major hepatectomy. Br J Surg 102:796–804

    Article  CAS  PubMed  Google Scholar 

  23. Goh BK, Chan CY, Wong JS, Lee SY, Lee VT, Cheow PC, Chow PK, Ooi LL, Chung AY (2015) Factors associated with and outcomes of open conversion after laparoscopic minor hepatectomy: initial experience at a single institution. Surg Endosc 29:2636–2642

    Article  PubMed  Google Scholar 

  24. Hasegawa Y, Nitta H, Sasaki A, Takahara T, Ito N, Fujita T, Kanno S, Nishizuka S, Wakabayashi G (2013) Laparoscopic left lateral sectionectomy as a training procedure for surgeons learning laparoscopic hepatectomy. J Hepatobiliary Pancreat Sci 20:525–530

    Article  PubMed  Google Scholar 

  25. Terminology Committee of the International Hepato-Pancreato-Biliary Association (2000) IHPBA Brisbane 2000. Terminology of liver anatomy and resections. HPB 2:333–339

    Article  Google Scholar 

  26. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  27. Tranchart H, Di Giuro G, Lainas P, Roudie J, Agostini H, Franco D, Dagher I (2010) Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 24:1170–1176

    Article  PubMed  Google Scholar 

  28. Troisi RI, Van Huysse J, Berrevoet F, Vandenbossche B, Sainz-Barriga M, Vinci A, Ricciardi S, Bocchetti T, Rogiers X, de Hemptinne B (2011) Evolution of laparoscopic left lateral sectionectomy without the Pringle maneuver: through resection of benign and malignant tumors to living liver donation. Surg Endosc 25:79–87

    Article  PubMed  Google Scholar 

  29. Rao A, Rao G, Ahmed I (2011) Laparoscopic left lateral liver resection should be a standard operation. Surg Endosc 25:1603–1610

    Article  PubMed  Google Scholar 

  30. Azagra JS, Goergen M, Brondello S, Calmes MO, Philippe P, Schmitz B (2009) Laparoscopic liver sectionectomy 2 and 3 (LLS 2 and 3): towards the “gold standard”. J Hepatobiliary Pancreat Surg 16:422–426

    Article  CAS  PubMed  Google Scholar 

  31. Makuuchi M (2013) Surgical treatment for HCC—special reference to anatomical resection. Int J Surg 11(Suppl 1):S47–S49

    Article  PubMed  Google Scholar 

  32. Takamoto T, Hashimoto T, Ogata S, Inoue K, Maruyama Y, Miyazaki A, Makuuchi M (2013) Planning of anatomical liver segmentectomy and subsegmentectomy with 3-dimensional simulation software. Am J Surg 206:530–538

    Article  PubMed  Google Scholar 

  33. Wakabayashi G, Cherqui D, Geller DA, Han HS, Kaneko H, Buell JF (2014) Laparoscopic hepatectomy is theoretically better than open hepatectomy: preparing for the 2nd international consensus conference on laparoscopic liver resection. J Hepatobiliary Pancreat Sci 21:723–731

    Article  PubMed  Google Scholar 

  34. Makino T, Shukla PJ, Rubino F, Milsom JW (2012) The impact of obesity on perioperative outcomes after laparoscopic colorectal resection. Ann Surg 255:228–236

    Article  PubMed  Google Scholar 

  35. Zhou Y, Wu L, Li X, Wu X, Li B (2012) Outcome of laparoscopic colorectal surgery in obese and nonobese patients: a meta-analysis. Surg Endosc 26:783–789

    Article  PubMed  Google Scholar 

  36. Mathur AK, Ghaferi AA, Osborne NH, Pawlik TM, Campbell DA, Englesbe MJ, Welling TH (2010) Body mass index and adverse perioperative outcomes following hepatic resection. J Gastrointest Surg 14:1285–1291

    Article  PubMed  PubMed Central  Google Scholar 

  37. Nomi T, Fuks D, Ferraz JM, Kawaguchi Y, Nakajima Y, Gayet B (2015) Influence of body mass index on postoperative outcomes after laparoscopic liver resection. Surg Endosc 29:3647–3654

    Article  PubMed  Google Scholar 

  38. Edholm D, Kullberg J, Karlsson FA, Haenni A, Ahlstrom H, Sundbom M (2015) Changes in liver volume and body composition during 4 weeks of low calorie diet before laparoscopic gastric bypass. Surg Obes Relat Dis 11:602–606

    Article  PubMed  Google Scholar 

  39. Shehta A, Han HS, Yoon YS, Cho JY, Choi Y (2016) Laparoscopic liver resection for hepatocellular carcinoma in cirrhotic patients: 10-year single-center experience. Surg Endosc 30:638–648

    Article  PubMed  Google Scholar 

  40. Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, Hasegawa Y, Katagiri T, Takagi C, Itano O, Kaneko H, Wakabayashi G (2014) A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci 21:745–753

    Article  PubMed  Google Scholar 

  41. Kawaguchi Y, Fuks D, Kokudo N, Gayet B (2017) Difficulty of laparoscopic liver resection: proposal for a new classification. Ann Surg. doi:10.1097/SLA.0000000000002176

    Google Scholar 

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Acknowledgements

The authors would like to thank the staff of the Department of Anesthesiology, Iwate Medical University School of Medicine for their assistance.

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Authors and Affiliations

  1. Department of Surgery, School of Medicine, Iwate Medical University, 19-1, Uchimaru, Morioka City, Iwate, 020-8505, Japan

    Yasushi Hasegawa, Go Wakabayashi, Hiroyuki Nitta, Takeshi Takahara, Hirokatsu Katagiri, Akira Umemura, Kenji Makabe & Akira Sasaki

  2. Department of Surgery, Ageo Central General Hospital, 1-10-10, Kashiwaza, Ageo City, Saitama, 362-8588, Japan

    Go Wakabayashi

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  1. Yasushi Hasegawa
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Correspondence to Yasushi Hasegawa.

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Drs. Yasushi Hasegawa, Go Wakabayashi, Hiroyuki Nitta, Takeshi Takahara, Hirokatsu Katagiri, Akira Umemura, Kenji Makabe, and Akira Sasaki have no conflicts of interest or financial ties to disclose.

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Hasegawa, Y., Wakabayashi, G., Nitta, H. et al. A novel model for prediction of pure laparoscopic liver resection surgical difficulty. Surg Endosc 31, 5356–5363 (2017). https://doi.org/10.1007/s00464-017-5616-8

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  • DOI: https://doi.org/10.1007/s00464-017-5616-8

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