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Evaluation of the Iwate Model for Predicting the Difficulty of Laparoscopic Liver Resection: Does Tumor Size Matter?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

This study aimed to externally validate the Iwate scoring model and its prognostic value for predicting the risks of intra- and postoperative complications of laparoscopic liver resection.

Methods

Consecutive patients who underwent pure laparoscopic liver resection between 2008 and 2019 at a single tertiary center were included. The Iwate scores were calculated according to the original proposition (four difficulty levels based on six indices). Intra- and postoperative complications were compared across difficulty levels. Fitting the obtained data to the cumulative density function of the Weibull distribution and a linear function provided the mean risk curves for intra- and postoperative complications, respectively.

Results

The difficulty levels of 142 laparoscopic liver resections were scored as low, intermediate, advanced, and expert level in 41 (28.9%), 53 (37.3%), 32 (22.5%), and 16 (11.3%) patients, respectively. Intraoperative complications were detected in 26 (18.3%) patients and its rates (2.4%, 7.5%, 34.3%, and 62.5%) increased gradually with statistically significant values among difficulty levels (P ˂ 0.001). Major postoperative complications occurred in 21 (14.8%) patients and its rates (4.8%, 5.6%, 28.1%, 43.7%; P ˂ 0.001) showed the same trend as for intraoperative complications. Then, the mean risk curves of both complications were obtained. Due to outliers, a new threshold for a tumor size index was proposed at 38 mm. The repeated analysis showed improved results.

Conclusions

The Iwate scoring model predicts the probability of complications across difficulty levels. Our proposed tumor size threshold (38 mm) improves the quality of the prediction. The model is upgraded by a probability of complications for every difficulty score.

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Funding

The funding for this study was provided by the University Medical Center Maribor.

Author information

Authors and Affiliations

  1. Department of Abdominal and General Surgery, University Medical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia

    Arpad Ivanecz, Irena Plahuta, Tomislav Magdalenić, Bojan Ilijevec & Stojan Potrč

  2. Faculty of Civil Engineering, Transportation Engineering and Architecture, University of Maribor, Smetanova ulica 17, 2000, Maribor, Slovenia

    Matej Mencinger & Iztok Peruš

  3. Center of Applied Mathematics and Theoretical Physics, University of Maribor, Mladinska 3, 2000, Maribor, Slovenia

    Matej Mencinger

  4. Institute of Mathematics, Physics and Mechanics, Jadranska 19, 1000, Ljubljana, Slovenia

    Matej Mencinger

  5. Faculty of Natural Science and Engineering, University of Ljubljana, Aškerčeva cesta 12, 1000, Ljubljana, Slovenia

    Iztok Peruš

Authors
  1. Arpad Ivanecz
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  2. Irena Plahuta
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  3. Tomislav Magdalenić
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  4. Bojan Ilijevec
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  5. Matej Mencinger
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  6. Iztok Peruš
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  7. Stojan Potrč
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Corresponding author

Correspondence to Arpad Ivanecz.

Ethics declarations

Ethical approval for this study was obtained from the local institutional review board (UKC-MB-KME-46/2019).

Conflict of Interest

The authors declare that they have no conflict of interest.

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The funding source has no role in the design, practice, or analysis of this study.

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A part of the study findings was presented as an oral presentation at the 2nd World Congress of the International Laparoscopic Liver Society (ILLS) held in Tokyo, Japan, in May 2019.

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Ivanecz, A., Plahuta, I., Magdalenić, T. et al. Evaluation of the Iwate Model for Predicting the Difficulty of Laparoscopic Liver Resection: Does Tumor Size Matter?. J Gastrointest Surg 25, 1451–1460 (2021). https://doi.org/10.1007/s11605-020-04657-9

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  • DOI: https://doi.org/10.1007/s11605-020-04657-9

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