Validation of the IWATE criteria as a laparoscopic liver resection difficulty score in a single North American cohort

Influence of Child–Pugh B7 and B8/9 cirrhosis on laparoscopic liver resection for hepatocellular carcinoma: a retrospective cohort study

“…However, because there are very few cases of LLR for HCC in patients with advanced cirrhosis in previous studies, LLR is not currently established as technically or oncologically safe for the treatment of HCC in patients with advanced cirrhosis compared with early cirrhosis [ 26 ]. In the present study, using the IWATE difficulty scoring systems validated in a previous paper, which were shown to correlate with postoperative complications [ 32 ], we evaluated the complexity of LLR and found no significant differences in the difficulty scores for both the two groups of Child–Pugh A and B ( P = 0.348) and the three groups of Child–Pugh A, B7, and B8/9 ( P = 0.490). We therefore consider that the impact of the complexity of LLR on the comparison of complication rates between these groups was limited.…”

“…We extracted the following clinical and pathological data from the database: age, sex, body mass index (BMI), American Society of Anesthesiologists performance score, hypertension, diabetes, hepatitis B/C infection, clinical cancer stage according to the tumor-node-metastasis (TNM) Classification of Malignant Tumors (Union for International Cancer Control, 8th edition) [ 28 ], Model for End-Stage Liver Disease (MELD) score [ 29 ], clinical staging according to albumin–bilirubin (ALBI) score [ 30 ] and the Japan Integrated Staging (JIS) score [ 31 ], previous treatment, ascites within 30 days prior to surgery, laboratory values, Child–Pugh grade, indocyanine green (ICG) retention rate, type of resection (i.e., anatomical or non-anatomical), LLR difficulty score in the IWATE criteria [ 32 ], intraoperative data (blood loss, transfusions, and operation time), short-term outcomes (90-day morbidity, major morbidity, complications, and postoperative hospital stay), tumor size and grade, pathologic data [microvascular invasion, capsular invasion, and margin status (i.e., R0 or R1)], and oncological outcomes [recurrence, treatment of recurrence, recurrence-free survival (RFS), and overall survival (OS)]. Informed consent was obtained in accordance with the principles of the Declaration of Helsinki.…”

Systematic review and meta‐analysis of difficulty scoring systems for laparoscopic and robotic liver resections

“…Literature search yielded 1895 unique articles, of which 35 3,6‐14,19‐43 were shortlisted after title and abstract screen for full text review (Figure 2). An additional two articles were identified through screening of references, 17,18 and three were identified by co‐authors 44‐46 .…”

“…Twelve studies in the literature had supporting data for the Iwate DSS for MILR. [11][12][13]18,32,[33][34][35][36][37][38][39] Notably, the Iwate DSS was not formulated based on any data but as a modification of the Ban DSS based on expert opinion. Ten studies had supporting data for Iwate DSS for LLR against various outcome measures, 11,12,18,[32][33][34][35][36]38,39 of which eight studies 11,12,18,21,[32][33][34][35][36] published data that was amenable to pooling (Table 3).…”

“…[11][12][13]18,32,[33][34][35][36][37][38][39] Notably, the Iwate DSS was not formulated based on any data but as a modification of the Ban DSS based on expert opinion. Ten studies had supporting data for Iwate DSS for LLR against various outcome measures, 11,12,18,[32][33][34][35][36]38,39 of which eight studies 11,12,18,21,[32][33][34][35][36] published data that was amenable to pooling (Table 3). On pooling of data, Iwate DSS was found to be significant discriminator for operative time, blood loss, need for transfusion, need for Pringle's maneuver, conversion rate, intraoperative and postoperative complication rates, and mortality for LLR (P < .05), but not for Pringle's time (P = .77) and length of stay (P = .37).…”