Impact of anthropometric data on technical difficulty of laparoscopic liver of resections of segments 7 and 8: the CHALLENGE index

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

“…51 Our systematic review found 11 unique DSS. 3,[6][7][8][9][20][21][22][23] The Ban and Iwate DSS were based on traditional variables associated with difficult resections including resection extent, tumor location and size, liver function, proximity to major vessels, and subsequent use of HALS or hybrid method. The Hasegawa DSS is based on the effect of resection extent, tumor location, obesity, and platelet count on surgical time.…”

“…Studies comparing DSS did not establish a clear superior DSS and found all DSS to be predictive of the surrogates of difficulty to some extent. The other novel DSS by Kinoshita el al, 20 Russolillo et al, 21 Cipriani et al, 22 Mosteanu et al, 44 Onda et al, 23 and Tong et al 45 have thus far not been validated. Several studies were performed to validate the use of the various DSS in specific scenarios.…”

“…A total of 11 studies 3,[6][7][8][9][20][21][22][23]44,45 reported on the formulation of unique DSS for MILR (Table 1). Ban et al 6 proposed the first DSS in 2014 with the objective of guiding new surgeons adopting MILR in progressing from straightforward to technically complex LLR.…”

“…The independent risk factors -previous open approach, ≥2 previous liver resection, previous resections not less than sectionectomy, tumor near resected site of previous liver resection, intermediate/high difficulty on Ban DSS, were then combined to form a difficulty score with three classifications: low (0-1), intermediate (2)(3), or high (4-5). Russolillo et al 21 correlated difficulty of LLR in segment 7/8 resections based on transection time and blood loss with the craniocaudal liver diameter/laterolateral abdominal diameter, which they termed CHALLENGE index. Cipriani et al 22 assessed difficulty in performing right-sided LLR in terms of conversion rate and assigned points to each independent risk factor, namely previous LLR, preoperative chemotherapy, malignant diagnosis, closeness to hepatocaval confluence/ IVC, and tumor volume.…”

“…[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).…”