Novel patient risk factors and validation of a difficulty scoring system in laparoscopic repeat hepatectomy

Abstract

The indications for laparoscopic liver resection have expanded; however, the safety and benefits of laparoscopic repeat hepatectomy (LRH) remain unclear. We retrospectively reviewed data from 137 patients who underwent partial hepatectomy or left lateral sectionectomy without thoracotomy. We compared patients’ clinical factors using a difficulty scoring system for LRH. We defined factors associated with blood loss volumes in the 75th percentile or above as risk factors for bleeding in open repeat hepatectomy, and determined whether these factors were useful for LRH risk assessment. Open repeat hepatectomy and LRH was performed in 96 and 41 patients, respectively. Four of 41 (9.8%) patients undergoing LRH were converted to laparotomy. Blood loss volume was significantly greater in the intermediate-risk group than in the low-risk group (P = 0.046). Multivariate analysis revealed that the presence of tumours located adjacent and caudal or dorsal to the primary tumour site was an independent risk factor for bleeding in LRH (odds ratio 3.21, 95% confidence interval 1.16–8.88, P = 0.024). Our study validated the usefulness of a difficulty scoring system, identified patient factors that predicted the difficulty of LRH, and presented a novel difficulty scoring system for LRH based on an existing difficulty scoring system.

Predicting Complications following Surgical Resection of Hepatocellular Carcinoma Using Newly Developed Neo-Glasgow Prognostic Score with ALBI Grade: Comparison of Open and Laparoscopic Surgery Cases

“…The results of the current study, namely, the lower rate of complications and less intraoperative bleeding volume associated with a laparoscopic hepatectomy as compared with an open hepatectomy (Table 2) confirm previously reported findings [21][22][23][24][25][26][27][28][29]. There are various possible reasons to explain the favorable short-term outcomes of a laparoscopic hepatectomy shown in this study.…”

A novel difficulty grading system for laparoscopic living donor nephrectomy

“…In addition, we proposed the benchmark operations based on the difficulty classification evaluated by the difficulty index. Several difficulty indexes, consisting of patient characteristics, anatomy, and tumor characteristics, have been used to classify the difficulty of several laparoscopic procedures [5][6][7][8]. Operative time has been reported to be a useful factor reflecting technical difficulty of laparoscopic procedures [15,16], therefore we established a grading system to predict the difficulty of LDN based on multivariable analyses investigating preoperative donor factors associated with prolonged operative time.…”

“…Using the difficulty index of 0-8, indexes 0 and 8 were defined as the easiest and the most difficult case. Difficulty index was further categorized into three levels as the difficulty classification: low difficulty (0-2), intermediate difficulty (3)(4)(5), and high difficulty (6)(7)(8).…”

“…Recently, several practical difficulty scoring systems have been developed in the field of laparoscopic procedures [5][6][7], and can be helpful for selecting patients and educating surgeons especially for those with initial laparoscopic experiences. In addition, these scoring systems can quantify the degree of difficulty creating more awareness for more complex cases and their pitfalls in experienced surgeons.…”

Laparoscopic liver resection: indications, limitations, and economic aspects

“…There are multiple definitions and risk scores available to assess the difficulty of laparoscopic liver resections, of which the Iwate criteria are most commonly used [40][41][42][43]. Several parameters are included in the Iwate criteria, such as tumor location, tumor size, proximity of the tumor to large vessels, liver function, and technical considerations.…”