The external validation of a difficulty scoring system for predicting the risk of intraoperative complications during laparoscopic liver resection

Abstract Background This study aimed to externally validate and upgrade the recent difficulty scoring system (DSS) proposed by Halls et al. to predict intraoperative complications (IOC) during laparoscopic liver resection (LLR). Methods The DSS was validated in a cohort of 128 consecutive patients undergoing pure LLRs between 2008 and 2019 at a single tertiary referral center. The validated DSS includes four difficulty levels based on five risk factors (neoadjuvant chemotherapy, previous open liver resection, lesion type, lesion size and classification of resection). As established by the validated DSS, IOC was defined as excessive blood loss (> 775 mL), conversion to an open approach and unintentional damage to surrounding structures. Additionally, intra- and postoperative outcomes were compared according to the difficulty levels with usual statistic methods. The same five risk factors were used for validation done by linear and advanced nonlinear (artificial neural network) models. The study was supported by mathematical computations to obtain a mean risk curve predicting the probability of IOC for every difficulty score. Results The difficulty level of LLR was rated as low, moderate, high and extremely high in 36 (28.1%), 63 (49.2%), 27 (21.1%) and 2 (1.6%) patients, respectively. IOC was present in 23 (17.9%) patients. Blood loss of >775 mL occurred in 8 (6.2%) patients. Conversion to open approach was required in 18 (14.0%) patients. No patients suffered from unintentional damage to surrounding structures. Rates of IOC (0, 9.5, 55.5 and 100%) increased gradually with statistically significant value among difficulty levels (P < 0.001). The relations between the difficulty level, need for transfusion, operative time, hepatic pedicle clamping, and major postoperative morbidity were statistically significant (P < 0.05). Linear and nonlinear validation models showed a strong correlation (correlation coefficients 0.914 and 0.948, respectively) with the validated DSS. The Weibull cumulative distribution function was used for predicting the mean risk probability curve of IOC. Conclusion This external validation proved this DSS based on patient’s, tumor and surgical factors enables us to estimate the risk of intra- and postoperative complications. A surgeon should be aware of an increased risk of complications before starting with more complex procedures.

Download Full-text

LARAPOSCOPIC LIVER RESECTION IN SURGERY FOR COLORECTAL CANCER METASTASES

Koloproktologia ◽

10.33878/2073-7556-2019-18-1-58-65 ◽

2019 ◽

Vol 18 (1) ◽

pp. 58-65

Author(s):

N. R. Torchua ◽

A. A. Ponomarenko ◽

E. G. Rybakov ◽

S. I. Achkasov

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Blood Loss ◽

Hospital Stay ◽

Laparoscopic Liver Resection ◽

Colorectal Liver Metastases ◽

Postoperative Hospital Stay ◽

Open Approach ◽

Intraoperative Blood Loss ◽

Liver Resections

BACKGROUND: nowadays laparoscopic liver resection (LapLR) in contrast to traditional open approach is more preferable because of reduction of intraoperative blood loss and postop morbidity, decrease of postop hospital stay. Unfortunately, the place of LapLR in surgery for colorectal liver metastases is still controversial because of small number of comparative studies. PATIENTS AND METHODS: between November 2017 and December 2018 fifty two patients with resectable colorectal liver metastases were included in our pilot study - 35 in the prospective group for laparoscopic liver resection and 17 patients in retrospective group of open-approach liver resections (selected group of historical control) (OLR). RESULTS: one patient was excluded from LapLR group because of absence of intraoperative evidence for metastatic disease (in spite of preop MRI). Two patients had lap-to-open conversion (in one case because of technical difficulties due to the location of the permanent ileostomy in the right mesogastric region; in the other case due to intraoperative bleeding). These patients were included into open group. Atypical liver resections were the most often procedures in both groups - 79% (23/32) and 76% (13/19), p=0.3 (LapLR and OLR, respectively). Duration of the procedure was shorter in the OLR group: 218+71 min vs. 237+101min in LapLR, p=0.6. The mediana for blood loss in LapLR was 100 ml (quartile 100; 200) vs. 320 ml (quartile 200;600) in OLR, p=0.0001. The rate of R0 resections was comparable in both groups (p=1.0). The patients of OLR group more often had >1 complication (16 vs. 13, p=0.01) and had higher frequency of bile fistulas, abscesses in the liver resection area and clostridial colitis. Postoperative hospital stay was shorter in the LapLR group: 11+3 vs. 14+5 days, p=0.008. CONCLUSION: laparoscopic liver resections for metastases of colorectal cancer were associated with less intraoperative blood loss, morbidity, and shorter postoperative hospital stay, with comparable rate of R0 resections.

Download Full-text

The learning curve of laparoscopic liver resection utilising a difficulty score

Radiology and Oncology ◽

10.2478/raon-2021-0035 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Arpad Ivanecz ◽

Irena Plahuta ◽

Matej Mencinger ◽

Iztok Perus ◽

Tomislav Magdalenic ◽

...

Keyword(s):

Liver Resection ◽

Learning Curve ◽

Learning Process ◽

Laparoscopic Liver Resection ◽

Extreme Values ◽

Intraoperative Complications ◽

Open Approach ◽

Predicted Probability ◽

Theoretical Predictions ◽

Difficulty Score

Abstract Background This study aimed to quantitatively evaluate the learning curve of laparoscopic liver resection (LLR) of a single surgeon. Patients and methods A retrospective review of a prospectively maintained database of liver resections was conducted. 171 patients undergoing pure LLRs between April 2008 and April 2021 were analysed. The Halls difficulty score (HDS) for theoretical predictions of intraoperative complications (IOC) during LLR was applied. IOC was defined as blood loss over 775 mL, unintentional damage to the surrounding structures, and conversion to an open approach. Theoretical association between HDS and the predicted probability of IOC was utilised to objectify the shape of the learning curve. Results The obtained learning curve has resulted from thirteen years of surgical effort of a single surgeon. It consists of an absolute and a relative part in the mathematical description of the additive function described by the logarithmic function (absolute complexity) and fifth-degree regression curve (relative complexity). The obtained learning curve determines the functional dependency of the learning outcome versus time and indicates several local extreme values (peaks and valleys) in the learning process until proficiency is achieved. Conclusions This learning curve indicates an ongoing learning process for LLR. The proposed mathematical model can be applied for any surgical procedure with an existing difficulty score and a known theoretically predicted association between the difficulty score and given outcome (for example, IOC).

Download Full-text

Risk factors and management of conversions to an open approach in laparoscopic liver resection: analysis of 265 consecutive cases

HPB ◽

10.1111/hpb.12077 ◽

2014 ◽

Vol 16 (1) ◽

pp. 75-82 ◽

Cited By ~ 66

Author(s):

Roberto I. Troisi ◽

Roberto Montalti ◽

Jurgen G.M. Van Limmen ◽

Daniele Cavaniglia ◽

Koen Reyntjens ◽

...

Keyword(s):

Risk Factors ◽

Liver Resection ◽

Laparoscopic Liver Resection ◽

Open Approach

Download Full-text

The external validation of a difficulty score to predict intraoperative complications during laparoscopic liver resection

HPB ◽

10.1016/j.hpb.2020.04.035 ◽

2020 ◽

Vol 22 ◽

pp. S208-S209

Author(s):

A. Ivanecz ◽

I. Plahuta ◽

T. Magdalenic ◽

L. Oblak ◽

B. Krebs ◽

...

Keyword(s):

Liver Resection ◽

Laparoscopic Liver Resection ◽

Intraoperative Complications ◽

External Validation ◽

Difficulty Score

Download Full-text

External validation of different difficulty scoring systems of laparoscopic liver resection for hepatocellular carcinoma

Surgical Endoscopy ◽

10.1007/s00464-021-08687-5 ◽

2021 ◽

Author(s):

Haiping Lin ◽

Yang Bai ◽

Mengqiu Yin ◽

Zewei Chen ◽

Shian Yu

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Laparoscopic Liver Resection ◽

External Validation ◽

Scoring Systems

Download Full-text

Impact of Intraoperative Gravity-Dependent Atelectasis Following Laparoscopic Liver Resection Performed in the Lateral Position

10.21203/rs.3.rs-683021/v1 ◽

2021 ◽

Author(s):

Ryoichi Miyamoto ◽

Toshiro Ogura ◽

Amane Takahashi ◽

Akifumi Kimura ◽

Shinichi Matsudaira ◽

...

Keyword(s):

Risk Factors ◽

Liver Resection ◽

Postoperative Complications ◽

Laparoscopic Liver Resection ◽

Operating Time ◽

Multivariate Logistic Regression Analysis ◽

Lateral Position ◽

Cancer Center ◽

Related Factors ◽

Left Half

Abstract Purpose Laparoscopic liver resection (LLR) is currently an accepted approach for liver surgery in select patients. The correlation between the intraoperative position and the presence of gravity-dependent atelectasis (GDA) has been well discussed. However, LLR is performed in the left half lateral position, and the relationship between this position and the presence of GDA remains unclear. We evaluated the extent to which the intraoperative left half lateral position affects the presence of GDA. Furthermore, univariate and multivariate analyses were performed to identify potential risk factors for LLR postoperative complications with a special emphasis on the presence of GDA by comparing various patient-, liver- and surgery-related factors in a retrospective cohort. Methods We retrospectively evaluated 129 patients who underwent LLR in the left half lateral position at the Saitama Cancer Center in Saitama, Japan between March 2011 and July 2020. The frequency and duration of GDA were investigated. We divided the cohort into with GDA and without GDA groups based on a cutoff value (≥ 5 days, n = 61 and < 5 days, n = 68, respectively). Using multivariate analysis, the duration of GDA and several risk factors for LLR postoperative complications were independently assessed. Results Postoperative GDA was observed in 61 patients (47%) and lasted for 1 to 8 days in these patients. The mean duration of GDA was 4.3 days. Multivariate logistic regression analysis revealed a GDA duration of 5 days or more (odds ratio [OR], 2.03; p = 0.001) and an operating time > 388 minutes (OR, 5.31; p < 0.001) to be independent risk factors for LLR postoperative complications. Conclusions The incidence and duration of postoperative GDA are considered useful predictors of postoperative complications, and these predictors should be assessed to improve the short-term outcomes of patients undergoing LLR.

Download Full-text

Development of a Sex-Specific Risk Scoring System for Predicting Cognitive Normal to Mild Cognitive Impairment (SRSS-CNMCI)

10.21203/rs.3.rs-517520/v1 ◽

2021 ◽

Author(s):

Wen Luo ◽

Hao Wen ◽

Shuqi Ge ◽

Chunzhi Tang ◽

Xiufeng Liu ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

High Risk ◽

Scoring System ◽

External Validation ◽

Scoring Systems ◽

Cutoff Point ◽

Risk Scoring ◽

Risk Scoring System

Abstract Objective: We aim to develop a sex-specific risk scoring system for predicting cognitive normal (CN) to mild cognitive impairment (MCI), abbreviated SRSS-CNMCI, to provide a reliable tool for the prevention of MCI.Methods: Participants aged 61-90 years old with a baseline diagnosis of CN and an endpoint diagnosis of MCI were screened from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database with at least one follow-up. Multivariable Cox proportional hazards models were used to identify risk factors associated with conversion from CN to MCI and to build risk scoring systems for male and female groups. Receiver operating characteristic (ROC) curve analysis was applied to determine the risk probability cutoff point corresponding to the optimal prediction effect. We ran an external validation of the discrimination and calibration based on the Harvard Aging Brain Study (HABS) database.Results: A total of 471 participants, including 240 women (51%) and 231 men (49%), aged 61 to 90 years, were included in the study cohort for subsequent primary analysis. The final multivariable models and the risk scoring systems for females and males included age, APOE ε4, Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR). The scoring systems for females and males revealed C statistics of 0.902 (95% CI 0.840-0.963) and 0.911 (95% CI 0.863-0.959), respectively, as measures of discrimination. The cutoff point of high and low risk was 33% in females, and more than 33% was considered high risk, while more than 9% was considered high risk for males. The external validation effect of the scoring systems was good: C statistic 0.950 for the females and C statistic 0.965 for the males. Conclusions: Our parsimonious model accurately predicts conversion from CN to MCI with four risk factors and can be used as a predictive tool for the prevention of MCI.

Download Full-text

Evolution and trends in the adoption of laparoscopic liver resection in Singapore: Analysis of 300 cases

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2021213 ◽

2021 ◽

Vol 50 (10) ◽

pp. 742-750

Author(s):

Brian K Goh ◽

Zhongkai Wang ◽

Ye-Xin Koh ◽

Kai-Inn Lim

Keyword(s):

Liver Resection ◽

Blood Loss ◽

Abdominal Surgery ◽

Laparoscopic Liver Resection ◽

Conversion Rate ◽

Perioperative Outcomes ◽

Transfusion Rate ◽

Open Conversion ◽

Previous Abdominal Surgery ◽

Surgeon Experience

ABSTRACT Introduction: The introduction of laparoscopic surgery has changed abdominal surgery. We evaluated the evolution and changing trends associated with adoption of laparoscopic liver resection (LLR) and the experience of a surgeon without prior LLR experience. Methods: A retrospective review of 310 patients who underwent LLR performed by a single surgeon from 2011 to 2020 was conducted. Exclusion criteria were patients who underwent laparoscopic liver surgeries such as excision biopsy, local ablation, drainage of abscesses and deroofing of liver cysts. There were 300 cases and the cohort was divided into 5 groups of 60 patients. Results: There were 288 patients who underwent a totally minimally invasive approach, including 28 robotic-assisted procedures. Open conversion occurred for 13 (4.3%) patients; the conversion rate decreased significantly from 10% in the initial period to 3.3% subsequently. There were 83 (27.7%) major resections and 131 (43.7%) resections were performed for tumours in the difficult posterosuperior location. There were 152 (50.7%) patients with previous abdominal surgery, including 52 (17.3%) repeat liver resections for recurrent tumours, and 60 patients had other concomitant operations. According to the Iwate criteria, 135 (44.7%) were graded as high/expert difficulty. Major morbidity (>grade 3a) occurred in 12 (4.0%) patients and there was no 30-day mortality. Comparison across the 5 patient groups demonstrated a significant trend towards older patients, higher American Society of Anesthesiologists (ASA) score, increasing frequency of LLR with previous abdominal surgery, increasing frequency of portal hypertension and huge tumours, decreasing blood loss and decreasing transfusion rate across the study period. Surgeon experience (≤60 cases) and Institut Mutualiste Montsouris (IMM) high grade resections were independent predictors of open conversion. Open conversion was associated with worse perioperative outcomes such as increased blood loss, transfusion rate, morbidity and length of stay. Conclusion: LLR can be safely adopted for resections of all difficulty grades, including major resections and for tumours located in the difficult posterosuperior segments, with a low open conversion rate. Keywords: Laparoscopic hepatectomy, laparoscopic liver resection, robotic hepatectomy, robotic liver resection, Singapore

Download Full-text