Utility of the Iwate difficulty scoring system for laparoscopic right posterior sectionectomy: do surgical outcomes differ for tumors in segments VI and VII?

 

Sung Hoon Choi, Kuo-Hsin Chen, Nicholas L Syn, Federica Cipriani, Tan-To Cheung, Adrian K H Chiow, Gi-Hong Choi, Tiing-Foong Siow, Iswanto Sucandy, Marco V Marino, Mikel Gastaca, Charing C Chong, Jae Hoon Lee, Arpad Ivanecz, Vincenzo Mazzaferro, Santiago Lopez-Ben, Constantino Fondevila, Fernando Rotellar, Ricardo Robles Campos, Mikhail Efanov, T Peter Kingham, Robert P Sutcliffe, Roberto I Troisi, Johann Pratschke, Xiaoying Wang, Mathieu D'Hondt, Chee Chien Yong, Giovanni Battista Levi Sandri, Chung Ngai Tang, Andrea Ruzzenente, Daniel Cherqui, Alessandro Ferrero, Go Wakabayashi, Olivier Scatton, Davit Aghayan, Bjørn Edwin, Fabricio Ferreira Coelho, Felice Giuliante, Rong Liu, Jasper Sijberden, Mohammad Abu Hilal, Atsushi Sugioka, Tran Cong Duy Long, David Fuks, Luca Aldrighetti, Ho-Seong Han, Brian K P Goh, International robotic and laparoscopic liver resection study group investigators

Surgical endoscopy, Online ahead of print, doi: 10.1007/s00464-022-09404-6

ABSTRACT

Introduction: The Iwate Score (IS) have not been well-validated for specific procedures, especially for right posterior sectionectomy (RPS). In this study, the utility of the IS was determined for laparoscopic (L)RPS and the effect of tumor location on surgical outcomes was investigated.

Methods: Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria. Baseline characteristics and perioperative outcomes of patients stratified based on the Iwate score were compared to determine whether a correlation with surgical difficulty existed. A 1:1 Mahalanobis distance matching was utilized to investigate the effect of tumor location on L-RPS outcomes.

Results: The patients were stratified into 3 levels of difficulty (31 intermediate, 143 advanced, and 422 expert) based on the IS. When using a stepwise increase of the IS excluding the tumor location score, only Pringle's maneuver was more frequently used in the higher surgical difficulty level (35.5%, 54.6%, and 65.2%, intermediate, advanced, and expert levels, respectively, Z = 3.34, p = 0.001). Other perioperative results were not associated with a statistical gradation toward higher difficulty level. 80 of 85 patients with a segment VI lesion and 511 patients with a segment VII lesion were matched 1:1. There were no significant differences in the perioperative outcomes of the two groups including open conversion, operating time, blood loss, intraoperative blood transfusion, postoperative stay, major morbidity, and mortality.

Conclusion: Among patients undergoing L-RPS, the IS did not significantly correlate with most outcome measures associated with intraoperative difficulty and postoperative outcomes. Similarly, tumor location had no effect on L-RPS outcomes.

Keywords: Difficulty score; Iwate; Laparoscopic hepatectomy; Laparoscopic liver; Right posterior sectionectomy.

- PMID: 35851819

- Fulltext: https://link.springer.com/article/10.1007/s00464-022-09404-6