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.
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Acknowledgements
The members of International robotic and laparoscopic liver resection study group investigators are Incheon Kang (Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea); Jae Young Jang (Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea); Chung-Yip Chan (Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital); Mizelle D’Silva (Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, Korea); Henri Schotte (Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium); Celine De Meyere (Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium); Eric Lai (Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China); Felix Krenzien (Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany); Moritz Schmelzle (Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany); Prashant Kadam (Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom); Roberto Montalti (Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy); Mariano Giglio (Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy); Qu Liu (Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China); Kit-Fai Lee (Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China; Diana Salimgereeva (Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia); Ruslan Alikhanov (Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia); Lip-Seng Lee (Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore); Mikel Prieto (Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain); Chetana Lim (Department of Digestive, HBP and Liver Transplantation, Hopital Pitte-Salpetriere, Sorbonne Universite, Paris, France; Phan Phuoc Nghia (HPB Surgery Department, University Medical Center, Ho Chi Minh City, Vietnam); Masayuki Kojima (Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan); Yutaro Kato (Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan); Jasper Sijberden (Department of Surgery, Fondazione Poliambulanza, Brescia, Italy); Paulo Herman (Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil); Jaime Arthur Pirola Kruger (Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil); Mansour Saleh (Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France); Franco Pascual (Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France); Bernardo Dalla Valle (General and Hepatobiliary Surgery. Department of Surgery, Dentistry, Gynecology and Pediatrics, University of Verona, GB Rossi Hospital, Verona, Italy); Victor Lopez-Lopez (Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia Spain); Margarida Casellas-Robert (Hepatobiliary and Pancreatic Surgery Unit, Department of Surgery, Dr. Josep Trueta Hospital, IdIBGi, Girona, Spain); Ugo Giustizieri (HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy); Davide Citterio (HPB Surgery, Hepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy); Kohei Mishima (Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan); Asmund Avdem Fretland (The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway); Jacob Ghotbi (The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway); Giuseppe Maria Ettorre (Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy); Marco Colasanti (Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy); Yoelimar Guzmán (General & Digestive Surgery, Hospital Clínic, Barcelona, Spain); Francesco Ardito (Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy); Simone Vani (Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy); Hao-Ping Wang Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung.
Funding
Dr T. P. Kingham was partially supported by the US National Cancer Institute MSKCC Core Grant number P30 CA008747 for this study.
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Dr Goh BK has received travel grants and honoraria from Johnson & Johnson, Olympus and Transmedic the local distributor for the Da Vinci Robot. (ii) Dr Marino MV is a consultant for CAVA Robotics, LLC. (iii) Johann Pratschke received a research grant from Intuitive Surgical Deutschland GmbH and personal fees or non-financial support from Johnson & Johnson, Medtronic, AFS Medical, Astellas, CHG Meridian, Chiesi, Falk Foundation, La Fource Group, Merck, Neovii, NOGGO, pharma-consult Peterson, and Promedicis. (iv) Moritz Schmelzle received personal fees or other support outside of the submitted work from Merck, Bayer, ERBE, Amgen, Johnson & Johnson, Takeda, Olympus, Medtronic, and Intuitive. (v) Asmund Fretland reports receiving speaker fees from Bayer. (vi) Fernando Rotellar reports speaker fees and support outside the submitted work from Integra, Medtronic, Olympus, Corza, Sirtex and Johnson & Johnson. Drs 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, 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, Xiaoying Wang, Mathieu D’Hondt, Chee Chine 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 and Ho-Seong Han have no conflicts of interest to declare.
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The members of International robotic and laparoscopic liver resection study group investigators are listed in Acknowledgements.
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Choi, S., Chen, KH., Syn, N.L. et al. Utility of the Iwate difficulty scoring system for laparoscopic right posterior sectionectomy: do surgical outcomes differ for tumors in segments VI and VII?. Surg Endosc 36, 9204–9214 (2022). https://doi.org/10.1007/s00464-022-09404-6
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DOI: https://doi.org/10.1007/s00464-022-09404-6