Tanaka Shogo, Kubo Shoji, Kanazawa Akishige, Takeda Yutaka, Hirokawa Fumitoshi, Nitta Hiroyuki, Nakajima Takayoshi, Kaizu Takashi, Kaneko Hironori, Wakabayashi Go
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
J Am Coll Surg. 2017 Aug;225(2):249-258.e1. doi: 10.1016/j.jamcollsurg.2017.03.016. Epub 2017 Apr 10.
Laparoscopic liver resection (LLR) is widely used for hepatic disease treatment. Preoperative prediction of operative difficulty can be beneficial as a roadmap for surgeons advancing from simple to highly technical LLR. We performed a multicenter analysis to investigate a "difficulty scoring system" for predicting the difficulty of LLR.
The proposed "difficulty scoring system" includes 3 difficulty levels based on 5 factors. The system was validated in a cohort of 2,199 patients who underwent LLR at 74 Japanese centers between 2010 and 2014; the difficulty level was rated as low (n = 965), intermediate (n = 891), and high (n = 343). Operative parameters, postoperative complications, and outcomes were compared according to the difficulty levels.
The median operation time and blood loss were 258 minutes (range 30 to 1,275 minutes) and 75 mL (range 0 to 7,798 mL), respectively. The overall conversion rate was 5.0% (n = 110). The incidences of postoperative complications, liver failure, and in-hospital death were 5.3% (n = 116), 1.5% (n = 32), and 0.5% (n = 12), respectively. Median hospital stay was 9 days (range 1 to 189 days). Conversion rate, operation time, and blood loss showed a direct correlation with the difficulty level. A strong correlation was observed among the difficulty level, incidence of postoperative complications, and hospital stay. Incidence of postoperative liver failure and in-hospital death in the high difficulty group was higher than that in the low difficulty group.
Preoperative evaluation with the "difficulty scoring system" predicted the difficulty of the operation and the postoperative outcomes of LLR. In the beginning of LLR training, surgeons should start with low difficulty-level operations.
腹腔镜肝切除术（LLR）广泛应用于肝脏疾病的治疗。术前预测手术难度有助于为外科医生从简单的LLR手术向高难度手术进阶提供路线图。我们进行了一项多中心分析，以研究一种用于预测LLR手术难度的“难度评分系统”。
所提出的“难度评分系统”基于5个因素分为3个难度级别。该系统在2010年至2014年间于日本74个中心接受LLR手术的2199例患者队列中进行了验证；难度级别分为低（n = 965）、中（n = 891）和高（n = 343）。根据难度级别比较手术参数、术后并发症和结局。
中位手术时间和失血量分别为258分钟（范围30至1275分钟）和75毫升（范围0至7798毫升）。总体中转率为5.0%（n = 110）。术后并发症、肝衰竭和住院死亡的发生率分别为5.3%（n = 116）、1.5%（n = 32）和0.5%（n = 12）。中位住院时间为9天（范围1至189天）。中转率、手术时间和失血量与难度级别呈直接相关。在难度级别、术后并发症发生率和住院时间之间观察到强相关性。高难度组术后肝衰竭和住院死亡的发生率高于低难度组。
使用“难度评分系统”进行术前评估可预测LLR手术的难度和术后结局。在LLR培训初期，外科医生应从低难度级别的手术开始。
