Department of Surgery, Odette Cancer Centre - Sunnybrook Health Sciences Centre, 2075, Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
Department of Surgery, University of Toronto, Toronto, ON, Canada.
Surg Endosc. 2019 Feb;33(2):366-376. doi: 10.1007/s00464-018-6479-3. Epub 2018 Oct 22.
Objective assessment of the difficulty of laparoscopic liver resection (LLR) preoperatively is key in improving its uptake. Difficulty scores are proposed but are not used routinely in practice. We identified and appraised predictive models to estimate LLR difficulty.
We systematically searched the literature for tools predicting LLR difficulty. Two independent reviewers selected studies, abstracted data and assessed methodology. We evaluated tools' quality and clinical relevance using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) guidelines.
From 1037 citations, we included 8 studies reporting on 4 predictive tools using data from 1995 to 2016 in Asia and Europe. In 4 development studies, tools were designed to predict difficulty as assigned by experts using a 10-level difficulty index, operative time, post-operative morbidity or intra-operative complications. Internal validation and performance metrics were reported in one development study. One tool was subjected to external validations in 4 studies (1 independent and geographic). Validations compared post-operative outcomes (operative time, blood loss, transfusion, major morbidity and conversion) between the risk categories. One study validated discrimination (AUROC 0.53). Calibration was not assessed.
Existing tools cannot be used confidently to predict LLR difficulty. Consistent objective clinical outcomes to predict to define LLR difficulty should be established, and better-quality tools developed and validated in a wide array of populations and clinical settings, following best practices for predictive tools development and validation. This will improve risk stratification for future trials and uptake of LLR.
术前客观评估腹腔镜肝切除术（LLR）的难度是提高其应用的关键。目前已经提出了一些难度评分标准，但并未在临床实践中常规使用。我们旨在识别和评估预测腹腔镜肝切除术难度的模型。
我们系统地检索了预测腹腔镜肝切除术难度的相关工具的文献。两位独立的审查员选择研究、提取数据并评估方法学。我们使用系统评价中预测模型研究的批判性评价和数据提取（CHARMS）指南来评估工具的质量和临床相关性。
从 1037 条引用中，我们纳入了 8 项研究，这些研究报告了 4 种预测工具，数据来源于 1995 年至 2016 年亚洲和欧洲的研究。在 4 项开发研究中，工具旨在预测专家根据 10 级难度指数、手术时间、术后发病率或术中并发症分配的难度。一个开发研究报告了内部验证和性能指标。有一个工具在 4 项研究（1 项独立和地理分布）中进行了外部验证。验证比较了风险类别之间的术后结果（手术时间、出血量、输血、主要发病率和中转开腹）。有一项研究验证了区分度（AUROC 为 0.53）。未评估校准度。
现有的工具不能被自信地用于预测腹腔镜肝切除术的难度。应该建立一致的客观临床结局来预测腹腔镜肝切除术的难度，并且应该在广泛的人群和临床环境中开发和验证更好质量的工具，遵循预测工具开发和验证的最佳实践。这将改善未来试验的风险分层和腹腔镜肝切除术的应用。
