Prediction of complexity and complications of laparoscopic liver surgery: The comparison of the Halls-score to the IWATE-score in 100 consecutive laparoscopic liver resections.

BACKGROUND

The development of laparoscopic liver surgery is slower than in other disciplines. Two different scoring systems have been proposed to estimate difficulty of laparoscopic liver resections (LLR) preoperatively. The aim of this analysis was to compare these two scores in an independent patient cohort regarding the predictability of morbidity.

METHODS

All LLRs performed between 01/2011 until 01/2019 were identified from our prospective institutional database. Patient characteristics as well as intra- and postoperative data were analyzed. Postoperative complications were graded according to Dindo-Clavien classification. Difficulty of LLR was classified using IWATE- and Halls-score.

RESULTS

We identified 100 LLR, of which 13 were performed in liver cirrhosis. Conversion rate was 4%, postoperative complications (≥°III) occurred in 10% of the patients, and two patients died within 90 days. Higher difficulty levels were associated with higher intraoperative blood loss (P < .001 and P = .002), longer duration of surgery (both P < .001) and hospital stay (P = .012 and P = .033) for the Halls- and IWATE-scores, respectively. ROC curve analysis revealed better performance for the Halls- than for the IWATE-score regarding morbidity as well as for mortality.

CONCLUSIONS

The IWATE- and the Halls-score correlate well with postoperative morbidity. The Halls-score predicted postoperative morbidity and mortality slightly better than the IWATE-score.