Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan.
Surg Endosc. 2022 Dec;36(12):9054-9063. doi: 10.1007/s00464-022-09372-x. Epub 2022 Jul 13.
Partial laparoscopic liver resection (LLR) is a procedure that can have varying levels of surgical difficulty depending on the tumor status and procedure. Therefore, we aimed to evaluate the surgical outcomes of partial LLR using a new resection classification system.
From January 2009 to May 2021, 156 patients underwent LLR; of them, 87 patients who underwent pure partial LLR were included in this study. They were classified according to the IWATE criteria as the low (n = 56) and intermediate (n = 31) difficulty groups and reclassified according to the resection type as the edge (ER, n = 45), bowl-shaped (BSR, n = 27), and dome-shaped resection (DSR, n = 15) groups. The following surgical outcomes were comparatively analyzed among the groups: intraoperative blood loss, the operation time, and complication rates. Preoperative risk factors for intraoperative blood transfusion and complications were evaluated.
In the IWATE criteria-based analysis, the intermediate-difficulty group had significantly higher intraoperative blood loss (p = 0.005), operation time (p = 0.005), and Clavien-Dindo (CD) grade-based complication rates (CD grade 2 or higher, p = 0.03) than the low-difficulty group. When analyzing the resection type, the CD grade-based complication rate (p = 0.013) and surgical site infection (SSI, p = 0.005) were significantly higher and the postoperative hospitalization was significantly longer (p = 0.028) in the bowl-shaped resection (BSR) group than in the edge- (ER) and dome-shaped resection (DSR) groups. The tumor size (p = 0.011) and IWATE criteria score (p = 0.006) were independent risk factors for intraoperative blood transfusion in the multivariate analysis. The tumor depth (p = 0.011) and BSR (p = 0.002) were independent risk factors for complications of CD grade 2 or higher in the multivariate analysis. BSR was an independent risk factor for SSI in the multivariate analysis (p = 0.017).
Resection type could predict the rate of postoperative complications, while the IWATE criteria could predict the intraoperative surgical difficulty.
部分腹腔镜肝切除术（LLR）是一种手术，其手术难度可能因肿瘤状况和手术方式而有所不同。因此，我们旨在使用新的切除分类系统评估部分 LLR 的手术结果。
从 2009 年 1 月至 2021 年 5 月，有 156 名患者接受了 LLR；其中，87 名接受纯部分 LLR 的患者被纳入本研究。根据岩手标准，他们被分为低（n=56）和中（n=31）难度组，并根据切除类型重新分类为边缘（ER，n=45）、碗形（BSR，n=27）和穹顶形（DSR，n=15）切除组。比较分析各组之间的术中出血量、手术时间和并发症发生率。评估术中输血和并发症的术前危险因素。
在岩手标准基础分析中，中难度组的术中出血量（p=0.005）、手术时间（p=0.005）和 Clavien-Dindo（CD）分级相关并发症发生率（CD 分级 2 级或以上，p=0.03）均明显高于低难度组。当分析切除类型时，BSR 组的 CD 分级相关并发症发生率（p=0.013）和手术部位感染（SSI，p=0.005）显著升高，术后住院时间明显延长（p=0.028）。与边缘（ER）和穹顶形（DSR）切除组相比。多变量分析显示，肿瘤大小（p=0.011）和岩手标准评分（p=0.006）是术中输血的独立危险因素。肿瘤深度（p=0.011）和 BSR（p=0.002）是 CD 分级 2 级或以上并发症的独立危险因素。BSR 是 SSI 的独立危险因素多变量分析（p=0.017）。
切除类型可以预测术后并发症的发生率，而岩手标准可以预测术中手术难度。
