Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA.
Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
Am Surg. 2023 Sep;89(9):3788-3793. doi: 10.1177/00031348231173948. Epub 2023 Jun 2.
BACKGROUND: Identification of resections with high risk of intraoperative complications is critical in guiding case selection for minimally invasive liver surgery. Several Japanese and European difficulty scoring systems have been proposed for laparoscopic liver surgery. However, the applicability of these systems for robotic liver resections has not been fully investigated. This study considers the Southampton system and examines its validity when applied to robotic hepatectomies. METHODS: We undertook a retrospective review of 372 patients who underwent robotic hepatectomies for various indications between 2013 and 2022. Of these patients, 63 operations were classified as low risk, 91 as moderate risk, 198 as high risk and 20 as extremely high risk based on Southampton criteria. Patient outcomes were compared by utilizing an ANOVA of repeated measures. Data are presented as median (mean ± SD). RESULTS: The Southampton difficulty scoring system was a strong predictor of intraoperative variables including tumor size, operative duration, estimated blood loss (EBL), and incidence of major vs minor resection (all < .0001). In contrast, the Southampton system was a weaker predictor of postoperative outcomes including 30-day mortality ( = .15), length of stay ( = .13), and readmissions within 30 days ( = .38). CONCLUSION: The Southampton difficulty scoring system is a valid system for classifying robotic liver resections and is a strong predictor of intraoperative outcomes. However, the system was found to be a weaker predictor of postoperative outcomes. This finding may suggest the need for proposal of a new difficulty scoring system for robotic hepatectomies.
背景:识别术中并发症风险高的切除术对于指导微创肝外科手术的病例选择至关重要。已经提出了几种用于腹腔镜肝手术的日本和欧洲难度评分系统。然而,这些系统对于机器人肝切除术的适用性尚未得到充分研究。本研究考虑了南安普顿系统,并检验了其在机器人肝切除术中的有效性。
方法:我们对 2013 年至 2022 年间因各种适应症接受机器人肝切除术的 372 名患者进行了回顾性研究。根据南安普顿标准,其中 63 例手术被归类为低风险,91 例为中风险,198 例为高风险,20 例为极高风险。利用重复测量的方差分析比较患者的结局。数据以中位数(均值±标准差)表示。
结果:南安普顿难度评分系统是术中变量(包括肿瘤大小、手术时间、估计出血量(EBL)和主要与次要切除的发生率)的有力预测指标(均<0.0001)。相比之下,南安普顿系统对术后结局(包括 30 天死亡率(=0.15)、住院时间(=0.13)和 30 天内再入院率(=0.38))的预测能力较弱。
结论:南安普顿难度评分系统是一种有效的分类机器人肝切除术的系统,是术中结局的有力预测指标。然而,该系统对术后结局的预测能力较弱。这一发现可能表明需要提出一种新的机器人肝切除术难度评分系统。
J Gastrointest Surg. 2024-5
Surg Endosc. 2024-2
Ann Surg. 2014-3