Division of HPB Surgery, Department of Surgery, Atrium Health - Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 600, Charlotte, NC, 28204, USA.
Division of HPB Surgery, Department of Surgery, Atrium Health - Carolinas Medical Center, Charlotte, NC, USA.
Surg Endosc. 2023 Sep;37(9):7288-7294. doi: 10.1007/s00464-023-10330-4. Epub 2023 Aug 9.
The Japanese difficulty score (JDS) categorizes laparoscopic hepatectomy into low, intermediate, and high complexity procedures, and correlates with operative and postoperative outcomes. We sought to perform a validation study to determine if the JDS correlates with operative and postoperative indicators of surgical complexity for patients undergoing robotic-assisted hepatectomy.
Retrospective review of 657 minimally invasive hepatectomy procedures was performed between January 2008 through March 2019. Outcomes included operative time, estimated blood loss (EBL), blood transfusion, complications, post-hepatectomy liver failure (PHLF), length of stay, 30-day readmission, and 30-day and 90-day mortality. Patients were grouped based on JDS defined as: low (< 4), intermediate (4-6), and high (7 +) complexity procedures. Statistical comparisons were analyzed by ANOVA or χ test.
241 of 657 patients underwent robotic-assisted resection. Of these patients, 137 were included in the analysis based on JDS: 25 low, 58 intermediate, and 54 high. High JDS was associated with more major resections (≥ 4 contiguous segments) versus minor resections (median JDS 8 vs. 5, P < 0.0001). High JDS was associated with significantly longer operative times, higher EBL, and more blood transfusions. High JDS was associated with higher rates of PHLF at 16.7%, compared with 5.2% intermediate and 0.0% low, (P = 0.018). Complication rates, 30-day readmissions, and mortality rates were similar between groups. Median LOS was longer in patients with high JDS compared with intermediate and low (4 days vs. 3 days vs. 2 days; P = 0.0005).
Higher JDS was associated with multiple indicators of operative complexity, including greater extent of resection, increased operative time, EBL, blood transfusion, PHLF, and LOS. This validation study supports the ability of the JDS to categorize patients undergoing robotic-assisted hepatectomy by complexity.
日本难度评分（JDS）将腹腔镜肝切除术分为低、中和高复杂程度的手术，并与手术和术后结果相关。我们试图进行一项验证研究，以确定 JDS 是否与接受机器人辅助肝切除术的患者的手术复杂性的手术和术后指标相关。
回顾性分析了 2008 年 1 月至 2019 年 3 月期间进行的 657 例微创肝切除术。结果包括手术时间、估计失血量（EBL）、输血、并发症、术后肝衰竭（PHLF）、住院时间、30 天再入院率和 30 天及 90 天死亡率。根据 JDS 将患者分为低（<4）、中（4-6）和高（7+）复杂程度的手术。通过 ANOVA 或 χ 检验分析统计学比较。
657 例患者中有 241 例接受了机器人辅助切除术。在这些患者中，根据 JDS 有 137 例纳入分析：25 例低、58 例中、54 例高。高 JDS 与更多的主要切除术（≥4 个连续节段）相比，与次要切除术相关（中位数 JDS 为 8 比 5，P<0.0001）。高 JDS 与手术时间延长、EBL 升高和输血增加相关。高 JDS 与更高的 PHLF 发生率相关，为 16.7%，而中 JDS 为 5.2%，低 JDS 为 0.0%（P=0.018）。各组并发症发生率、30 天再入院率和死亡率相似。与中 JDS 和低 JDS 相比，高 JDS 患者的中位 LOS 更长（4 天比 3 天比 2 天；P=0.0005）。
高 JDS 与手术复杂性的多个指标相关，包括切除范围更大、手术时间延长、EBL、输血、PHLF 和 LOS。这项验证研究支持 JDS 对接受机器人辅助肝切除术的患者进行分类的能力。
