Imamura Taisuke, Yamamoto Yusuke, Morimura Ryo, Ikoma Hisashi, Arita Tomohiro, Konishi Hirotaka, Shiozaki Atsushi, Kubota Takeshi, Fujiwara Hitoshi, Otsuji Eigo
Division of Digestive Surgery, Department of Surgery Kyoto Prefectural University of Medicine Kamigyo-ku Kyoto Japan.
Ann Gastroenterol Surg. 2024 Nov 12;9(3):546-558. doi: 10.1002/ags3.12879. eCollection 2025 May.
Laparoscopic liver resection has a steep learning curve, and multiple difficulty-scoring systems have been proposed to support safe implementation. Though the IWATE scoring system is widely used, the rationale for its tumor location score is unclear. The objective of our study was to establish a more accurate definition of tumor location based on subsegments of the Glisson branches.
We included 176 patients who underwent laparoscopic liver resection between January 2017 and February 2024, excluding those who underwent multiple or concomitant resections of other organs. Tumor location was defined by the most proximal subsegment of the Glisson branches (1sp, Spiegel; 1pc, para-caval; 1cp, caudate process; 3a, apical; 3b, basal; 4a; 4b; 5v, ventral; 5d, dorsal; 6v; 6d; 6 L, lateral; 7v; 7d; 8v; 8d).
Within each segment, comparing operative time between subsegments showed significant differences, except for S1 (3a vs. 3b, = 0.011; 4a vs. 4b, = 0.001; 5v vs. 5d, = 0.012; 6v vs. 6d vs. 6 L, = 0.007; 7v vs. 7d, = 0.003; 8v vs. 8d, = 0.030). Blood loss significantly differed except for S1 (3a vs. 3b, = 0.018; 4a vs. 4b, = 0.002; 5v vs. 5d, = 0.016; 6v vs. 6d vs. 6 L, = 0.011; 7v vs. 7d, = 0.013; 8v vs. 8d, < 0.001). The incidence of postoperative complications did not differ significantly; however, hospital stay was significantly different only in S4 (4a vs. 4b, = 0.049).
There are significant differences in the difficulty of laparoscopic liver resection among subsegments. More detailed scoring based on subsegments may improve accuracy, and we propose a new scoring system.
腹腔镜肝切除术有陡峭的学习曲线，并且已经提出了多种难度评分系统以支持安全实施。尽管岩手评分系统被广泛使用，但其肿瘤位置评分的基本原理尚不清楚。我们研究的目的是基于肝门分支的亚段建立更准确的肿瘤位置定义。
我们纳入了2017年1月至2024年2月期间接受腹腔镜肝切除术的176例患者，排除那些接受了其他器官的多次或联合切除术的患者。肿瘤位置由肝门分支的最近端亚段定义（1sp，斯皮格尔；1pc，腔静脉旁；1cp，尾状突；3a，尖部；3b，基部；4a；4b；5v，腹侧；5d，背侧；6v；6d；6L，外侧；7v；7d；8v；8d）。
在每个肝段内，比较亚段之间的手术时间显示出显著差异，S1段除外（3a与3b，=0.011；4a与4b，=0.001；5v与5d，=0.012；6v与6d与6L，=0.007；7v与7d，=0.003；8v与8d，=0.030）。除S1段外，失血量有显著差异（3a与3b，=0.018；4a与4b，=0.002；5v与5d，=0.016；6v与6d与6L，=0.011；7v与7d，=0.013；8v与8d，<0.001）。术后并发症的发生率没有显著差异；然而，仅在S4段住院时间有显著差异（4a与4b，=0.049）。
腹腔镜肝切除术在亚段之间的难度存在显著差异。基于亚段的更详细评分可能会提高准确性，并且我们提出了一种新的评分系统。
