Laparoscopic Liver Resection Difficulty Score—a Validation Study

Ser Yee Lee, Brian K.P. Goh, Sepideh Gholami, John C. Allen, Ryan P. Merkow, Jin Yao Teo, Deepa Chandra, Ye Xin Koh, Ek Khoon Tan, Juinn Haur Kam, Peng Chung Cheow, Pierce K.H. Chow, London L.P.J. Ooi, Alexander Y.F. Chung, Michael I. D’Angelica, William R. Jarnagin, T. Peter Kingham, Chung Yip Chan

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective(s): The technical complexity of laparoscopic liver resection (LLR) poses unique challenges distinct from open surgery. An objective scoring system was developed that preoperatively quantifies the difficulty of LRR to help guide surgeon decision-making regarding the feasibility and safety of minimally invasive approaches. The aim of this multiinstitutional study was to externally validate this scoring system. Methods: Patients who underwent LLR at two institutions were reviewed. LLR difficulty score (LDS) was calculated based on patient, tumor, and anatomic characteristics by two independent, blinded hepatobiliary surgeons. Surrogates of case complexity (e.g., conversion rate, operative time) were used for validation of this index. Results: From 2006 to 2016, 444 LLR were scored as low (n = 94), intermediate (n = 98), and high difficulty (n = 152) with respective conversion rates of 5.3%, 15.7%, and 25%. Cases of higher LDS correlated with larger mean blood loss (203 ml vs. 331 ml vs. 635 ml). Mean operative and Pringle maneuver used were associated with increasing LDS (155 min vs. 202 min vs. 315 min and 14.4% vs. 29.7% vs. 45.1% respectively). These operative surrogates of difficulty correlated significantly with the LDS (all p < 0.0001). Conclusions: This comprehensive external validation of the LDS is robust and applicable in diverse patient populations. This LDS serves as a useful objective predictor of technical difficulty for LLR to help surgeons in selecting patients according to their individual operative experience and is valuable for preoperative risk estimation and stratification in randomized trials.

Original languageEnglish (US)
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

Fingerprint

Validation Studies
Liver
Operative Time
Decision Making
Safety
Population
Surgeons
Neoplasms

Keywords

  • Difficulty score
  • Laparoscopic liver resection

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Lee, S. Y., Goh, B. K. P., Gholami, S., Allen, J. C., Merkow, R. P., Teo, J. Y., ... Chan, C. Y. (Accepted/In press). Laparoscopic Liver Resection Difficulty Score—a Validation Study. Journal of Gastrointestinal Surgery. https://doi.org/10.1007/s11605-018-4036-y

Laparoscopic Liver Resection Difficulty Score—a Validation Study. / Lee, Ser Yee; Goh, Brian K.P.; Gholami, Sepideh; Allen, John C.; Merkow, Ryan P.; Teo, Jin Yao; Chandra, Deepa; Koh, Ye Xin; Tan, Ek Khoon; Kam, Juinn Haur; Cheow, Peng Chung; Chow, Pierce K.H.; Ooi, London L.P.J.; Chung, Alexander Y.F.; D’Angelica, Michael I.; Jarnagin, William R.; Peter Kingham, T.; Chan, Chung Yip.

In: Journal of Gastrointestinal Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Lee, SY, Goh, BKP, Gholami, S, Allen, JC, Merkow, RP, Teo, JY, Chandra, D, Koh, YX, Tan, EK, Kam, JH, Cheow, PC, Chow, PKH, Ooi, LLPJ, Chung, AYF, D’Angelica, MI, Jarnagin, WR, Peter Kingham, T & Chan, CY 2018, 'Laparoscopic Liver Resection Difficulty Score—a Validation Study', Journal of Gastrointestinal Surgery. https://doi.org/10.1007/s11605-018-4036-y
Lee, Ser Yee ; Goh, Brian K.P. ; Gholami, Sepideh ; Allen, John C. ; Merkow, Ryan P. ; Teo, Jin Yao ; Chandra, Deepa ; Koh, Ye Xin ; Tan, Ek Khoon ; Kam, Juinn Haur ; Cheow, Peng Chung ; Chow, Pierce K.H. ; Ooi, London L.P.J. ; Chung, Alexander Y.F. ; D’Angelica, Michael I. ; Jarnagin, William R. ; Peter Kingham, T. ; Chan, Chung Yip. / Laparoscopic Liver Resection Difficulty Score—a Validation Study. In: Journal of Gastrointestinal Surgery. 2018.
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abstract = "Objective(s): The technical complexity of laparoscopic liver resection (LLR) poses unique challenges distinct from open surgery. An objective scoring system was developed that preoperatively quantifies the difficulty of LRR to help guide surgeon decision-making regarding the feasibility and safety of minimally invasive approaches. The aim of this multiinstitutional study was to externally validate this scoring system. Methods: Patients who underwent LLR at two institutions were reviewed. LLR difficulty score (LDS) was calculated based on patient, tumor, and anatomic characteristics by two independent, blinded hepatobiliary surgeons. Surrogates of case complexity (e.g., conversion rate, operative time) were used for validation of this index. Results: From 2006 to 2016, 444 LLR were scored as low (n = 94), intermediate (n = 98), and high difficulty (n = 152) with respective conversion rates of 5.3{\%}, 15.7{\%}, and 25{\%}. Cases of higher LDS correlated with larger mean blood loss (203 ml vs. 331 ml vs. 635 ml). Mean operative and Pringle maneuver used were associated with increasing LDS (155 min vs. 202 min vs. 315 min and 14.4{\%} vs. 29.7{\%} vs. 45.1{\%} respectively). These operative surrogates of difficulty correlated significantly with the LDS (all p < 0.0001). Conclusions: This comprehensive external validation of the LDS is robust and applicable in diverse patient populations. This LDS serves as a useful objective predictor of technical difficulty for LLR to help surgeons in selecting patients according to their individual operative experience and is valuable for preoperative risk estimation and stratification in randomized trials.",
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AU - Goh, Brian K.P.

AU - Gholami, Sepideh

AU - Allen, John C.

AU - Merkow, Ryan P.

AU - Teo, Jin Yao

AU - Chandra, Deepa

AU - Koh, Ye Xin

AU - Tan, Ek Khoon

AU - Kam, Juinn Haur

AU - Cheow, Peng Chung

AU - Chow, Pierce K.H.

AU - Ooi, London L.P.J.

AU - Chung, Alexander Y.F.

AU - D’Angelica, Michael I.

AU - Jarnagin, William R.

AU - Peter Kingham, T.

AU - Chan, Chung Yip

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N2 - Objective(s): The technical complexity of laparoscopic liver resection (LLR) poses unique challenges distinct from open surgery. An objective scoring system was developed that preoperatively quantifies the difficulty of LRR to help guide surgeon decision-making regarding the feasibility and safety of minimally invasive approaches. The aim of this multiinstitutional study was to externally validate this scoring system. Methods: Patients who underwent LLR at two institutions were reviewed. LLR difficulty score (LDS) was calculated based on patient, tumor, and anatomic characteristics by two independent, blinded hepatobiliary surgeons. Surrogates of case complexity (e.g., conversion rate, operative time) were used for validation of this index. Results: From 2006 to 2016, 444 LLR were scored as low (n = 94), intermediate (n = 98), and high difficulty (n = 152) with respective conversion rates of 5.3%, 15.7%, and 25%. Cases of higher LDS correlated with larger mean blood loss (203 ml vs. 331 ml vs. 635 ml). Mean operative and Pringle maneuver used were associated with increasing LDS (155 min vs. 202 min vs. 315 min and 14.4% vs. 29.7% vs. 45.1% respectively). These operative surrogates of difficulty correlated significantly with the LDS (all p < 0.0001). Conclusions: This comprehensive external validation of the LDS is robust and applicable in diverse patient populations. This LDS serves as a useful objective predictor of technical difficulty for LLR to help surgeons in selecting patients according to their individual operative experience and is valuable for preoperative risk estimation and stratification in randomized trials.

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