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Surg Endosc. 2019 Jul 23. doi: 10.1007/s00464-019-06986-6. [Epub ahead of print]

Validation and performance of three-level procedure-based classification for laparoscopic liver resection.

Author information

1
Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France. yokawaguchi-tky@umin.ac.jp.
2
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. yokawaguchi-tky@umin.ac.jp.
3
Departments of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan. m8827074@msic.med.osaka-cu.ac.jp.
4
Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.
5
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City General Hospital, Osaka, Japan.
6
Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan.
7
Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan.
8
Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan.
9
Department of Surgery, Meiwa Hospital, Nishinomiya, Japan.
10
Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
11
Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Japan.
12
Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan.
13
Division of General and Gastroenterological Surgery, Department of Surgery, Toho University, Faculty of Medicine, Tokyo, Japan.
14
Departments of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan.
15
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
16
National Center for Global Health and Medicine, Tokyo, Japan.
17
Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Japan.

Abstract

BACKGROUND:

A procedure-based laparoscopic liver resection (LLR) classification (IMM classification) stratified 11 different LLR procedures into 3 grades. IMM classification assessed the difficulty of LLR differently than an index-based LLR classification (IWATE criteria), which scored each procedure on an index scale of 12. We validated the difference of 3 IMM grades using an external cohort, evaluated the IMM classification using the scores of the IWATE criteria, and compared the performance of IMM classification with the IWATE criteria and the minor/major classification.

METHODS:

Patients undergoing LLR without simultaneous procedures were selected from a prospectively maintained database at the Institut Mutualiste Montsouris (IMM cohort) and from the database of 43 Japanese institutions (JMI cohort). Surgical and postoperative outcomes were evaluated according to the 3 IMM grades using the JMI cohort. The 11 LLR procedures included in the IMM classification were scored according to the IWATE criteria. The area under the curves (AUCs) for surgical and postoperative outcomes were compared.

RESULTS:

In the JMI (n = 1867) cohort, operative time, blood loss, conversion rate, and major complication rate were significantly associated with a stepwise increase in grades from I to III (all, P < 0.001). In the IMM (n = 433) and JMI cohorts, IMM grades I, II, and III corresponded to three low-scoring, two intermediate-scoring, and six high-scoring LLR procedures as per the IWATE criteria, respectively. Mean ± standard deviation among the IMM grades were significantly different: 3.7 ± 1.4 (grade I) versus 7.5 ± 1.7 (grade II) versus 10.2 ± 1.0 (grade III) (P < 0.001) in the IMM cohort and 3.6 ± 1.4 (grade I) versus 6.7 ± 1.5 (grade II) versus 9.3 ± 1.4 (grade III) (P < 0.001) in the JMI cohort. The AUCs for surgical and postoperative outcomes are higher for the 3-level IMM classification than for the minor/major classification.

CONCLUSIONS:

The difference of 3 IMM grades with respect to surgical and postoperative outcomes was validated using an external cohort. The 3-level procedure-based IMM classification was in accordance with the index-based IWATE criteria. The IMM classification performed better than the minor/major classification for stratifying LLR procedures.

KEYWORDS:

Classification; Complexity; Difficulty; Laparoscopic hepatectomy; Laparoscopic liver resection; Three-level

PMID:
31338665
DOI:
10.1007/s00464-019-06986-6

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