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Related Experiment Video

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

Yoshikuni Kawaguchi1,2, Shogo Tanaka3, David Fuks4

  • 1Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France. yokawaguchi-tky@umin.ac.jp.

Surgical Endoscopy
|July 25, 2019
PubMed
Summary

A new 3-grade classification for laparoscopic liver resection (LLR) procedures, the IMM classification, effectively stratifies surgical difficulty and patient outcomes. This system aligns with the IWATE criteria and outperforms the minor/major classification for LLR risk assessment.

Keywords:
ClassificationComplexityDifficultyLaparoscopic hepatectomyLaparoscopic liver resectionThree-level

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Area of Science:

  • Hepatobiliary Surgery
  • Minimally Invasive Procedures
  • Surgical Classification Systems

Background:

  • Existing index-based classifications for laparoscopic liver resection (LLR), such as the IWATE criteria, provide a detailed but complex scoring system.
  • A simpler, procedure-based classification is needed to effectively stratify LLR complexity and predict patient outcomes.
  • The Institut Mutualiste Montsouris (IMM) developed a 3-grade classification (IMM classification) for 11 LLR procedures.

Purpose of the Study:

  • To validate the 3-grade IMM classification for laparoscopic liver resection (LLR) using an external cohort.
  • To evaluate the concordance of the IMM classification with the established IWATE criteria.
  • To compare the performance of the IMM classification against the IWATE criteria and the traditional minor/major classification in stratifying LLR procedures.

Main Methods:

  • Patients undergoing LLR without simultaneous procedures were analyzed from the IMM cohort (n=433) and a Japanese multicenter cohort (JMI, n=1867).
  • Surgical and postoperative outcomes were assessed based on the 3 IMM grades in the JMI cohort.
  • The 11 LLR procedures were scored using the IWATE criteria, and areas under the curves (AUCs) for outcomes were compared between classifications.

Main Results:

  • In the JMI cohort, operative time, blood loss, conversion rate, and major complication rate significantly increased with higher IMM grades (I to III, P < 0.001).
  • IMM grades I, II, and III corresponded to low, intermediate, and high IWATE scores, respectively, with significant differences in mean scores between grades in both cohorts (P < 0.001).
  • The 3-level IMM classification demonstrated higher AUCs for surgical and postoperative outcomes compared to the minor/major classification.

Conclusions:

  • The 3-grade IMM classification effectively stratifies laparoscopic liver resection (LLR) procedures based on surgical and postoperative outcomes, validated in an external cohort.
  • The IMM classification aligns with the index-based IWATE criteria, offering a simpler yet robust system for assessing LLR complexity.
  • The IMM classification exhibits superior performance over the minor/major classification in stratifying LLR procedures.