Which technical difficulty score can best predict postoperative outcomes after minimally invasive liver resections?

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Surgical Outcomes Research

Background:

• Assessing technical difficulty in laparoscopic liver resections (LLR) is crucial for patient safety and outcome prediction.
• Existing scoring systems require validation in large, well-characterized patient cohorts.

Purpose of the Study:

• To evaluate the accuracy of various technical difficulty scores for LLR.
• To determine the performance of these scores in predicting postoperative outcomes.

Main Methods:

• A retrospective analysis of 301 LLR patients and comparison with open liver resection (OLS) patients (2007-2022).
• Application and calibration of Ban, IWATE, Hasegawa, IMM, and Southhampton (SHH) scores.
• Assessment of score calibration against postoperative outcomes like morbidity, mortality, and operative time.

Main Results:

• A significant proportion of LLRs were classified as high difficulty (18.9% to 52.2% by different scores).
• Low rates of intraoperative events and 90-day major morbidity (5.3%) and mortality (1.0%) were observed.
• IWATE criteria demonstrated the best calibration for predicting outcomes such as non-textbook outcomes, operative time, and morbidity.

Conclusions:

• LLR is safe and effective, even for technically challenging cases, with low complication rates.
• The evaluated scoring systems accurately predict major liver surgery outcomes.
• IWATE criteria emerged as the most effective scoring system for assessing LLR difficulty and predicting outcomes.