Louisa Bolm, Martina Nebbia, Onofrio Catalano, Gabriella Lionetto, Johanna von Bresinsky, Jannis Duhn, Shahrzad Arya, Marco Ventin, Julia Straesser, Cristina R Ferrone
{"title":"哪种技术难度评分能最好地预测微创肝切除术后的预后?","authors":"Louisa Bolm, Martina Nebbia, Onofrio Catalano, Gabriella Lionetto, Johanna von Bresinsky, Jannis Duhn, Shahrzad Arya, Marco Ventin, Julia Straesser, Cristina R Ferrone","doi":"10.1007/s00423-025-03612-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>To assess technical difficulty scores for laparoscopic liver resections (LLR) in a large well-characterized cohort of low to high difficulty LLR.</p><p><strong>Methods: </strong>Patients undergoing LLR and open liver resection (OLS) (2007-2022) at Massachusetts General Hospital were included. Patients were classified according to the technical difficulty scores Ban difficulty score, IWATE criteria, Hasegawa score, IMM score, and Southhampton score (SHH) and calibration of these scores in predicting postoperative outcome parameters was assessed.</p><p><strong>Results: </strong>301 patients underwent LLR. Median age was 59 years and 58.5% of the patients were female. Median lesion size was 42.2 mm, median operative time was 197.7 min, and median estimated blood loss was 400.5 ml. According to the different scoring systems, 18.9% (SHH) to 52.2% (IWATE) of the LLR were high difficulty. Overall intraoperative events according to the modified Satava classification grade II (6.6%) and grade III (2.7%) were low as was postoperative 90 days major morbidity (5.3%) and mortality (1.0%). The respective scores' calibration for predicting non-textbook outcomes, intraoperative events, operative time, major postoperative morbidity, blood transfusion rates, and length of hospital stay was moderate to good for the respective scores and best for the IWATE criteria.</p><p><strong>Discussion: </strong>Even high technical difficulty LLR can be performed with low postoperative morbidity and mortality rates. The scores evaluated performed well in predicting major liver surgery outome parameters. Among the different difficulty scoring systems, the IWATE criteria performed best.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"79"},"PeriodicalIF":2.1000,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845553/pdf/","citationCount":"0","resultStr":"{\"title\":\"Which technical difficulty score can best predict postoperative outcomes after minimally invasive liver resections?\",\"authors\":\"Louisa Bolm, Martina Nebbia, Onofrio Catalano, Gabriella Lionetto, Johanna von Bresinsky, Jannis Duhn, Shahrzad Arya, Marco Ventin, Julia Straesser, Cristina R Ferrone\",\"doi\":\"10.1007/s00423-025-03612-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>To assess technical difficulty scores for laparoscopic liver resections (LLR) in a large well-characterized cohort of low to high difficulty LLR.</p><p><strong>Methods: </strong>Patients undergoing LLR and open liver resection (OLS) (2007-2022) at Massachusetts General Hospital were included. Patients were classified according to the technical difficulty scores Ban difficulty score, IWATE criteria, Hasegawa score, IMM score, and Southhampton score (SHH) and calibration of these scores in predicting postoperative outcome parameters was assessed.</p><p><strong>Results: </strong>301 patients underwent LLR. Median age was 59 years and 58.5% of the patients were female. Median lesion size was 42.2 mm, median operative time was 197.7 min, and median estimated blood loss was 400.5 ml. According to the different scoring systems, 18.9% (SHH) to 52.2% (IWATE) of the LLR were high difficulty. Overall intraoperative events according to the modified Satava classification grade II (6.6%) and grade III (2.7%) were low as was postoperative 90 days major morbidity (5.3%) and mortality (1.0%). The respective scores' calibration for predicting non-textbook outcomes, intraoperative events, operative time, major postoperative morbidity, blood transfusion rates, and length of hospital stay was moderate to good for the respective scores and best for the IWATE criteria.</p><p><strong>Discussion: </strong>Even high technical difficulty LLR can be performed with low postoperative morbidity and mortality rates. The scores evaluated performed well in predicting major liver surgery outome parameters. Among the different difficulty scoring systems, the IWATE criteria performed best.</p>\",\"PeriodicalId\":17983,\"journal\":{\"name\":\"Langenbeck's Archives of Surgery\",\"volume\":\"410 1\",\"pages\":\"79\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-02-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845553/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Langenbeck's Archives of Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00423-025-03612-z\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Langenbeck's Archives of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00423-025-03612-z","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
背景:评估腹腔镜肝切除术(LLR)的技术难度评分在一个大型的低到高难度LLR队列中。方法:纳入2007-2022年在马萨诸塞州总医院(Massachusetts General Hospital)接受LLR和开放肝切除术(OLS)的患者。根据技术难度评分Ban难度评分、IWATE标准、Hasegawa评分、IMM评分和Southhampton评分(SHH)对患者进行分类,并评估这些评分在预测术后结局参数方面的校准。结果:301例患者行LLR。中位年龄59岁,女性占58.5%。中位病灶大小为42.2 mm,中位手术时间为197.7 min,中位估计失血量为4000.5 ml。根据不同的评分系统,18.9% (SHH)至52.2% (IWATE)的LLR为高难度。根据改进的Satava分类,总的术中事件II级(6.6%)和III级(2.7%)较低,术后90天主要发病率(5.3%)和死亡率(1.0%)也较低。在预测非教科书结果、术中事件、手术时间、术后主要发病率、输血率和住院时间方面,各评分的校准均为中等至良好,IWATE标准的校准为最佳。讨论:即使是高技术难度的LLR,术后发病率和死亡率也很低。评估的评分在预测主要肝脏手术结果参数方面表现良好。在不同的难度评分系统中,IWATE标准表现最好。
Which technical difficulty score can best predict postoperative outcomes after minimally invasive liver resections?
Background: To assess technical difficulty scores for laparoscopic liver resections (LLR) in a large well-characterized cohort of low to high difficulty LLR.
Methods: Patients undergoing LLR and open liver resection (OLS) (2007-2022) at Massachusetts General Hospital were included. Patients were classified according to the technical difficulty scores Ban difficulty score, IWATE criteria, Hasegawa score, IMM score, and Southhampton score (SHH) and calibration of these scores in predicting postoperative outcome parameters was assessed.
Results: 301 patients underwent LLR. Median age was 59 years and 58.5% of the patients were female. Median lesion size was 42.2 mm, median operative time was 197.7 min, and median estimated blood loss was 400.5 ml. According to the different scoring systems, 18.9% (SHH) to 52.2% (IWATE) of the LLR were high difficulty. Overall intraoperative events according to the modified Satava classification grade II (6.6%) and grade III (2.7%) were low as was postoperative 90 days major morbidity (5.3%) and mortality (1.0%). The respective scores' calibration for predicting non-textbook outcomes, intraoperative events, operative time, major postoperative morbidity, blood transfusion rates, and length of hospital stay was moderate to good for the respective scores and best for the IWATE criteria.
Discussion: Even high technical difficulty LLR can be performed with low postoperative morbidity and mortality rates. The scores evaluated performed well in predicting major liver surgery outome parameters. Among the different difficulty scoring systems, the IWATE criteria performed best.
期刊介绍:
Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.