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Prediction of Surgical Outcomes of Laparoscopic Liver Resections for Hepatocellular Carcinoma by Defining Surgical Difficulty

Jai Young Cho1, Mohan Periyasamy1, Soyeon Ahn2, Ho-Seong Han1, Yoo-Seok Yoon1, YoungRok Choi1, Jae Seong Jang1, Seong Uk Kwon1, Sungho Kim1, Jang Kyu Choi1, Hanisah Guro1. 1Department of Surgery, Seoul National University Bundang Hospital, Republic of Korea, 2Medical Research Collaborating Center, Seoul National University Bundang Hospital, Republic of Korea

Background: There are a few classifications to define surgical difficulty of laparoscopic liver resections. We evaluated current three classifications including traditional major/minor classification, complexity classification and difficulty scoring system for predicting operative outcomes after laparoscopic liver resection.

Methods: We reviewed the clinical data of 301 patients who underwent laparoscopic liver resections for hepatocellular carcinoma between March, 2004 and June, 2015. We compared prognostic value of three classifications using receiver operating characteristic (ROC) curve analysis.

Results: All three major/minor, difficulty scoring system, and complexity classification differentiated well surgical difficulties including blood loss (P = 0.001, P = 0.009, and P < 0.001, respectively) and operation time (P < 0.001, all). Difficulty scoring system and complexity classification differentiated rate of transfusion (P = 0.001 and P < 0.001, respectively). Complexity classification was the only one to predict well postoperative development of severe complications (P = 0.032), the severity of complications (P < 0.001), and length of hospital stay (P = 0.005). Complexity classification (area under the curve [AUC] = 0.611) outperformed major/minor classification (AUC = 0.544) or difficulty scoring system (AUC = 0.530) as a predictor of severe complication by ROC curve analysis.

Conclusion: The complexity classification defined best the surgical difficulty and predicted well complications after laparoscopic liver resection for hepatocellular carcinoma.

Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 77384

Program Number: S059

Presentation Session: HPB

Presentation Type: Podium

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