Validation of difficulty scoring system for laparoscopic liver resection in patients underwent laparoscopic left lateral sectionectomy

Jai Young Cho, PhD, FACS, Ho-Seong Han, Yoo-Seok Yoon, YoungRok Choi, Jae Yool Jang, Hanlim Choi, Jae Seong Jang, Seong Uk Kwon, Chami Im. Department of Surgery, Seoul National University Bundang Hospital

Background: Recently, a novel difficulty scoring system (DSS) using the extent of liver resection, tumor location, liver function, tumor size, and tumor proximity to major vessels was developed to assess the difficulty of various laparoscopic hepatectomy procedures. However, even in laparoscopic left lateral sectionectomy (LLS), operative difficulties vary according to the severity and diagnosis of disease. We validated DSS in all patients underwent laparoscopic LLS.

Methods: We reviewed the clinical data of 106 patients who underwent laparoscopic LLS for tumor (n = 72) between July 2003 and July 2013 and validated the DSS to surgical outcomes. Additionally, the data of LLS for hepatolithiasis (n=34) was also evaluated.

Results: The DSS score ranged from 3 to 7 in laparoscopic LLS for tumors, and mean blood loss (P = 0.005) and the rate of complication grade (P = 0.015) were different according to the scores. When we applied DSS to all patients underwent laparoscopic LLC, the mean hospital day (P = 0.002), operation time (P = 0.018), and the rate of complications (P = 0.025) were longer in IHD stone group than tumor group. After we modify DSS with additional 2 score for IHD stones (“diagnosis” variable), modified DSS discriminated better intraoperative results according to the scores.

Conclusions: Operation difficulty varies even in LLS and modified DSS outperformed original DSS when we added diagnosis variable.

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