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British journal of surgery : BJS v.105 no.9, 2018년, pp.1182 - 1191  

Development and validation of a difficulty score to predict intraoperative complications during laparoscopic liver resection

Halls, M. C. (Department of Hepato‐Biliary and Pancreatic Surgery, University Hospital Southampton, Southampton, UK ) ; Berardi, G. (Department of General and Hepatobiliary Surgery, Liver Transplantation, Ghent University Hospital Medical School, Ghent, Belgium ) ; Cipriani, F. (Department of Hepato‐Biliary and Pancreatic Surgery, University Hospital Southampton, Southampton, UK ) ; Barkhatov, L. (Intervention Centre and Department of Hepatopancreatobiliary Surgery, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway ) ; Lainas, P. (Department of Hepatobiliary Surgery, Antoine‐Béclère Hospital, Paris, France ) ; Harris, S. (Department of Public Health Sciences and Medical Statistics, Faulty of Medicine, University of Southampton, Southampton, UK ) ; D'Hondt, M. (Department of Digestive and Hepatopancreatobiliary Surgery, Groeninge Hospital, Kortrijk, Belgium ) ; Rotellar, F. (D ) ; Dagher, I. ; Aldrighetti, L. ; Troisi, R. I. ; Edwin, B. ; Abu Hilal, M. ;
  • 초록  

    Background Previous studies have demonstrated that patient, surgical, tumour and operative variables affect the complexity of laparoscopic liver resections. However, current difficulty scoring systems address only tumour factors. The aim of this study was to develop and validate a predictive model for the risk of intraoperative complications during laparoscopic liver resections. Methods The prospectively maintained databases of seven European tertiary referral liver centres were compiled. Data from two‐thirds of the patients were used for development and one‐third for validation of the model. Intraoperative complications were based on a modified Satava classification. Using the methodology of the Framingham Heart Study, developed to identify risk factors that contribute to the development of cardiovascular disease, factors found to predict intraoperative complications independently were assigned points, and grouped into low‐, moderate‐, high‐ and extremely high‐risk groups based on the likelihood of intraoperative complications. Results A total of 2856 patients were included. Neoadjuvant chemotherapy, lesion type and size, classification of resection and previous open liver resection were found to be independent predictors of intraoperative complications. Patients with intraoperative complications had a longer duration of hospital stay (5 versus 4 days; P versus 15·5 per cent; P versus 0·3 per cent; P versus 0·8 per cent; P Conclusion This comprehensive scoring system, based on patient, surgical and tumour factors, and developed and validated using a large multicentre European database, helped estimate the risk of intraoperative complications.


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