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Validation and performance of three-level procedure-based classification for laparoscopic liver resection

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Abstract

Background

A procedure-based laparoscopic liver resection (LLR) classification (IMM classification) stratified 11 different LLR procedures into 3 grades. IMM classification assessed the difficulty of LLR differently than an index-based LLR classification (IWATE criteria), which scored each procedure on an index scale of 12. We validated the difference of 3 IMM grades using an external cohort, evaluated the IMM classification using the scores of the IWATE criteria, and compared the performance of IMM classification with the IWATE criteria and the minor/major classification.

Methods

Patients undergoing LLR without simultaneous procedures were selected from a prospectively maintained database at the Institut Mutualiste Montsouris (IMM cohort) and from the database of 43 Japanese institutions (JMI cohort). Surgical and postoperative outcomes were evaluated according to the 3 IMM grades using the JMI cohort. The 11 LLR procedures included in the IMM classification were scored according to the IWATE criteria. The area under the curves (AUCs) for surgical and postoperative outcomes were compared.

Results

In the JMI (n = 1867) cohort, operative time, blood loss, conversion rate, and major complication rate were significantly associated with a stepwise increase in grades from I to III (all, P < 0.001). In the IMM (n = 433) and JMI cohorts, IMM grades I, II, and III corresponded to three low-scoring, two intermediate-scoring, and six high-scoring LLR procedures as per the IWATE criteria, respectively. Mean ± standard deviation among the IMM grades were significantly different: 3.7 ± 1.4 (grade I) versus 7.5 ± 1.7 (grade II) versus 10.2 ± 1.0 (grade III) (P < 0.001) in the IMM cohort and 3.6 ± 1.4 (grade I) versus 6.7 ± 1.5 (grade II) versus 9.3 ± 1.4 (grade III) (P < 0.001) in the JMI cohort. The AUCs for surgical and postoperative outcomes are higher for the 3-level IMM classification than for the minor/major classification.

Conclusions

The difference of 3 IMM grades with respect to surgical and postoperative outcomes was validated using an external cohort. The 3-level procedure-based IMM classification was in accordance with the index-based IWATE criteria. The IMM classification performed better than the minor/major classification for stratifying LLR procedures.

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Abbreviations

LLR:

Laparoscopic liver resection

EBL:

Estimated blood loss

ICCLLR:

International consensus conference on laparoscopic liver resection

IMM:

Institut Mutualiste Montsouris

AL:

Anterolateral

PS:

Posterosuperior

ROC:

Receiver-operating characteristics

AUC:

Areas under the receiver-operating characteristics curve

Wedge-AL:

Wedge resection for anterolateral segment

Wedge-PS:

Wedge resection for posterosuperior segment

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Acknowledgements

The authors sincerely thank the surgeons for providing relevant data and valuable insights for the Endoscopic Liver Surgery Study Group in Japan (Supplementary Table 5).

Author information

Author notes

  1. Yoshikuni Kawaguchi and Shogo Tanaka have contributed equally as first co-authors. Go Wakabayashi and Brice Gayet have contributed equally as last co-authors.

Authors and Affiliations

  1. Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France

    Yoshikuni Kawaguchi, David Fuks & Brice Gayet

  2. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Yoshikuni Kawaguchi & Kiyoshi Hasegawa

  3. Departments of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan

    Shogo Tanaka & Shoji Kubo

  4. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City General Hospital, Osaka, Japan

    Akishige Kanazawa

  5. Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan

    Yutaka Takeda

  6. Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan

    Fumitoshi Hirokawa

  7. Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan

    Hiroyuki Nitta

  8. Department of Surgery, Meiwa Hospital, Nishinomiya, Japan

    Takayoshi Nakajima

  9. Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan

    Takashi Kaizu

  10. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Japan

    Masaki Kaibori

  11. Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan

    Toru Kojima

  12. Division of General and Gastroenterological Surgery, Department of Surgery, Toho University, Faculty of Medicine, Tokyo, Japan

    Yuichiro Otsuka & Hironori Kaneko

  13. National Center for Global Health and Medicine, Tokyo, Japan

    Norihiro Kokudo

  14. Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Japan

    Go Wakabayashi

Authors
  1. Yoshikuni Kawaguchi
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  2. Shogo Tanaka
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  3. David Fuks
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  4. Akishige Kanazawa
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  7. Hiroyuki Nitta
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  8. Takayoshi Nakajima
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  9. Takashi Kaizu
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  11. Toru Kojima
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  14. Kiyoshi Hasegawa
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  15. Norihiro Kokudo
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  16. Hironori Kaneko
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  17. Go Wakabayashi
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  18. Brice Gayet
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Corresponding authors

Correspondence to Yoshikuni Kawaguchi or Shogo Tanaka.

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Disclosures

Drs. Yoshikuni Kawaguchi, Shogo Tanaka, David Fuks, Akishige Kanazawa, Yutaka Takeda, Fumitoshi Hirokawa, Hiroyuki Nitta, Takayoshi Nakajima, Takashi Kaizu, Masaki Kaibori, Toru Kojima, Yuichiro Otsuka, Shoji Kubo, Kiyoshi Hasegawa, Norihiro Kokudo, Hironori Kaneko, Go Wakabayashi, and Brice Gayet have no conflicts of interest or financial ties to disclose.

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Kawaguchi, Y., Tanaka, S., Fuks, D. et al. Validation and performance of three-level procedure-based classification for laparoscopic liver resection. Surg Endosc 34, 2056–2066 (2020). https://doi.org/10.1007/s00464-019-06986-6

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