Publication

Validation of the Iwate scoring system for the stratification of laparoscopic liver resections: an international multicenter study

Abstract
Introduction: The Iwate difficulty scoring system (DSS) is one of the most widely validated DSS for laparoscopic liver resection (LLR). However, these studies only validated the 4 difficulty levels and did not validate the 12-point difficulty index of the system. To address current limitations in the studies validating the Iwate difficulty scoring system (DSS), we performed an international multicenter study to validate the Iwate DSS across both its four difficulty levels and 12-point difficulty index. Methods: A retrospective cohort study of 22,252 patients undergoing LLR across 64 centers worldwide between 2005 and 2021 was performed. Baseline characteristics and perioperative outcomes were analyzed across the four difficulty levels and 12-point difficulty index of the Iwate DSS. Results: A total of 14,759 patients met the inclusion criteria. The main indications for LLR were hepatocellular carcinoma/intrahepatic cholangiocarcinoma (52.8 %), and metastatic tumors liver (26.5 %). In terms of underlying liver pathology, 5127 patients (34.8 %) had liver cirrhosis, and 1214 patients (8.3 %) had portal hypertension. Intraoperative outcomes (operation time, blood loss, blood transfusion, use of Pringles maneuver and open conversion) and postoperative outcomes (length of stay, morbidity, major complications, and 90-day mortality) significantly increased with stepwise increases across the four difficulty levels (P < 0.001) and 12-point difficulty index (P < 0.001). These trends remained significant following adjustment for baseline characteristics (P < 0.001). Conclusion: The Iwate DSS 12-point difficulty index and four difficulty levels correlated well with LLR difficulty as determined by key surrogate perioperative measures.
Author
Peng, Yufu
Liu, Fei
Li, Bo
Wei, Yonggang
Tan, Hwee-Leong
Syn, Nicholas L
Fuks, David
Soubrane, Olivier
Dokmak, Safi
Gruttadauria, Salvatore
Zimmitti, Giuseppe
Jaber, Bashar
Cipriani, Federica
Kato, Yutaro
Scatton, Olivier
Herman, Paulo
Aghayan, Davit L
Marino, Marco V
Croner, Roland S
Mazzaferro, Vincenzo
Chiow, Adrian K H
Sucandy, Iswanto
Ivanecz, Arpad
Choi, Sung Hoon
Lee, Jae Hoon
Prieto, Mikel
Vivarelli, Marco
Giuliante, Felice
Ruzzenente, Andrea
Yong, Chee-Chien
Yin, Mengqiu
Fondevila, Constantino
Efanov, Mikhail
Morise, Zenichi
Di Benedetto, Fabrizio
Brustia, Raffaele
Dalla Valle, Raffaele
Boggi, Ugo
Geller, David
Belli, Andrea
Memeo, Riccardo
Mejia, Alejandro
Park, James O
Rotellar, Fernando
Choi, Gi-Hong
Robles-Campos, Ricardo
Hasegawa, Kiyoshi
Wang, Xiaoying
Sutcliffe, Robert P
Pratschke, Johann
Lai, Eric C H
Chong, Charing C N
D'Hondt, Mathieu
Monden, Kazuteru
Lopez-Ben, Santiago
Kingham, T Peter
Liu, Rong
Ferrero, Alessandro
Ettorre, Giuseppe Maria
Cherqui, Daniel
Liang, Xiao
Mishima, Kohei
Wakabayashi, Go
Troisi, Roberto I
Cheung, Tan-To
Sugimoto, Motokazu
Sugioka, Atsushi
Han, Ho-Seong
Duy Long, Tran Cong
Abu Hilal, Mohammad
Zhang, Wanguang
Chen, Kuo-Hsin
Aldrighetti, Luca
Edwin, Bjorn
Goh, Brian K P
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Date
2025-01-24
Type
Article
Subject
Hepatectomy, Carcinoma, hepatocellular, Liver neoplasms, Liver cirrhosis, Hepatectomy
Collections
UHB General Surgery
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Citation
Peng Y, Liu F, Li B, Wei Y, Tan HL, Syn NL, Fuks D, Soubrane O, Dokmak S, Gruttadauria S, Zimmitti G, Jaber B, Cipriani F, Kato Y, Scatton O, Herman P, Aghayan DL, Marino MV, Croner RS, Mazzaferro V, Chiow AKH, Sucandy I, Ivanecz A, Choi SH, Lee JH, Prieto M, Vivarelli M, Giuliante F, Ruzzenente A, Yong CC, Yin M, Fondevila C, Efanov M, Morise Z, Di Benedetto F, Brustia R, Dalla Valle R, Boggi U, Geller D, Belli A, Memeo R, Mejia A, Park JO, Rotellar F, Choi GH, Robles-Campos R, Hasegawa K, Wang X, Sutcliffe RP, Pratschke J, Lai ECH, Chong CCN, D'Hondt M, Monden K, Lopez-Ben S, Kingham TP, Liu R, Ferrero A, Ettorre GM, Cherqui D, Liang X, Mishima K, Wakabayashi G, Troisi RI, Cheung TT, Sugimoto M, Sugioka A, Han HS, Duy Long TC, Abu Hilal M, Zhang W, Chen KH, Aldrighetti L, Edwin B, Goh BKP; International robotic and laparoscopic liver resection study group investigators. Validation of the Iwate scoring system for the stratification of laparoscopic liver resections: An international multicenter study. Eur J Surg Oncol. 2025 Jun;51(6):109597. doi: 10.1016/j.ejso.2025.109597. Epub 2025 Jan 24.
Journal / Source Title
European Journal of Surgical Oncology
DOI
10.1016/j.ejso.2025.109597
URI
https://mider.dspace7.openrepository.com/handle/20.500.14200/8756
PMID
40088501
Publisher
Elsevier
Publisher’s URL
https://www.sciencedirect.com/journal/european-journal-of-surgical-oncology
Publisher’s statement
Note / Copyright