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The external validation of a difficulty scoring system for predicting the risk of intraoperative complications during laparoscopic liver resection

BACKGROUND: This study aimed to externally validate and upgrade the recent difficulty scoring system (DSS) proposed by Halls et al. to predict intraoperative complications (IOC) during laparoscopic liver resection (LLR). METHODS: The DSS was validated in a cohort of 128 consecutive patients undergoi...

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Autores principales: Ivanecz, Arpad, Plahuta, Irena, Magdalenić, Tomislav, Mencinger, Matej, Peruš, Iztok, Potrč, Stojan, Krebs, Bojan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882247/
https://www.ncbi.nlm.nih.gov/pubmed/31775813
http://dx.doi.org/10.1186/s12893-019-0645-y
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author Ivanecz, Arpad
Plahuta, Irena
Magdalenić, Tomislav
Mencinger, Matej
Peruš, Iztok
Potrč, Stojan
Krebs, Bojan
author_facet Ivanecz, Arpad
Plahuta, Irena
Magdalenić, Tomislav
Mencinger, Matej
Peruš, Iztok
Potrč, Stojan
Krebs, Bojan
author_sort Ivanecz, Arpad
collection PubMed
description BACKGROUND: This study aimed to externally validate and upgrade the recent difficulty scoring system (DSS) proposed by Halls et al. to predict intraoperative complications (IOC) during laparoscopic liver resection (LLR). METHODS: The DSS was validated in a cohort of 128 consecutive patients undergoing pure LLRs between 2008 and 2019 at a single tertiary referral center. The validated DSS includes four difficulty levels based on five risk factors (neoadjuvant chemotherapy, previous open liver resection, lesion type, lesion size and classification of resection). As established by the validated DSS, IOC was defined as excessive blood loss (> 775 mL), conversion to an open approach and unintentional damage to surrounding structures. Additionally, intra- and postoperative outcomes were compared according to the difficulty levels with usual statistic methods. The same five risk factors were used for validation done by linear and advanced nonlinear (artificial neural network) models. The study was supported by mathematical computations to obtain a mean risk curve predicting the probability of IOC for every difficulty score. RESULTS: The difficulty level of LLR was rated as low, moderate, high and extremely high in 36 (28.1%), 63 (49.2%), 27 (21.1%) and 2 (1.6%) patients, respectively. IOC was present in 23 (17.9%) patients. Blood loss of >775 mL occurred in 8 (6.2%) patients. Conversion to open approach was required in 18 (14.0%) patients. No patients suffered from unintentional damage to surrounding structures. Rates of IOC (0, 9.5, 55.5 and 100%) increased gradually with statistically significant value among difficulty levels (P < 0.001). The relations between the difficulty level, need for transfusion, operative time, hepatic pedicle clamping, and major postoperative morbidity were statistically significant (P < 0.05). Linear and nonlinear validation models showed a strong correlation (correlation coefficients 0.914 and 0.948, respectively) with the validated DSS. The Weibull cumulative distribution function was used for predicting the mean risk probability curve of IOC. CONCLUSION: This external validation proved this DSS based on patient’s, tumor and surgical factors enables us to estimate the risk of intra- and postoperative complications. A surgeon should be aware of an increased risk of complications before starting with more complex procedures.
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spelling pubmed-68822472019-12-03 The external validation of a difficulty scoring system for predicting the risk of intraoperative complications during laparoscopic liver resection Ivanecz, Arpad Plahuta, Irena Magdalenić, Tomislav Mencinger, Matej Peruš, Iztok Potrč, Stojan Krebs, Bojan BMC Surg Research Article BACKGROUND: This study aimed to externally validate and upgrade the recent difficulty scoring system (DSS) proposed by Halls et al. to predict intraoperative complications (IOC) during laparoscopic liver resection (LLR). METHODS: The DSS was validated in a cohort of 128 consecutive patients undergoing pure LLRs between 2008 and 2019 at a single tertiary referral center. The validated DSS includes four difficulty levels based on five risk factors (neoadjuvant chemotherapy, previous open liver resection, lesion type, lesion size and classification of resection). As established by the validated DSS, IOC was defined as excessive blood loss (> 775 mL), conversion to an open approach and unintentional damage to surrounding structures. Additionally, intra- and postoperative outcomes were compared according to the difficulty levels with usual statistic methods. The same five risk factors were used for validation done by linear and advanced nonlinear (artificial neural network) models. The study was supported by mathematical computations to obtain a mean risk curve predicting the probability of IOC for every difficulty score. RESULTS: The difficulty level of LLR was rated as low, moderate, high and extremely high in 36 (28.1%), 63 (49.2%), 27 (21.1%) and 2 (1.6%) patients, respectively. IOC was present in 23 (17.9%) patients. Blood loss of >775 mL occurred in 8 (6.2%) patients. Conversion to open approach was required in 18 (14.0%) patients. No patients suffered from unintentional damage to surrounding structures. Rates of IOC (0, 9.5, 55.5 and 100%) increased gradually with statistically significant value among difficulty levels (P < 0.001). The relations between the difficulty level, need for transfusion, operative time, hepatic pedicle clamping, and major postoperative morbidity were statistically significant (P < 0.05). Linear and nonlinear validation models showed a strong correlation (correlation coefficients 0.914 and 0.948, respectively) with the validated DSS. The Weibull cumulative distribution function was used for predicting the mean risk probability curve of IOC. CONCLUSION: This external validation proved this DSS based on patient’s, tumor and surgical factors enables us to estimate the risk of intra- and postoperative complications. A surgeon should be aware of an increased risk of complications before starting with more complex procedures. BioMed Central 2019-11-27 /pmc/articles/PMC6882247/ /pubmed/31775813 http://dx.doi.org/10.1186/s12893-019-0645-y Text en © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Ivanecz, Arpad
Plahuta, Irena
Magdalenić, Tomislav
Mencinger, Matej
Peruš, Iztok
Potrč, Stojan
Krebs, Bojan
The external validation of a difficulty scoring system for predicting the risk of intraoperative complications during laparoscopic liver resection
title The external validation of a difficulty scoring system for predicting the risk of intraoperative complications during laparoscopic liver resection
title_full The external validation of a difficulty scoring system for predicting the risk of intraoperative complications during laparoscopic liver resection
title_fullStr The external validation of a difficulty scoring system for predicting the risk of intraoperative complications during laparoscopic liver resection
title_full_unstemmed The external validation of a difficulty scoring system for predicting the risk of intraoperative complications during laparoscopic liver resection
title_short The external validation of a difficulty scoring system for predicting the risk of intraoperative complications during laparoscopic liver resection
title_sort external validation of a difficulty scoring system for predicting the risk of intraoperative complications during laparoscopic liver resection
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882247/
https://www.ncbi.nlm.nih.gov/pubmed/31775813
http://dx.doi.org/10.1186/s12893-019-0645-y
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