Validation of the Iwate scoring system for the stratification of laparoscopic liver resections: an international multicenter study
Peng, Yufu Liu, Fei Li, Bo Wei, Yonggang Tan, Hwee-Leong Syn, Nicholas L Fuks, David Soubrane, Olivier Dokmak, Safi Gruttadauria, Salvatore
Peng, Yufu
Liu, Fei
Li, Bo
Wei, Yonggang
Tan, Hwee-Leong
Syn, Nicholas L
Fuks, David
Soubrane, Olivier
Dokmak, Safi
Gruttadauria, Salvatore
Affiliation
West China Hospital; Sichuan University; Singapore General Hospital; National Cancer Centre Singapore; National University of Singapore; Universite Paris Descartes; Beaujon Hospital; University of Catania; Fondazione Poliambulanza; IRCCS San Raffaele Hospital; Fujita Health University; Sorbonne Universite; Assistance Publique – Hopitaux de Paris; University of Sao Paulo; Oslo University Hospital; University of Oslo; Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello; P. Giaccone University Hospital; University Hospital Magdeburg; Fondazione IRCCS Istituto Nazionale Tumori di Milano; University of Milan; Changi General Hospital; AdventHealth Tampa; University Medical Center Maribor; CHA University; CHA Bundang Medical Center; Asan Medical Center; University of Ulsan; Cruces University Hospital; University of the Basque Country; United Hospital of Ancona; University of Marche; Catholic University of the Sacred Heart; University of Verona; GB Rossi Hospital; Chang Gung Memorial Hospital; Affiliated Jinhua Hospital; Zhejiang University; Hospital Universitario La Paz; University of Barcelona; Moscow Clinical Scientific Center; Okazaki Medical Center; Fujita Health University; University of Modena and Reggio Emilia; University of Parma; University of Pisa; University of Pittsburgh Medical Center; National Cancer Center - IRCCS-G. Pascale; "F. Miulli" General Regional Hospital; Methodist Dallas Medical Center; University of Washington Medical Center; Clinica Universidad de Navarra; Universidad de Navarra; Severance Hospital; Yonsei University; Virgen de la Arrixaca University Hospital; University of Tokyo; Zhongshan Hospital; Fudan University; University Hospitals Birmingham NHS Foundation Trust; Charité-Universitätsmedizin; Freie Universität Berlin; Berlin Institute of Health; Pamela Youde Nethersole Eastern Hospital; Prince of Wales Hospital; Chinese University of Hong Kong; Groeninge Hospital; Fukuyama City Hospital; Dr. Josep Trueta Hospital; Memorial Sloan Kettering Cancer Center; First Medical Center of Chinese People's Liberation Army General Hospital; Mauriziano Hospital; San Camillo Forlanini Hospital; Sir Run-Run Shaw Hospital; Ageo Central General Hospital; Federico II University Hospital Naples; Queen Mary Hospital; National Cancer Hospital East; Seoul National University Hospital Bundang; Seoul National University; University Medical Center Ho Chi Minh City; University Hospital Southampton NHS Foundation Trust; Tongji Hospital; Huazhong University; Far Eastern Memorial Hospital; Hospital Clínic Barcelona; University of Pittsburgh Medical Center Italy
Other Contributors
Ratti, Francesca
Gastaca, Mikel
Meurs, Juul
De Meyere, Celine
Lee, Kit-Fai
Ng, Kelvin K
Salimgereeva, Diana
Alikhanov, Ruslan
Thiruchelvam, Nita
Jang, Jae Young
Kojima, Masayuki
Pirola Kruger, Jaime Arthur
Ferreira Coehlo, Fabricio
Lopez-Lopez, Victor
Casella I Robert, Margarida
Montalti, Roberto
Giglio, Mariano
Lee, Boram
D'Silva, Mizelle
Wang, Hao-Ping
Saleh, Mansour
Pascual, Franco
Chen, Zewei
Yu, Shian
Vani, Simone
Ardito, Francesco
Giustuzieri, Ugo
Citterio, Davide
Mocchegiani, Federico
Colasanti, Marco
Berardi, Giammauro
Guzman, Yoelimar
Labadie, Kevin P
Conticchio, Maria
Dogeas, Epameinondas
Kauffmann, Emanuele F
Giuffrida, Mario
Sommacale, Daniele
Laurent, Alexis
Magistri, Paolo
Cauchy, Francois
Tang, Chung-Ngai
Barbara, Marco
Pagano, Duilio
Liu, Qu
Siow, Tiing-Foong
Lim, Chetana
Nghia, Phan Phuoc
Dalla Valle, Bernardo
Kawaguchi, Yoshikuni
Kadam, Prashsant
Krenzien, Felix
Schmelzle, Moritz
Zheng, Junhao
Rahimli, Mirhasan
Fretland, Asmund Avdem
Ghotbi, Jacob
Gastaca, Mikel
Meurs, Juul
De Meyere, Celine
Lee, Kit-Fai
Ng, Kelvin K
Salimgereeva, Diana
Alikhanov, Ruslan
Thiruchelvam, Nita
Jang, Jae Young
Kojima, Masayuki
Pirola Kruger, Jaime Arthur
Ferreira Coehlo, Fabricio
Lopez-Lopez, Victor
Casella I Robert, Margarida
Montalti, Roberto
Giglio, Mariano
Lee, Boram
D'Silva, Mizelle
Wang, Hao-Ping
Saleh, Mansour
Pascual, Franco
Chen, Zewei
Yu, Shian
Vani, Simone
Ardito, Francesco
Giustuzieri, Ugo
Citterio, Davide
Mocchegiani, Federico
Colasanti, Marco
Berardi, Giammauro
Guzman, Yoelimar
Labadie, Kevin P
Conticchio, Maria
Dogeas, Epameinondas
Kauffmann, Emanuele F
Giuffrida, Mario
Sommacale, Daniele
Laurent, Alexis
Magistri, Paolo
Cauchy, Francois
Tang, Chung-Ngai
Barbara, Marco
Pagano, Duilio
Liu, Qu
Siow, Tiing-Foong
Lim, Chetana
Nghia, Phan Phuoc
Dalla Valle, Bernardo
Kawaguchi, Yoshikuni
Kadam, Prashsant
Krenzien, Felix
Schmelzle, Moritz
Zheng, Junhao
Rahimli, Mirhasan
Fretland, Asmund Avdem
Ghotbi, Jacob
Publication date
2025-01-24
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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.
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.
Type
Article