Detailed Abstract
[E-poster]
[E22] Development and validation of a novel difficulty scoring system for laparoscopic liver re-resection for hepatocellular carcinoma with previous hepatectomy
Eunhye LEE1 , Jai Young CHO*1 , Ho-Seong HAN1 , Yoo-Seok YOON1 , Hae Won LEE1 , Jun Suh LEE1 , Boram LEE1 , Yeongsoo JO1 , Meeyoung KANG1 , Yeshong PARK1
1 Department Of Surgery, Seoul National University Bundang Hospital, REPUBLIC OF KOREA
Background : Surgical difficulty of laparoscopic liver re-resection (LLR-R) is subjectively experienced due to the factors related to previous hepatectomy and preoperative liver condition. However, only few attempted to objectively predict the difficulty of LLR-R. The aim of this study is to develop the difficulty scoring system (DSS) of LLR-R using preoperative factors and the information of previous hepatectomy among hepatocellular carcinoma (HCC) patients.
Methods : Patients who underwent LLR-R for HCC from 2004 to 2021 with history of liver resection for HCC were retrospectively reviewed. The DSS of LLR-R was developed with respect to operation time and estimated blood loss (EBL) by identifying the risk factors and assigning the points to each independent factor determined from the multivariate analysis.
Results : 77 patients, diagnosed with hepatocellular carcinoma, who previously underwent any kind of liver resection and consecutive laparoscopic liver re-resection, were included and retrospectively reviewed. Surgical difficulty of LLR-R was estimated with the operation time and EBL. Multivariate analysis showed that gender (male, OR 4.44, 95% CI 0.97-20.29, p=0.04), preoperative albumin (OR 8.19, 95% CI 1.49-45.05, p=0.016), tumor location: anterolateral and posterosuperior (OR 5.81, 95% CI 1.89-17.88, p=0.002), and, additionally, preoperative total bilirubin (OR 5.20, 95% CI 0.93-29.04, p=0.06) were independent predictors of surgical difficulty of LLR-R. These variables were assigned with the points based on their ORs, ranging from 4 to 12. The cases were calculated with this new DSS and divided into high score group and low score group by the median score (high ≥ 7, low <7), and the surgical outcomes were compared between these groups. Operation time was longer (128.55 ± 90.78 vs. 226.41 ± 153.13min, p=0.001), EBL was larger (278.16 ± 362.04 vs. 630.26 ± 843.95ml, p=0.21), and hospital stay was longer (4.74 ± 2.44 vs. 8.36 ± 9.19d, p=0.022) significantly in the high score group than the low score group.
Conclusions : Surgical difficulty of LLR-R is well predicted by the novel scoring system. Although the previous liver resection may affect subordinately, yet the patients’ current liver condition and tumor location at LLR-R was important to predict the difficulty.
Methods : Patients who underwent LLR-R for HCC from 2004 to 2021 with history of liver resection for HCC were retrospectively reviewed. The DSS of LLR-R was developed with respect to operation time and estimated blood loss (EBL) by identifying the risk factors and assigning the points to each independent factor determined from the multivariate analysis.
Results : 77 patients, diagnosed with hepatocellular carcinoma, who previously underwent any kind of liver resection and consecutive laparoscopic liver re-resection, were included and retrospectively reviewed. Surgical difficulty of LLR-R was estimated with the operation time and EBL. Multivariate analysis showed that gender (male, OR 4.44, 95% CI 0.97-20.29, p=0.04), preoperative albumin (OR 8.19, 95% CI 1.49-45.05, p=0.016), tumor location: anterolateral and posterosuperior (OR 5.81, 95% CI 1.89-17.88, p=0.002), and, additionally, preoperative total bilirubin (OR 5.20, 95% CI 0.93-29.04, p=0.06) were independent predictors of surgical difficulty of LLR-R. These variables were assigned with the points based on their ORs, ranging from 4 to 12. The cases were calculated with this new DSS and divided into high score group and low score group by the median score (high ≥ 7, low <7), and the surgical outcomes were compared between these groups. Operation time was longer (128.55 ± 90.78 vs. 226.41 ± 153.13min, p=0.001), EBL was larger (278.16 ± 362.04 vs. 630.26 ± 843.95ml, p=0.21), and hospital stay was longer (4.74 ± 2.44 vs. 8.36 ± 9.19d, p=0.022) significantly in the high score group than the low score group.
Conclusions : Surgical difficulty of LLR-R is well predicted by the novel scoring system. Although the previous liver resection may affect subordinately, yet the patients’ current liver condition and tumor location at LLR-R was important to predict the difficulty.
SESSION
E-poster
E-Session 09/16 ALL DAY