Luo B, Wu SK, Zhang K, Wang PH, Chen WW, Fu N, Yang ZM, Hao JC. Development of a novel difficulty scoring system for laparoscopic liver resection procedure in patients with intrahepatic duct stones. World J Gastrointest Surg 2024; 16(10): 3133-3141 [PMID: 39575299 DOI: 10.4240/wjgs.v16.i10.3133]
Corresponding Author of This Article
Jing-Cheng Hao, MD, Associate Professor, Department of Hepatobiliary and Pancreatic Surgery, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, No. 278 Baoguang Avenue, Xindu District, Chengdu 610500, Sichuan Province, China. jingcheng.hao@cmc.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Oct 27, 2024; 16(10): 3133-3141 Published online Oct 27, 2024. doi: 10.4240/wjgs.v16.i10.3133
Development of a novel difficulty scoring system for laparoscopic liver resection procedure in patients with intrahepatic duct stones
Bo Luo, Si-Kai Wu, Ke Zhang, Pei-Hong Wang, Wei-Wei Chen, Ning Fu, Zhi-Ming Yang, Jing-Cheng Hao
Bo Luo, Si-Kai Wu, Ke Zhang, Wei-Wei Chen, Ning Fu, Zhi-Ming Yang, Department of Hepatobiliary and Vascular Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
Pei-Hong Wang, Department of General Surgery, The Western Theater Command General Hospital, Chengdu 610500, Sichuan Province, China
Jing-Cheng Hao, Department of Hepatobiliary and Pancreatic Surgery, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
Co-first authors: Bo Luo and Si-Kai Wu.
Author contributions: Luo B and Wu SK contributed equally to this study; Luo B, Wu SK analyzed the data and wrote the manuscript; Hao JC and Zhang K collected the data; Wang PH, Cheng WW, Fu N, and Yang ZM performed the surgery and provided constructive discussion; All authors have read and approved the final manuscript.
Institutional review board statement: The Institutional Review Board of the First Affiliated Hospital of Chengdu Medical College approved our study, No. 2024CYFYIRB-BA-Apr11.
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Dataset available from the corresponding author.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing-Cheng Hao, MD, Associate Professor, Department of Hepatobiliary and Pancreatic Surgery, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, No. 278 Baoguang Avenue, Xindu District, Chengdu 610500, Sichuan Province, China. jingcheng.hao@cmc.edu.cn
Received: July 18, 2024 Revised: August 23, 2024 Accepted: September 11, 2024 Published online: October 27, 2024 Processing time: 71 Days and 17.6 Hours
Abstract
BACKGROUND
For intrahepatic duct (IHD) stones, laparoscopic liver resection (LLR) is currently a reliable treatment. However, the current LLR difficulty scoring system (DSS) is only available for patients with hepatocellular carcinoma.
AIM
To explore the development of a DSS for IHD stone patients with LLR and the validation of its reliability.
METHODS
We used clinical data from 80 patients who received LLR for IHD stones. Forty-six of these patients were used in multiple linear regression to construct a scoring system. Another 34 patients from different centers were used as external validation. The completeness of our DSS was then evaluated in patients with varying degrees of surgical difficulty based on documented surgical outcomes in the study group of patients.
RESULTS
The following five predictors were ultimately included and scored by calculating the weighted contribution of each factor to the prediction of operative time in the training cohort: Location of stones, number of stones ≥ 3, stones located in the bile ducts of several grades, previous biliary surgery less than twice, distal bile duct atrophy. Subsequently, the data set was validated using a DSS developed from the variables. The following variables were identified as statistically significant in external validation: Operative time, blood loss, intraoperative transfusion, postoperative alanine aminotransferase, and Clavien-Dindo grading ≥ 3. These variables demonstrated statistically significant differences in patients with three or more grades.
CONCLUSION
Patients with IHD stones have varying degrees of surgical difficulty, and the newly developed DSS can be validated with external data to effectively predict risks and complications after LLR surgery.
Core Tip: This is a retrospective observational study that employs a training group to develop a difficulty scoring system for evaluating patients with intrahepatic duct stones who are undergoing laparoscopic liver resection. By employing multiple linear regression modeling, five correlates of surgical difficulty were identified (location of stones, number of stones ≥ 3, stones located in the bile ducts of several grades, previous biliary surgery less than twice, distal bile duct atrophy). Validation with an external dataset demonstrated that the model exhibits favorable predictive performance to surgical difficulty and surgical complications.
