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

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Pubmed体系：
作者：
Peng Yufu[1] * ; Liu Fei[1] ; Li Bo[1] ; Wei Yonggang[2] ; Tan Hwee-Leong[3] ; Syn Nicholas L[4] ; Fuks David[5] ; Soubrane Olivier[5] ; Dokmak Safi[6] ; Gruttadauria Salvatore[7] ; Zimmitti Giuseppe[8] ; Jaber Bashar[8] ; Cipriani Federica[9] ; Kato Yutaro[10] ; Scatton Olivier[11] ; Herman Paulo[12] ; Aghayan Davit L[13] ; Marino Marco V[14] ; Croner Roland S[15] ; Mazzaferro Vincenzo[16] ; Chiow Adrian K H[17] ; Sucandy Iswanto[18] ; Ivanecz Arpad[19] ; Choi Sung Hoon[20] ; Lee Jae Hoon[21] ; Prieto Mikel[22] ; Vivarelli Marco[23] ; Giuliante Felice[24] ; Ruzzenente Andrea[25] ; Yong Chee-Chien[26] ; Yin Mengqiu[27] ; Fondevila Constantino[28] ; Efanov Mikhail[29] ; Morise Zenichi[30] ; Di Benedetto Fabrizio[31] ; Brustia Raffaele[32] ; Dalla Valle Raffaele[33] ; Boggi Ugo[34] ; Geller David[35] ; Belli Andrea[36] ; Memeo Riccardo[37] ; Mejia Alejandro[38] ; Park James O[39] ; Rotellar Fernando[40] ; Choi Gi-Hong[41] ; Robles-Campos Ricardo[42] ; Hasegawa Kiyoshi[43] ; Wang Xiaoying[44] ; Sutcliffe Robert P[45] ; Pratschke Johann[46] ; Lai Eric C H[47] ; Chong Charing C N[48] ; D'Hondt Mathieu[49] ; Monden Kazuteru[50] ; Lopez-Ben Santiago[51] ; Kingham T Peter[52] ; Liu Rong[53] ; Ferrero Alessandro[54] ; Ettorre Giuseppe Maria[55] ; Cherqui Daniel[56] ; Liang Xiao[57] ; Mishima Kohei[58] ; Wakabayashi Go[58] ; Troisi Roberto I[59] ; Cheung Tan-To[60] ; Sugimoto Motokazu[61] ; Sugioka Atsushi[10] ; Han Ho-Seong[62] ; Duy Long Tran Cong[63] ; Abu Hilal Mohammad[64] ; Zhang Wanguang[65] ; Chen Kuo-Hsin[66] ; Aldrighetti Luca[9] ; Edwin Bjorn[13] ; Goh Brian K P[67] ;
机构： [1]Division of Liver Surgery,Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China. [2]Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China. [3]Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore. [4]Yong Loo Lin School of Medicine, National University of Singapore, Singapore. [5]Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France. [6]Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France. [7]Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT, University of Pittsburgh Medical Center Italy, Palermo, Italy, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy, Department of Surgery and Medical and Surgical Specialties, University of Catania, Catania, Italy. [8]Department of Surgery, Fondazione Poliambulanza, Brescia, Italy. [9]Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy. [10]Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan. [11]Department of Digestive, HBP and Liver Transplantation, Hopital Pitte-Salpetriere, Sorbonne Universite, Paris, France. [12]Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil. [13]The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. [14]General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy, Oncologic Surgery Department, P. Giaccone University Hospital, Palermo, Italy. [15]Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany. [16]HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano and University of Milan, Milan, Italy. [17]Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore. [18]AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA. [19]Department of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia. [20]Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea. [21]Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. [22]Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain. [23]HPB Surgery and Transplantation Unit, United Hospital of Ancona, Department of Experimental and Clinical Medicine Polytechnic University of Marche, Ancona, Italy. [24]Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy. [25]General and Hepatobiliary Surgery, Department of Surgery, Dentistry, Gynecology and Pediatrics University of Verona, GB Rossi Hospital, Verona, Italy. [26]Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan. [27]Department of Hepatobiliary Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China. [28]General and Digestive Surgery, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain, General and Digestive Surgery, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain. [29]Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia. [30]Department of Surgery, Okazaki Medical Center, Fujita Health University School of Medicine, Okazaki, Japan. [31]Hepatopancreatobiliary Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy. [32]Department of Digestive and Hepatobiliary and Pancreatic Surgery, AP-HP, Henri-Mondor Hospital, Creteil, France. [33]Hepatobiliary Surgery Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy. [34]Division of General and Transplant Surgery, University of Pisa, Pisa, Italy. [35]Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA. [36]Department of Abdominal Oncology, Division of Hepatopancreatobiliary Surgical Oncology, National Cancer Center - IRCCS-G. Pascale, Naples, Italy. [37]Unit of Hepato-Pancreatc-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy. [38]The Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA. [39]Department of Surgery, University of Washington Medical Center. Seattle, USA. [40]HPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain, Institute of Health Research of Navarra (IdisNA), Pamplona, Spain. [41]Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. [42]Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain. [43]Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. [44]Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China. [45]Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom. [46]Department of Surgery, Campus Charite Mitte and Campus Virchow-Klinikum, Charite-Universitatsmedizin, Corporate Member of Freie Universitat Berlin, and Berlin Institute of Health, Berlin, Germany. [47]Department of Surgery, Pamela Youde Nethersole Eastern Hospital, China. [48]Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, China. [49]Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium. [50]Department of Surgery, Fukuyama City Hospital, Hiroshima, Japan. [51]Hepatobiliary and Pancreatic Surgery Unit, Department of Surgery, Dr. Josep Trueta Hospital, IdIBGi, Girona, Spain. [52]Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. [53]Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China. [54]Department of General and Oncological Surgery. Mauriziano Hospital, Turin, Italy. [55]Division of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy. [56]Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France. [57]Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China. [58]Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan. [59]Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy. [60]Department of Surgery, Queen Mary Hospital, The University of Hong Kong, China. [61]Department of Hepatobiliary and Pancreatic Surgery, National Cancer Hospital East, Chiba, Japan. [62]Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, South Korea. [63]Department of Hepato-Pancreato-Biliary Surgery, University Medical Center Ho Chi Minh City, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam. [64]Department of Surgery, Fondazione Poliambulanza, Brescia, Italy, Department of Surgery, University Hospital Southampton, United Kingdom. [65]Hepatic Surgery Center and Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China. [66]Division of General Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan. [67]Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Duke National University of Singapore Medical School, Singapore.
出处：
DOI： 10.1016/j.ejso.2025.109597
ISSN：

关键词： Laparoscopic liver resection Iwate criteria Validation Perioperative outcomes Difficulty score

摘要：
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.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.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).The Iwate DSS 12-point difficulty index and four difficulty levels correlated well with LLR difficulty as determined by key surrogate perioperative measures.Copyright © 2025. Published by Elsevier Ltd.

基金：
Dr T. P. Kingham was partially supported by the US National Cancer Institute MSKCC Core Grant number P30 CA008747 for this study. Dr M. Yin was partially funded by the Research Project of Zhejiang Provincial Public Welfare Fund project in the Field of Social development (LGF20H160028) Dr B. K. Goh was partially funded by a grant from the Intuitive Foundation for this work.
语种：
外文
PubmedID：
中科院(CAS)分区：
出版当年[2025]版：
大类 | 2 区 医学
小类 | 2 区 肿瘤学 2 区 外科
最新[2025]版：
大类 | 2 区 医学
小类 | 2 区 肿瘤学 2 区 外科
第一作者：
第一作者机构： [1]Division of Liver Surgery,Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
通讯作者：
推荐引用方式(GB/T 7714)：
Peng Yufu,Liu Fei,Li Bo,et al.Validation of the Iwate scoring system for the stratification of laparoscopic liver resections: An international multicenter study[J].European Journal Of Surgical Oncology : The Journal Of The European Society Of Surgical Oncology And The British Association Of Surgical Oncology.2025,51(6):109597.doi:10.1016/j.ejso.2025.109597.
APA：
Peng Yufu,Liu Fei,Li Bo,Wei Yonggang,Tan Hwee-Leong...&Goh Brian K P.(2025).Validation of the Iwate scoring system for the stratification of laparoscopic liver resections: An international multicenter study.European Journal Of Surgical Oncology : The Journal Of The European Society Of Surgical Oncology And The British Association Of Surgical Oncology,51,(6)
MLA：
Peng Yufu,et al."Validation of the Iwate scoring system for the stratification of laparoscopic liver resections: An international multicenter study".European Journal Of Surgical Oncology : The Journal Of The European Society Of Surgical Oncology And The British Association Of Surgical Oncology 51..6(2025):109597

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