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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2016

01-08-2016 | Hepatobiliary Tumors

Defining Surgical Difficulty According to the Perceived Complexity of Liver Resection: Validation of a Complexity Classification in Patients with Hepatocellular Carcinoma

Authors: Paramin Muangkaew, MD, Jai Young Cho, MD, PhD, Ho-Seong Han, MD, PhD, Yoo-Seok Yoon, MD, PhD, YoungRok Choi, MD, Jae Yool Jang, MD, Hanlim Choi, MD, Jae Seong Jang, MD, Seong Uk Kwon, MD

Published in: Annals of Surgical Oncology | Issue 8/2016

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Abstract

Background

A classification system for defining the complexity of hepatectomy according to its technical difficulty was recently proposed as a consensus of a panel of experts. We validated this classification system for a prospective liver resection cohort in patients with hepatocellular carcinoma (HCC).

Method

The complexity classification separated liver resections into three categories of complexity (low, medium, or high). We retrospectively reviewed 150 open hepatectomies between 1 March 2004 and 30 November 2013 in patients with HCC, and compared the perioperative outcomes according to the complexity classification.

Results

No differences in patient demographics or pathologic findings were observed among the three groups according to the complexity classification, which effectively differentiated the three groups in terms of intraoperative findings and short-term outcomes. The mean estimated blood loss (p = 0.001), rate of blood transfusion (p < 0.001), and mean operation time (p < 0.001) were significantly different among the three groups. The rates of overall and major complications (p = 0.026 and 0.005, respectively) were significantly greater in the high-complexity group. Multivariate analysis showed that the complexity classification was independently associated with major complications (odds ratio 4.73; p = 0.040); however, overall patient survival (p = 0.139) and disease-free survival (p = 0.076) were not significantly different among the three groups.

Conclusion

The complexity classification effectively differentiated intraoperative and short-term outcomes, and was independently associated with major complications after hepatectomy in patients with HCC.
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Metadata
Title
Defining Surgical Difficulty According to the Perceived Complexity of Liver Resection: Validation of a Complexity Classification in Patients with Hepatocellular Carcinoma
Authors
Paramin Muangkaew, MD
Jai Young Cho, MD, PhD
Ho-Seong Han, MD, PhD
Yoo-Seok Yoon, MD, PhD
YoungRok Choi, MD
Jae Yool Jang, MD
Hanlim Choi, MD
Jae Seong Jang, MD
Seong Uk Kwon, MD
Publication date
01-08-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-5058-2

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