Ban- Iwate difficulty scoring system for laparoscopic liver resection- Validation in a Single centre UK cohort

Abstract

Background: Evolution and wide-spreading of laparoscopic liver resection has been a drive to develop scoring systems to predict difficulty such as the Ban- Iwate scoring system. Our aim was to validate the 'Difficulty Scoring System' in a single centre UK cohort. Methods: The proposed 'difficulty scoring system' for laparoscopic liver resection (LLR) includes a three-level index of difficulty based on tumor parameters (location, size, proximity to major vessels), liver function and extend of planned liver resection. The system was validated in a single tertiary centre cohort of 123 patients who underwent LLR between 2015 and 2018. Perioperative parameters and short term outcomes were compared between the three levels of difficulty groups. Results: 123 patients who underwent LLR were classified as low (n=24), intermediate (n=68) and high (n=31) difficulty. Conversion rate was associated with the difficulty level (p=0.026). Overall complication rate was 16.7%, 18.5% and 29% in the low, intermediate and high difficulty group, respectively. Difficulty scoring system was associated with increased transfusion rate (p= 0.034). None in the low, 2 in the intermediate and 5 in the high difficulty group. Ban- Iwate classification was significantly correlated with the length of stay (p=0.027). Conclusion: Preoperative evaluation using the Ban- Iwate difficulty scoring system for laparoscopic liver resection predicted the difficulty of the operation and the postoperative outcomes. Implementing the difficulty scoring system could allow appropriate patients' selection, especially for surgeons in the beginning of their training.