Single Center Laparoscopic Liver Resection Difficulty Scoring System

Objective: Research on clinical feasibility of laparoscopic liver resection difficulty scoring system which is applicable for evaluating the difficulty of surgery and its differences.Methods: Review and analysize clinical data of 292 patients with laparoscopic liver resection in the First Affiliated Hospital of Fujian Medical University from January 2014 to December 2017.Measure operation difficulty with operation time and research difficulty factors with single factor analysis.Mark P<0.05 the border line,to explore difficulty factors of P<0.05 in single factor analysis with multi-factors analysis method to confirm the root factors.Use multiple linear regression to build difficulty model and difficulty points-scoring system,apply which on surgery difficulty scoring and rating to analyze its differences,including operation time,intraoperative blood loss,intraoperative blood transfusion,hepatic inflow occlusion,complications,serious complications,postoperative hospital stay and the time of removal drainage tube.rainage tube.Results: According to the proportion of each factor affecting the predicted operation time to determine four of them,resection range(local resection,left lateral sectionectomy:0,right posterior hepatectomy:2,left hepatectomy:3,right hepatectomy:4)tumor location(S2/S3/S4:0,S5:1,S6:2,S7/S8: 4),tumor diameter(<3cm:0,≥3cm:1),tumor close blood vessel(No:0,Yes:1).Classify surgical difficulty into three levels: low(total score 0-3);medium(total score 4-6);and high(total score ≥7).Based on grouping,low group has 196 cases(67.1%),medium one has 66 cases(22.6%),and high one has 30 cases(10.3%).Operation for low,medium and high group are 110(85-147)min,173.5(136.7-230)min,and 268.5(222-305)min respectively.The difference analysis between two groups is statistically significant(P<0.05);intraoperative blood loss are 200(100-300)ml,350(200-600)ml and 450(300-700)ml;hepatic inflow occlusion are 28(14.3%),37(56.6%),and 12(40%);complications are16(8.2%),11(16.7%),and 7(23.3%);severe complications were 0(0%),3(4.5%),and 4(13.3%);postoperative hospital stay are 6(5-7)days,6(5-8)days,8.5(5.7-9)days;the differences between low and medium groups and low and high groups are statistically significant(P<0.05);the time of removal of drainage tube are 3(2-3)days and 3(2-4)days and 4(2-5)days,the difference between the low and high groups and the medium and high groups are statistically significant(P<0.05);Intraoperative blood transfusion rate are 6 cases(3.1%)),5 cases(7.6%)and 3 cases(10%),pairwise comparison are no statistically significant(P> 0.05).There are no statistically significant to analyze difference in upper abdominal surgical history,hepatic surgery history,liver cirrhosis and BMI≥28 kg/m2 between different degrees of difficulty(P>0.05).Conclusion:The laparoscopic resection difficulty scoring system contribute to effectively distinguishing the difficulty of laparoscopic liver resection and helping liver surgeon to select appropriate surgery based on their own surgical experience and ability.