Empirical Study Of IC And DSS-ER Difficulty Score System In Laparoscopic Liver Resection

Objective: To evaluate the reliability of the difficulty score system based on the Iwate Criteria(IC)and the difficulty scoring system based on extent of ressection(DSS-ER)in predicting the difficulty of laparoscopic liver tumor resection,in order to verify the practicability of IC and DSS-ER.Methods: The clinical data of laparoscopic liver resection(LLR)for benign and malignant liver tumors treated in the Department of Hepatobiliary and Pancreatic surgery of the affiliated Hospital of Zunyi Medical University from January 2012 to October 2021 were collected and analyzed.First of all,to explore the correlation between the two surgical difficulty scoring systems of IC and DSS-ER,and then score the LLR patients according to the IC difficulty scoring system,and then divide them into different difficulty groups according to the scoring results,and compare the differences of perioperative clinical data between the groups;on this basis,LLR patients are divided into anatomical resection and non-anatomical resection subgroups,and the differences of perioperative clinical data are compared between each group.Then the difficulty score was determined by DSS-ER difficulty score system and grouped,and the differences of perioperative clinical data were compared between groups.Finally,the predictive efficiency of IC and DSS-ER was evaluated.Results: A total of 184 patients were included.There were 107,57 and 20 patients in the low,medium and high difficulty groups according to DSS-ER score,respectively.The IC scores of the low,medium and high difficulty groups were analyzed.The median IC score of the low difficulty group was 5,the median IC score of the moderate difficulty group was 8,and the median IC score of the high difficulty group was 10.The difference was statistically significant(P<0.001).The results of Spearman correlation test showed that the correlation coefficient was 0.768(P<0.001),indicating that there was a high correlation between IC and DSS-ER.According to IC score,there were 24 cases,80 cases,50 cases and 30 cases in low,medium,high and expert difficulty groups,respectively.The intraoperative blood loss,operation time,postoperative hospital stay,intraoperative blood transfusion rate,hilar occlusion rate,conversion to laparotomy rate and postoperative complication rate all increased with the increase of operation difficulty,and the difference was statistically significant(P<0.05).In the subgroup analysis,in the anatomical hepatectomy group,the intraoperative blood loss,operation time,postoperative hospital stay,intraoperative blood transfusion rate,hilar obstruction rate,conversion to laparotomy rate and postoperative complication rate increased with the increase of operative difficulty,and the difference was statistically significant(P<0.05).In the non-anatomical hepatectomy group,only the amount of intraoperative blood loss and operation time increased with the increase of operation difficulty,and the difference was statistically significant(P<0.05).According to the DSS-ER score,the intraoperative blood loss,operation time,postoperative hospital stay,intraoperative blood transfusion rate,hilar occlusion rate,conversion to laparotomy rate and postoperative complication rate increased with the increase of operation difficulty,and the difference was statistically significant(P<0.05).Conclusion: To a certain extent,both IC and DSS-ER can effectively predict the difficulty of preoperative LLR operation,and IC has more advantages;they have a certain correlation,can complement each other,and can be applied and promoted in domestic clinical practice in the future,which has a certain reference value for guiding the establishment of LLR training system.