TY - JOUR
T1 - Difficulty scoring system in laparoscopic distal pancreatectomy
AU - Ohtsuka, Takao
AU - Ban, Daisuke
AU - Nakamura, Yoshiharu
AU - Nagakawa, Yuichi
AU - Tanabe, Minoru
AU - Gotoh, Yoshitaka
AU - Velasquez, Vittoria Vanessa D.M.
AU - Nakata, Kohei
AU - Sahara, Yatsuka
AU - Takaori, Kyoichi
AU - Honda, Goro
AU - Misawa, Takeyuki
AU - Kawai, Manabu
AU - Yamaue, Hiroki
AU - Morikawa, Takanori
AU - Kuroki, Tamotsu
AU - Mou, Yiping
AU - Lee, Woo Jung
AU - Shrikhande, Shailesh V.
AU - Tang, Chung Ngai
AU - Conrad, Claudius
AU - Han, Ho Seong
AU - Palanivelu, Chinnusamy
AU - Asbun, Horacio J.
AU - Kooby, David A.
AU - Wakabayashi, Go
AU - Takada, Tadahiro
AU - Yamamoto, Masakazu
AU - Nakamura, Masafumi
N1 - Funding Information:
This study was approved by the Ethics Committees of Kyushu University (No. 28-555), Tokyo Medical and Dental University (No. M2016-294), Nippon Medical University (No. 28-03-741), and Tokyo Medical University (No. 2018-016), and conducted following the guidelines for research ethics of the Ministry of Education, Culture, Sports, Science and Technology and the Ministry of Health, Labour and Welfare of Japan (http://www.life science.mext.go.jp/bioethics/ekigaku.html). Among 986 distal pancreatectomies (DPs) which are comprised of 535 LDPs and 451 open DPs between 2008 and 2017, data from 80 patients who underwent LDP were retrospectively reviewed from four Japanese high-volume centers for pancreatic surgery. Spleen preservation or combined splenectomy for benign disease was at the operating surgeon’s discretion. Spleen preservation with combined resection of splenic artery and vein (Warshaw operation [16]) was excluded in this study, since most of Warshaw’s operations performed in our institutions were conversion cases from L-SPDP, and the assessment of preoperative DS for this technique was not feasible.
Funding Information:
Acknowledgments This study was supported by a Grant-in-Aid from the Japan Society for the Promotion of Sciences for Scientific Research (B) (Grant Number 16H05417).
Publisher Copyright:
© 2018 Japanese Society of Hepato-Biliary-Pancreatic Surgery
PY - 2018/11
Y1 - 2018/11
N2 - Background: Several factors affect the level of difficulty of laparoscopic distal pancreatectomy (LDP). The purpose of this study was to develop a difficulty scoring (DS) system to quantify the degree of difficulty in LDP. Methods: We collected clinical data for 80 patients who underwent LDP. A 10-level difficulty index was developed and subcategorized into a three-level difficulty index; 1–3 as low, 4–6 as intermediate, and 7–10 as high index. The automatic linear modeling (LINEAR) statistical tool was used to identify factors that significantly increase level of difficulty in LDP. Results: The operator's 10-level DS concordance between the 10-level DS by the reviewers, LINEAR index DS, and clinical index DS systems were analyzed, and the weighted Cohen's kappa statistic were at 0.869, 0.729, and 0.648, respectively, showing good to excellent inter-rater agreement. We identified five factors significantly affecting level of difficulty in LDP; type of operation, resection line, proximity of tumor to major vessel, tumor extension to peripancreatic tissue, and left-sided portal hypertension/splenomegaly. Conclusions: This novel DS for LDP adequately quantified the degree of difficulty, and can be useful for selecting patients for LDP, in conjunction with fitness for surgery and prognosis.
AB - Background: Several factors affect the level of difficulty of laparoscopic distal pancreatectomy (LDP). The purpose of this study was to develop a difficulty scoring (DS) system to quantify the degree of difficulty in LDP. Methods: We collected clinical data for 80 patients who underwent LDP. A 10-level difficulty index was developed and subcategorized into a three-level difficulty index; 1–3 as low, 4–6 as intermediate, and 7–10 as high index. The automatic linear modeling (LINEAR) statistical tool was used to identify factors that significantly increase level of difficulty in LDP. Results: The operator's 10-level DS concordance between the 10-level DS by the reviewers, LINEAR index DS, and clinical index DS systems were analyzed, and the weighted Cohen's kappa statistic were at 0.869, 0.729, and 0.648, respectively, showing good to excellent inter-rater agreement. We identified five factors significantly affecting level of difficulty in LDP; type of operation, resection line, proximity of tumor to major vessel, tumor extension to peripancreatic tissue, and left-sided portal hypertension/splenomegaly. Conclusions: This novel DS for LDP adequately quantified the degree of difficulty, and can be useful for selecting patients for LDP, in conjunction with fitness for surgery and prognosis.
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U2 - 10.1002/jhbp.578
DO - 10.1002/jhbp.578
M3 - Article
C2 - 30118575
AN - SCOPUS:85053505192
VL - 25
SP - 489
EP - 497
JO - Journal of Hepato-Biliary-Pancreatic Sciences
JF - Journal of Hepato-Biliary-Pancreatic Sciences
SN - 1868-6974
IS - 11
ER -