Utility of a novel scoring system for difficulty of pure laparoscopic hepatectomy for intrahepatic cholangiocarcinoma

Abstract

Despite the growing adoption of laparoscopic hepatectomy (LH) for intrahepatic cholangiocarcinoma (ICC), there is no scoring system available designed to evaluate its surgical complexity. This paper aims to introduce a novel difficulty scoring system (DSS), designated as the Wei-DSS, exclusively tailored to assess the surgical difficulty of pure LH for ICC. We retrospectively collected clinical data from ICC patients who underwent pure LH at our institution, spanning from November 2018 to May 2024. Patients were categorized into two levels of Wei-DSS scores (low-difficulty [5-6], and high-difficulty [7-10]) determined by tumor characteristics, liver texture, resection extent and tumor marker levels. A total of 104 patients were enrolled in this study including a low-difficulty (LD) group comprising 47 patients and a high-difficulty (HD) group comprising 57 patients. Perioperative comparisons indicated that the HD group was significantly associated with a longer operation time (318.14 ± 125.89 min vs. 222.83 ± 119.03 min, P < 0.001), higher rates of intraoperative blood transfusions (59.6% vs. 27.7%, P = 0.001), and increased rates of postoperative complications (84.2% vs. 48.9%, P < 0.001) compared to the LD group. The receiver operating characteristic (ROC) curve analysis indicated that the Wei-DSS demonstrated superior predictive accuracy over the Major/Minor Classification for predicting postoperative complication rates (area under the curve [AUC] 0.702 vs. 0.622) and operating time (AUC 0.720 vs. 0.604 ). The Wei-DSS score may have the potential to assist surgeons in categorizing ICC patients with varying levels of surgical difficulty of LH, though it warrants further validations across multiple centers to solidify its efficacy and reliability.

Keywords: Difficulty scoring system; Intrahepatic cholangiocarcinoma; Laparoscopic hepatectomy.

Fig. 1

Comparison of operating time (A), morbidity of complications (B), blood transfusions (C) between the low-difficulty and high-difficulty groups, and comparison of predictive ability of Wei-DSS and the Major/Minor Classification for postoperative complications (D, F) and operating time (E, F).