Abstract：
The Iwate Score (IS) have not been well-validated for specific procedures, especially for right posterior sectionectomy (RPS). In this study, the utility of the IS was determined for laparoscopic (L)RPS and the effect of tumor location on surgical outcomes was investigated.
Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria. Baseline characteristics and perioperative outcomes of patients stratified based on the Iwate score were compared to determine whether a correlation with surgical difficulty existed. A 1:1 Mahalanobis distance matching was utilized to investigate the effect of tumor location on L-RPS outcomes.
The patients were stratified into 3 levels of difficulty (31 intermediate, 143 advanced, and 422 expert) based on the IS. When using a stepwise increase of the IS excluding the tumor location score, only Pringle\'s maneuver was more frequently used in the higher surgical difficulty level (35.5%, 54.6%, and 65.2%, intermediate, advanced, and expert levels, respectively, Z = 3.34, p = 0.001). Other perioperative results were not associated with a statistical gradation toward higher difficulty level. 80 of 85 patients with a segment VI lesion and 511 patients with a segment VII lesion were matched 1:1. There were no significant differences in the perioperative outcomes of the two groups including open conversion, operating time, blood loss, intraoperative blood transfusion, postoperative stay, major morbidity, and mortality.
Among patients undergoing L-RPS, the IS did not significantly correlate with most outcome measures associated with intraoperative difficulty and postoperative outcomes. Similarly, tumor location had no effect on L-RPS outcomes.
Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria. Baseline characteristics and perioperative outcomes of patients stratified based on the Iwate score were compared to determine whether a correlation with surgical difficulty existed. A 1:1 Mahalanobis distance matching was utilized to investigate the effect of tumor location on L-RPS outcomes.
The patients were stratified into 3 levels of difficulty (31 intermediate, 143 advanced, and 422 expert) based on the IS. When using a stepwise increase of the IS excluding the tumor location score, only Pringle\'s maneuver was more frequently used in the higher surgical difficulty level (35.5%, 54.6%, and 65.2%, intermediate, advanced, and expert levels, respectively, Z = 3.34, p = 0.001). Other perioperative results were not associated with a statistical gradation toward higher difficulty level. 80 of 85 patients with a segment VI lesion and 511 patients with a segment VII lesion were matched 1:1. There were no significant differences in the perioperative outcomes of the two groups including open conversion, operating time, blood loss, intraoperative blood transfusion, postoperative stay, major morbidity, and mortality.
Among patients undergoing L-RPS, the IS did not significantly correlate with most outcome measures associated with intraoperative difficulty and postoperative outcomes. Similarly, tumor location had no effect on L-RPS outcomes.
摘要：
岩手评分(IS)还没有得到很好的验证，用于特定的程序，尤其是右后段切除术（RPS）。在这项研究中,确定了IS在腹腔镜(L)RPS中的实用性,并研究了肿瘤位置对手术结局的影响.
对40个国际中心的647例L-RPS进行事后分析，其中596L-RPS病例符合纳入标准。比较基于Iwate评分分层的患者的基线特征和围手术期结局，以确定是否存在与手术难度的相关性。利用1:1马氏距离匹配来研究肿瘤位置对L-RPS结果的影响。
将患者分为3个难度级别（31个中级，143先进，和422专家)基于IS。当使用逐级增加不包括肿瘤位置评分的IS时，只有Pringle的动作在手术难度较高的情况下使用频率更高(35.5%，54.6%,和65.2%，中间,先进,和专家级，分别,Z=3.34，p=0.001）。其他围手术期结果与更高难度水平的统计分级无关。85例VI段病变患者中的80例和511例VII段病变患者1：1匹配。两组患者围手术期结局包括开放转换,差异无统计学意义。操作时间,失血,术中输血,术后停留时间,主要发病率，和死亡率。
在接受L-RPS的患者中，IS与术中困难和术后结局相关的大多数结局指标无显著相关性.同样，肿瘤位置对L-RPS结局无影响.
对40个国际中心的647例L-RPS进行事后分析，其中596L-RPS病例符合纳入标准。比较基于Iwate评分分层的患者的基线特征和围手术期结局，以确定是否存在与手术难度的相关性。利用1:1马氏距离匹配来研究肿瘤位置对L-RPS结果的影响。
将患者分为3个难度级别（31个中级，143先进，和422专家)基于IS。当使用逐级增加不包括肿瘤位置评分的IS时，只有Pringle的动作在手术难度较高的情况下使用频率更高(35.5%，54.6%,和65.2%，中间,先进,和专家级，分别,Z=3.34，p=0.001）。其他围手术期结果与更高难度水平的统计分级无关。85例VI段病变患者中的80例和511例VII段病变患者1：1匹配。两组患者围手术期结局包括开放转换,差异无统计学意义。操作时间,失血,术中输血,术后停留时间,主要发病率，和死亡率。
在接受L-RPS的患者中，IS与术中困难和术后结局相关的大多数结局指标无显著相关性.同样，肿瘤位置对L-RPS结局无影响.
