Journal article
IWATE criteria are associated with perioperative outcomes in robotic hepatectomy: a retrospective review of 225 resections
Surgical endoscopy, Vol.36(2), pp.889-895
02/01/2022
DOI: 10.1007/s00464-021-08345-w
PMCID: PMC8758630
PMID: 33608766
Abstract
Background Robotic hepatectomy (RH) is increasingly utilized for minor and major liver resections. The IWATE criteria were developed to classify minimally invasive liver resections by difficulty. The objective of this study was to apply the IWATE criteria in RH and to describe perioperative and oncologic outcomes of RH over the last decade at our institution. Methods Perioperative and oncologic outcomes of patients who underwent RH between 2011 and 2019 were retrospectively collected. The difficulty level of each operation was assessed using the IWATE criteria, and outcomes were compared at each level. Univariate linear regression was performed to characterize the relationship between IWATE criteria and perioperative outcomes (OR time, EBL, and LOS), and a multivariable model was also developed to address potential confounding by patient characteristics (age, sex, BMI, prior abdominal surgery, ASA class, and simultaneous non-hepatectomy operation). Results Two hundred and twenty-five RH were performed. Median IWATE criteria for RH were 6 (IQR 5-9), with low, intermediate, advanced, and expert resections accounting for 23% (n = 51), 34% (n = 77), 32% (n = 72), and 11% (n = 25) of resections, respectively. The majority of resections were parenchymal-sparing approaches, including anatomic segmentectomies and non-anatomic partial resections. 30-day complication rate was 14%, conversion to open surgery occurred in 9 patients (4%), and there were no deaths within 30 days postoperatively. In the univariate linear regression analysis, IWATE criteria were positively associated with OR time, EBL, and LOS. In the multivariable model, IWATE criteria were independently associated with greater OR time, EBL, and LOS. Two-year overall survival for hepatocellular carcinoma and intrahepatic cholangiocarcinoma was 94% and 50%, respectively. Conclusion In conclusion, the IWATE criteria are associated with surgical outcomes after RH. This series highlights the utility of RH for difficult hepatic resections, particularly parenchymal-sparing resections in the posterosuperior sector, extending the indication of minimally invasive hepatectomy in experienced hands and potentially offering select patients an alternative to open hepatectomy or other less definitive liver-directed treatment options.
Details
- Title: Subtitle
- IWATE criteria are associated with perioperative outcomes in robotic hepatectomy: a retrospective review of 225 resections
- Creators
- Kevin P. Labadie - University of WashingtonDavid J. Droullard - University of WashingtonAlex W. Lois - University of WashingtonSara K. Daniel - University of WashingtonKathryn E. McNevin - University of WashingtonJaqueline Valdez Gonzalez - University of WashingtonYongwoo D. Seo - University of WashingtonKevin M. Sullivan - University of WashingtonKyle S. Bilodeau - University of WashingtonLindsay K. Dickerson - University of WashingtonAlan F. Utria - University of WashingtonJohn Calhoun - University of WashingtonVenu G. Pillarisetty - Center for Special Minimally Invasive and Robotic SurgeryJonathan G. Sham - University of WashingtonRaymond S. Yeung - University of WashingtonJames O. Park - Center for Special Minimally Invasive and Robotic Surgery
- Resource Type
- Journal article
- Publication Details
- Surgical endoscopy, Vol.36(2), pp.889-895
- DOI
- 10.1007/s00464-021-08345-w
- PMID
- 33608766
- PMCID
- PMC8758630
- NLM abbreviation
- Surg Endosc
- ISSN
- 0930-2794
- eISSN
- 1432-2218
- Publisher
- Springer Nature
- Number of pages
- 7
- Language
- English
- Date published
- 02/01/2022
- Academic Unit
- Surgery
- Record Identifier
- 9985015821002771
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