A Novel Difficulty Classification for Perioperative Risk Assessment in High-level Hepatobiliary Pancreatic Surgeries

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  • YAMAZAKI Shiori
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • SHIMIZU Akira
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • KUBOTA Koji
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • NOTAKE Tsuyoshi
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • KITAGAWA Noriyuki
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • MASUO Hitoshi
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • YOSHIZAWA Takahiro
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • HAYASHI Hikaru
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • HIRANO Syohei
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • INUZUKA Hisamichi
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • SOEJIMA Yuji
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine

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Purpose : Although mortality and morbidity rate of high-level hepatobiliary pancreatic (HBP) surgery has been improved, which remains still high in some procedures. The difficulty of high-level HBP surgeries are varies depending on the surgical complexity, thereby perioperative outcomes can be variable. The aim this study was to establish a novel difficulty classification of high-level HBP surgeries and to assess its validity.<br>Methods : High-level HBP surgeries were classified into four groups, A to D, in order of increasing difficulty, based on the expert opinion. A total of 473 patients who underwent high-level HBP surgery from July 2014 to July 2021 in our hospital were classified into aforementioned four groups, and surgical and postoperative outcomes of which were compared.<br>Results : The numbers of patients in each difficulty group were as follows : A (n＝62), B (n＝278), C (n＝74) and D (n＝59). Operation time and blood loss showed a significant stepwise increase in the group A to D (p<0.001 and p<0.001 respectively). The duration of postoperative hospital stay also increased significantly from the group A to D (p<0.001). The incidence of complications over Clavien-Dindo classification IIIa increased in group A to D significantly (35.5％ vs 35.3 vs 37.8 vs 54.2％ ; p＝0.021). However, the 90-day mortality rates did not differ within four groups (1.6％ vs 0.4％ vs 2.7％ vs 1.7％ ; p＝0.394).<br>Conclusions : The novel difficulty classification of high-level HBP surgeries can predict surgical risk in each surgical procedure. Further large-scale nationwide study should be warranted to confirm these results.

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