Comparative Performance of the Complexity Classification and the Conventional Major/Minor Classification for Predicting the Difficulty of Liver Resection for Hepatocellular Carcinoma

Jae Seong Jang, Jai Young Cho, Soyeon Ahn, Ho Seong Han, Yoo Seok Yoon, Young Rok Choi, Seong Uk Kwon, Sungho Kim, Hanisah Guro

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7 Citations (Scopus)

Abstract

Objective: To compare performances for predicting surgical difficulty and postoperative complications. Background: An expert panel recently proposed a complexity classification for liver resection with 3 categories of complexity (low, medium, or high). We compared this new classification with the conventional major/minor classification. Methods: We retrospectively reviewed 469 hepatocellular carcinoma patients who underwent liver resection between 1 January 1, 2004 and June 30, 2015. We used receiver-operating characteristic curve analysis to compare the performances of both classifications for predicting perioperative outcomes. Results: Both classifications effectively differentiated subgroups of patients in terms of their intraoperative findings and short-term outcomes, including blood loss, transfusion rate, operation time, and postoperative hospital stay (all P < 0.05). The ability to predict complications was not significantly different between the major/minor classification and the complexity classification [area under the curve (AUC) 0.625 vs 0.617, respectively; P= 0.754). However, the complexity classification showed stronger correlations with blood loss (AUC 0.690 vs 0.617, respectively; P = 0.001) and operation time (AUC 0.727 vs 0.619, respectively; P < 0.001) compared with the major/minor classification. To check heterogeneity, the minor resection group was further divided into low (n = 184), medium (n = 149), and high complexity (n = 13) groups. Operation time and blood loss were significantly different among these 3 subgroups of patients. Conclusions: The complexity classification outperformed the major/minor classification for predicting the surgical difficulty of liver resection.

Original languageEnglish
Pages (from-to)18-23
Number of pages6
JournalAnnals of Surgery
Volume267
Issue number1
DOIs
StatePublished - 1 Jan 2018

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Hepatocellular Carcinoma
Liver
Area Under Curve
ROC Curve
Blood Transfusion
Length of Stay

Keywords

  • complications
  • hepatectomy
  • outcomes
  • prognosis

Cite this

@article{815135989ac44393a8ebf48f9d18c88a,
title = "Comparative Performance of the Complexity Classification and the Conventional Major/Minor Classification for Predicting the Difficulty of Liver Resection for Hepatocellular Carcinoma",
abstract = "Objective: To compare performances for predicting surgical difficulty and postoperative complications. Background: An expert panel recently proposed a complexity classification for liver resection with 3 categories of complexity (low, medium, or high). We compared this new classification with the conventional major/minor classification. Methods: We retrospectively reviewed 469 hepatocellular carcinoma patients who underwent liver resection between 1 January 1, 2004 and June 30, 2015. We used receiver-operating characteristic curve analysis to compare the performances of both classifications for predicting perioperative outcomes. Results: Both classifications effectively differentiated subgroups of patients in terms of their intraoperative findings and short-term outcomes, including blood loss, transfusion rate, operation time, and postoperative hospital stay (all P < 0.05). The ability to predict complications was not significantly different between the major/minor classification and the complexity classification [area under the curve (AUC) 0.625 vs 0.617, respectively; P= 0.754). However, the complexity classification showed stronger correlations with blood loss (AUC 0.690 vs 0.617, respectively; P = 0.001) and operation time (AUC 0.727 vs 0.619, respectively; P < 0.001) compared with the major/minor classification. To check heterogeneity, the minor resection group was further divided into low (n = 184), medium (n = 149), and high complexity (n = 13) groups. Operation time and blood loss were significantly different among these 3 subgroups of patients. Conclusions: The complexity classification outperformed the major/minor classification for predicting the surgical difficulty of liver resection.",
keywords = "complications, hepatectomy, outcomes, prognosis",
author = "Jang, {Jae Seong} and Cho, {Jai Young} and Soyeon Ahn and Han, {Ho Seong} and Yoon, {Yoo Seok} and Choi, {Young Rok} and Kwon, {Seong Uk} and Sungho Kim and Hanisah Guro",
year = "2018",
month = "1",
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T1 - Comparative Performance of the Complexity Classification and the Conventional Major/Minor Classification for Predicting the Difficulty of Liver Resection for Hepatocellular Carcinoma

AU - Jang, Jae Seong

AU - Cho, Jai Young

AU - Ahn, Soyeon

AU - Han, Ho Seong

AU - Yoon, Yoo Seok

AU - Choi, Young Rok

AU - Kwon, Seong Uk

AU - Kim, Sungho

AU - Guro, Hanisah

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To compare performances for predicting surgical difficulty and postoperative complications. Background: An expert panel recently proposed a complexity classification for liver resection with 3 categories of complexity (low, medium, or high). We compared this new classification with the conventional major/minor classification. Methods: We retrospectively reviewed 469 hepatocellular carcinoma patients who underwent liver resection between 1 January 1, 2004 and June 30, 2015. We used receiver-operating characteristic curve analysis to compare the performances of both classifications for predicting perioperative outcomes. Results: Both classifications effectively differentiated subgroups of patients in terms of their intraoperative findings and short-term outcomes, including blood loss, transfusion rate, operation time, and postoperative hospital stay (all P < 0.05). The ability to predict complications was not significantly different between the major/minor classification and the complexity classification [area under the curve (AUC) 0.625 vs 0.617, respectively; P= 0.754). However, the complexity classification showed stronger correlations with blood loss (AUC 0.690 vs 0.617, respectively; P = 0.001) and operation time (AUC 0.727 vs 0.619, respectively; P < 0.001) compared with the major/minor classification. To check heterogeneity, the minor resection group was further divided into low (n = 184), medium (n = 149), and high complexity (n = 13) groups. Operation time and blood loss were significantly different among these 3 subgroups of patients. Conclusions: The complexity classification outperformed the major/minor classification for predicting the surgical difficulty of liver resection.

AB - Objective: To compare performances for predicting surgical difficulty and postoperative complications. Background: An expert panel recently proposed a complexity classification for liver resection with 3 categories of complexity (low, medium, or high). We compared this new classification with the conventional major/minor classification. Methods: We retrospectively reviewed 469 hepatocellular carcinoma patients who underwent liver resection between 1 January 1, 2004 and June 30, 2015. We used receiver-operating characteristic curve analysis to compare the performances of both classifications for predicting perioperative outcomes. Results: Both classifications effectively differentiated subgroups of patients in terms of their intraoperative findings and short-term outcomes, including blood loss, transfusion rate, operation time, and postoperative hospital stay (all P < 0.05). The ability to predict complications was not significantly different between the major/minor classification and the complexity classification [area under the curve (AUC) 0.625 vs 0.617, respectively; P= 0.754). However, the complexity classification showed stronger correlations with blood loss (AUC 0.690 vs 0.617, respectively; P = 0.001) and operation time (AUC 0.727 vs 0.619, respectively; P < 0.001) compared with the major/minor classification. To check heterogeneity, the minor resection group was further divided into low (n = 184), medium (n = 149), and high complexity (n = 13) groups. Operation time and blood loss were significantly different among these 3 subgroups of patients. Conclusions: The complexity classification outperformed the major/minor classification for predicting the surgical difficulty of liver resection.

KW - complications

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