Predicting the complexity of robotic liver surgery: a comparative analysis of the IWATE, Kawaguchi-Gayet, Hasegawa, Southampton, and Tampa scores.

[BACKGROUND] The advent of robotic surgery in hepatic procedures has significantly contributed to the advancement and broader adoption of minimally invasive liver surgery, by enhancing the feasibility and safety of increasingly complex interventions. Evaluation of the complexity of minimally invasive liver resection has led to the development of various scoring systems. These scores aided in estimating the technical difficulties associated with hepatectomy. Currently, there is not a broadly validated specific score for robotic liver surgery (RLS). Therefore, it is crucial to evaluate the application of validated scores for minimal invasive liver surgery. This study aims to analyze the predictive performance of four established laparoscopic DSS (IWATE, Kawaguchi-Gayet, Hasegawa, and Southampton) and the recent robotic Tampa score, focusing on their ability to anticipate surgical complexity and major postoperative complications.

[METHODS] We analyzed a single-center prospective cohort of 101 patients who underwent RLS between May 2019 and June 2023. The receiver operating characteristic curve was used to evaluate the precision of the five scores. Spearman's coefficient was used to estimate the correlation strength among the five scores.

[RESULTS] Hepatocellular carcinoma (26.7%) was the most common surgical indication among 101 patients, with 26% of patients undergoing left lateral sectionectomy. The conversion rate was 4%. The mean hospital stay was 5.3 days, with a minimum follow-up of 15 months. The major postoperative complication rate (Clavien-Dindo ≥ IIIa) was 9%. The IWATE score was the most accurate predictor of relevant complications (area under the curve = 0.698).

[CONCLUSION] The IWATE score appeared to offer superior predictive value for major complications following RLS when compared to other difficulty scoring systems. These tools play a fundamental role not only in preoperative planning but also in guiding intraoperative decision-making, anticipating postoperative management needs, and structuring surgical training and case assignment.