{"title":"Institut Mutualiste Montsouris classification is associated with postoperative portal vein thrombosis in laparoscopic liver resection.","authors":"Tatsuya Sakamoto, Akihiro Tanemura, Benson Kaluba, Haruna Komatsubara, Koki Maeda, Daisuke Noguchi, Kazuyuki Gyoten, Takahiro Ito, Aoi Hayasaki, Takehiro Fujii, Yusuke Iizawa, Yasuhiro Murata, Naohisa Kuriyama, Masashi Kishiwada, Shugo Mizuno","doi":"10.1007/s00464-025-11558-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic liver resection (LLR) is a surgical procedure with varying degrees of difficulty depending on tumor status and surgical technique. Therefore, we aimed to evaluate the relationship between surgical difficulty levels and outcomes of LLR, particularly portal vein thrombosis (PVT).</p><p><strong>Methods: </strong>We performed LLRs in 214 patients between January 2009 and December 2022. Among them, 200 patients who underwent pure LLR were allocated into three groups according to the Institut Mutualiste Montsouris (IMM) classification: Group I (n = 152), Group II (n = 26), and Group III (n = 22). The perioperative outcomes were also compared; risk factors for postoperative complications were evaluated.</p><p><strong>Results: </strong>The operation time was significantly longer (p < 0.001) and intraoperative blood loss was significantly higher (p < 0.001) in Group III than in Groups I and II. The rates of complications of Clavien-Dindo (CD) grade 2 or higher (19.1% vs. 34.6% vs. 63.6%, p < 0.001) and CD grade 3 or higher (5.3% vs. 11.5% vs. 22.7%, p = 0.015) were significantly higher and postoperative hospital stay (9 vs. 13 vs. 16 days, p < 0.001) was significantly longer in Group III than in Groups I and II. The IMM classification (odds ratio [OR], 5.727; 95% confidence interval [CI], 1.863-17.610; p = 0.002] and blood transfusion (OR, 6.410; 95% CI, 2.215-18.549; p < 0.001) were independent risk factors for CD grade 2 or higher complication using multivariate analysis. PVT was the most common complication in patients with CD of grade 2 or higher, occurring in 14 of 48 patients. Hepatitis viral status (OR: 7.552, p = 0.021 [non-B non-C for HCV]) and the IMM classification (OR: 58.767, p < 0.001[II vs. I]; OR: 40.535, p = 0.002 [III vs. I]) were independent risk factors for PVT using multivariate analysis.</p><p><strong>Conclusions: </strong>The IMM classification could strongly predict postoperative complications, particularly PVT.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"1924-1934"},"PeriodicalIF":2.7000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgical Endoscopy And Other Interventional Techniques","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00464-025-11558-y","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/27 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Laparoscopic liver resection (LLR) is a surgical procedure with varying degrees of difficulty depending on tumor status and surgical technique. Therefore, we aimed to evaluate the relationship between surgical difficulty levels and outcomes of LLR, particularly portal vein thrombosis (PVT).
Methods: We performed LLRs in 214 patients between January 2009 and December 2022. Among them, 200 patients who underwent pure LLR were allocated into three groups according to the Institut Mutualiste Montsouris (IMM) classification: Group I (n = 152), Group II (n = 26), and Group III (n = 22). The perioperative outcomes were also compared; risk factors for postoperative complications were evaluated.
Results: The operation time was significantly longer (p < 0.001) and intraoperative blood loss was significantly higher (p < 0.001) in Group III than in Groups I and II. The rates of complications of Clavien-Dindo (CD) grade 2 or higher (19.1% vs. 34.6% vs. 63.6%, p < 0.001) and CD grade 3 or higher (5.3% vs. 11.5% vs. 22.7%, p = 0.015) were significantly higher and postoperative hospital stay (9 vs. 13 vs. 16 days, p < 0.001) was significantly longer in Group III than in Groups I and II. The IMM classification (odds ratio [OR], 5.727; 95% confidence interval [CI], 1.863-17.610; p = 0.002] and blood transfusion (OR, 6.410; 95% CI, 2.215-18.549; p < 0.001) were independent risk factors for CD grade 2 or higher complication using multivariate analysis. PVT was the most common complication in patients with CD of grade 2 or higher, occurring in 14 of 48 patients. Hepatitis viral status (OR: 7.552, p = 0.021 [non-B non-C for HCV]) and the IMM classification (OR: 58.767, p < 0.001[II vs. I]; OR: 40.535, p = 0.002 [III vs. I]) were independent risk factors for PVT using multivariate analysis.
Conclusions: The IMM classification could strongly predict postoperative complications, particularly PVT.
期刊介绍：
Uniquely positioned at the interface between various medical and surgical disciplines, Surgical Endoscopy serves as a focal point for the international surgical community to exchange information on practice, theory, and research.
Topics covered in the journal include:
-Surgical aspects of:
Interventional endoscopy,
Ultrasound,
Other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology,
-Gastroenterologic surgery
-Thoracic surgery
-Traumatic surgery
-Orthopedic surgery
-Pediatric surgery
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