Evidence map›Paper›PMID 41676763›Full record

ArticleHepatobiliary surgery and nutrition2026

Validation of the Institute Mutualiste Montsouris system for the stratification of laparoscopic liver resections: an international multicenter study.

Alessandro Mazzotta, David Fuks, Olivier Soubrane, Hwee-Leong Tan, Nicholas L Syn, Safi Dokmak, Salvatore Gruttadauria, Federica Cipriani, Giuseppe Zimmitti, Mohammad Alzoubi and 64 more

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Article in Hepatobiliary surgery and nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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74 authors.

Alessandro MazzottaDepartment of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France.
David FuksDepartment of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France.
Olivier SoubraneDepartment of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France.
Hwee-Leong TanDepartment of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.
Nicholas L SynYong Loo Lin School of Medicine, National University of Singapore, Singapore and Ministry of Health Holdings Singapore, Singapore, Singapore.
Safi DokmakDepartment of HPB Surgery and Liver Transplantation, Beaujon Hospital, University Paris Cite, Clichy, France.
Salvatore GruttadauriaDepartment for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT, University of Pittsburgh Medical Center, Palermo, Italy.
Federica CiprianiHepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.
Giuseppe ZimmittiDepartment of Surgery, Fondazione Poliambulanza, Brescia, Italy.
Mohammad AlzoubiDepartment of General Surgery, School of Medicine, The University of Jordan, Amman, Jordan.
Atsushi SugiokaDepartment of Surgery, Fujita Health University School of Medicine, Aichi, Japan.
Olivier ScattonDepartment of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, Sorbonne Universite, Paris, France.
Paulo HermanLiver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
Yufu PengDivision of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
Marco V MarinoGeneral Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
Roland S CronerDepartment of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany.
Vincenzo MazzaferroHPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano and University of Milan, Milan, Italy.
Adrian K H ChiowHepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore, Singapore.
Iswanto SucandyAdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA.
Arpad IvaneczDepartment of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia.
Sung-Hoon ChoiDepartment of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
Jae Hoon LeeDivision of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Mikel GastacaHepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain.
Marco VivarelliHPB Surgery and Transplantation Unit, Department of Experimental and Clinical Medicine, United Hospital of Ancona, Polytechnic University of Marche, Ancona, Italy.
Felice GiulianteHepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
Andrea RuzzenenteGeneral and Hepatobiliary Surgery, Department of Surgery, Dentistry, Gynecology and Pediatrics University of Verona, GB Rossi Hospital, Verona, Italy.
Chee-Chien YongDepartment of Surgery, Chang Gung Memorial Hospital, Kaohsiung.
Mengqiu YinDepartment of Hepatobiliary Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
Constantino FondevilaGeneral and Digestive Surgery, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
Mikhail EfanovDepartment of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia.
Zenichi MoriseDepartment of Surgery, Okazaki Medical Center, Fujita Health University School of Medicine, Okazaki, Japan.
Fabrizio Di BenedettoHepatopancreatobiliary Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy.
Raffaele BrustiaDepartment of Digestive and Hepatobiliary and Pancreatic Surgery, AP-HP, Henri-Mondor Hospital, Creteil, France.
Raffaele Dalla ValleHepatobiliary Surgery Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
Ugo BoggiDivision of General and Transplant Surgery, University of Pisa, Pisa, Italy.
David GellerDivision of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Andrea BelliDivision of Hepatopancreatobiliary Surgical Oncology, Department of Abdominal Oncology, National Cancer Center-IRCCS-G. Pascale, Naples, Italy.
Riccardo MemeoUnit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Acquaviva delle Fonti, 70021 Bari, Italy.
Alejandro MejiaThe Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA.
James O ParkDepartment of Surgery, University of Washington Medical Center, Seattle, WA, USA.
Fernando RotellarHPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain.
Gi-Hong ChoiDivision of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Ricardo Robles-CamposDepartment of Surgery, Virgen de la Arrixaca University Hospital, IMIB-Pascual Parrilla, Murcia, Spain.
Kiyoshi HasegawaHepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Yoshikuni KawaguchiHepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Xiaoying WangDepartment of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
Robert P SutcliffeDepartment of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Johann PratschkeDepartment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany.
Eric C H LaiDepartment of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
Charing C N ChongDepartment of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China.
Mathieu D'HondtDepartment of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium.
Kazuteru MondenDepartment of Surgery, Fukuyama City Hospital, Hiroshima, Japan.
Santiago Lopez-BenHepatobiliary and Pancreatic Surgery Unit, Department of Surgery, Dr. Josep Trueta Hospital, IdIBGi, Girona, Spain.
T Peter KinghamDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Rong LiuFaculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
Alessandro FerreroDepartment of General and Oncological Surgery. Mauriziano Hospital, Turin, Italy.
Giuseppe Maria EttorreDivision of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy.
Daniel CherquiDepartment of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France.
Xiao LiangDepartment of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Go WakabayashiCenter for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan.
Roberto I TroisiDivision of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital Naples, Naples, Italy.
Tan-To CheungDepartment of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
Motokazu SugimotoDepartment of Hepatobiliary and Pancreatic Surgery, National Cancer Hospital East, Kashiwa, Japan.
Ho-Seong HanDepartment of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, Korea.
Tran Cong Duy LongDepartment of Hepatopancreatobiliary Surgery, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.
Wanguang ZhangHepatic Surgery Center and Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Yonggang WeiDivision of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
Davit L AghayanThe Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Bjorn EdwinThe Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Kuo-Hsin ChenDivision of General Surgery, Far Eastern Memorial Hospital, New Taipei City.
Mohammad Abu HilalDepartment of General Surgery, School of Medicine, The University of Jordan, Amman, Jordan.
Luca AldrighettiHepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.
Brian K P GohDepartment of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.ORCID https://orcid.org/0000-0001-8218-4576
International Robotic and Laparoscopic Liver Resection Study Group Investigators

Funding

X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI SELWYN M VICKERS · 1985 to 2026
$347.4M
NCI NIH HHS P30 CA008748
6 · The paper itself

Abstract

Background: The Institut Mutualiste Montsouris (IMM) 3-level complexity classification has been validated for laparoscopic liver resection (LLR) in several studies with small sample size. However, it has not been well-validated in large studies down to the individual procedure type. Hence, in order to address current limitations in the studies validating the IMM complexity classification, we performed an international multicenter study to validate the IMM complexity classification across its three complexity levels and the categorization of the 11 distinct procedure types. Methods: A retrospective cohort study of 22,252 patients undergoing LLR across 64 centers worldwide between 2005 and 2021 was performed. Baseline characteristics and perioperative outcomes were analyzed across the three difficulty levels and 11 procedure types of the IMM complexity classification. Results: A total of 14,765 patients were included in our final analysis. The main indications for LLR in our study was hepatocellular carcinoma or intrahepatic cholangiocarcinoma (n=7,781, 52.7%) followed by liver metastasectomy (n=3,911, 26.5%). In terms of underlying liver pathology, 5,127 (34.7%) cases had cirrhosis, and 1,214 (8.3%) had portal hypertension. Perioperative outcomes including operative time, open conversion rate, intraoperative blood loss, need for intraoperative blood transfusion, need for Pringle's application, length of stay, postoperative morbidity, major postoperative morbidity and 90-day mortality all demonstrated a significant increasing trend with increasing IMM complexity grades (P<0.001). These trends remained significant following adjustment for baseline characteristics (P<0.001). Notably, when examining the 11 LLR procedure types, all procedures within each IMM complexity grade were individually higher than all procedures in the preceding complexity grade for operative time, blood loss, length of stay, postoperative morbidity and major postoperative morbidity. Conclusions: The three IMM complexity grades were well associated with LLR complexity as determined by key surrogate perioperative measures. Our findings also supported the categorization of the 11 distinct LLR procedures into the three complexity levels.

Indexed as

international multicenter studyIwate criteriaLaparoscopic liver resection (LLR)perioperative outcomesvalidation

Identifiers

PMID41676763
PMCPMC12887290

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