Minimally Invasive Hepatopancreatobiliary Surgery at a Large Regional Health System: Assessing the Safety of Program Expansion.

Autor:	Falls SJ; Surgical Institute, Allegheny Health Network, Pittsburgh, PA, USA., Maxwell CM; Surgical Institute, Allegheny Health Network, Pittsburgh, PA, USA., Kaye DJ; Drexel University College of Medicine, Philadelphia, PA, USA., Dighe SG; Surgical Institute, Allegheny Health Network, Pittsburgh, PA, USA., Schiffman SC; Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA., Bartlett DL; Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA., Wagner PL; Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA., Allen CJ; Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
Jazyk:	angličtina
Zdroj:	The American surgeon [Am Surg] 2024 Jan; Vol. 90 (1), pp. 85-91. Date of Electronic Publication: 2023 Aug 14.
DOI:	10.1177/00031348231192073
Abstrakt:	Background: Complex, minimally invasive hepatopancreatobiliary surgery (MIS HPB) is safe at high-volume centers, yet outcomes during early implementation are unknown. We describe our experience during period of rapid growth in an MIS HPB program at a large regional health system. Methods: During an increase in MIS HPB (60% greater from preceding year), hospital records of patients who underwent HPB surgery between 1/1/2019 and 12/31/2020 were reviewed. Operative time, estimated blood loss (EBL), conversion rates, length of stay (LOS), and perioperative outcomes were assessed. Results: 267 patients' cases were reviewed. The population was 62 ± 13 years, 50% female, 90% white. MIS was more frequently performed for hepatic than pancreatic resections (59% vs 21%, P < .001). Open cases were more frequently performed for invasive malignancy in both pancreatic (70% vs 40%, P < .018) and hepatic (87% vs 70%, P = .046) resections. There was no difference in operative time between MIS and open surgery (293[218-355]min vs 296[199-399]min, P = .893). When compared to open, there was a shorter LOS (4[2-6]d vs 7[6-10]d, P < .001) and lower readmission rate (21% vs 37%, P = .005) following MIS. Estimated blood loss was lower in MIS liver resections, particularly when performed for benign disease (200[63-500]mL vs 600[200-1200]mL, P = .041). Overall 30-day mortality was similar between MIS and open surgery (1.0% vs 1.8%, P = 1.000). Discussion: During a surgical expansion phase within our regional health system, MIS HPB offered improved perioperative outcomes when compared to open surgery. These data support the safety of implementation even during intervals of rapid programmatic growth. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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