Textbook outcomes in the liver-first approach for colorectal liver metastases: prospective multicentre analysis.

Autor:	Ramia JM; Department of Surgery, Hospital General Universitario Dr. Balmis, ISABIAL, Universidad Miguel Hernandez, Alicante, Spain., Villodre-Tudela C; Department of Surgery, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain., Falgueras-Verdaguer L; Department of Surgery, Hospital Universitario Dr. Josep Trueta, Girona, Spain., Zambudio-Carroll N; Department of Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain., Castell-Gómez JT; Department of Surgery, Hospital Universitario La Paz, Madrid, Spain., Carbonell-Morote S; Department of Surgery, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain., Blas-Laina JL; Department of Surgery, Hospital Royo Villanova, Zaragoza, Spain., Borrego-Estella V; Department of Surgery, Hospital Universitario Lozano Blesa, Zaragoza, Spain., Sánchez-Pérez B; Department of Surgery, Hospital Regional Universitario de Málaga, Málaga, Spain., Serradilla-Martín M; Instituto de Investigación Sanitaria Aragón, Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Jazyk:	angličtina
Zdroj:	BJS open [BJS Open] 2024 Jan 03; Vol. 8 (1).
DOI:	10.1093/bjsopen/zrad123
Abstrakt:	Background: Textbook outcome is a valuable tool for assessing surgical outcomes. The aim of this study was to analyse textbook-outcome rates in the prospective Spanish National Registry of the Liver-First Approach (RENACI Project) and the factors influencing textbook-outcome achievement. Additionally, a model for assessing a procedure-specific textbook outcome for the liver-first approach was proposed. Methods: A retrospective analysis of a prospective and multicentre database that included consecutive patients with colorectal cancers and synchronous liver metastases who underwent a liver-first approach between June 2019 and August 2020 was performed. Two types of textbook outcome were measured: classic textbook outcome and liver-first-approach-specific textbook outcome (which included negative margins, no perioperative transfusion, no postoperative major surgical complications, no prolonged length of hospital stay, no readmissions, no mortality, and full treatment completion). The primary endpoint was textbook-outcome rate for a liver-first approach at 90 days. Results: A total of 149 patients were included in the analysis. Classic and liver-first-approach-specific textbook-outcome rates were 71.8 per cent (107 patients) and 46 per cent (69 patients) respectively. Factors significantly associated with liver-first-approach-specific textbook-outcome achievement in the multivariable analysis were the number of metastases (OR 0.82 (95 per cent c.i. 0.73 to 0.92); P = 0.001) and intraoperative blood loss (OR 0.99 (95 per cent c.i. 0.99 to 1.00); P = 0.007). Prolonged length of hospital stay (33 patients, 41 per cent), positive margins (31 patients, 39 per cent), perioperative transfusion (27 patients, 34 per cent), and no full treatment completion (18 patients, 23 per cent) were the items that most frequently prevented liver-first-approach-specific textbook-outcome achievement. Conclusion: Liver-first-approach-specific textbook outcome is a promising tool for measuring the quality of care when using the liver-first approach for synchronous colorectal liver metastases. (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)
Databáze:	MEDLINE
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