Factors Associated with and Impact of Open Conversion in Laparoscopic and Robotic Minor Liver Resections: An International Multicenter Study of 10,541 Patients.

Autor: Saleh M; Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France., Pascual F; Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France., Ghallab M; Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France., Wu AGR; Ministry of Health Holdings Singapore, Singapore, Singapore., Chin KM; Ministry of Health Holdings Singapore, Singapore, Singapore., Ratti F; Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy., Giglio MC; Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy., Garatti M; Department of Surgery, Fondazione Poliambulanza, Brescia, Italy., Nghia PP; Department of Hepatopancreatobiliary Surgery, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam., Kato Y; Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan., Lim C; Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, Sorbonne Universite, Paris, France., Herman P; Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil., Coelho FF; Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil., Schmelzle M; Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany., Pratschke J; Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany., Aghayan DL; The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Liu Q; Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China., Marino MV; General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.; Oncologic Surgery Department, P. Giaccone University Hospital, Palermo, Italy., Belli A; Department of Abdominal Oncology, Division of Hepatopancreatobiliary Surgical Oncology, National Cancer Center-IRCCS-G, Pascale, Naples, Italy., Chiow AKH; Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore, Singapore., Sucandy I; AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA., Ivanecz A; Department of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia., Di Benedetto F; HPB Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy., Choi SH; Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea., Lee JH; Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea., Park JO; Department of Surgery, University of Washington Medical Center, Seattle, WA, USA., Prieto M; Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain., Guzman Y; General and Digestive Surgery, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain., Fondevila C; General and Digestive Surgery, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain.; General and Digestive Surgery, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain., Efanov M; Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia., Rotellar F; HPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain.; Institute of Health Research of Navarra (IdisNA), Pamplona, Spain., Choi GH; Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea., Robles-Campos R; Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain., Kadam P; Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Sutcliffe RP; Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Troisi RI; Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy., Tang CN; Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China., Chong CC; Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong SAR, China., D'Hondt M; Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium., Dalla Valle B; General and Hepatobiliary Surgery, Department of Surgery, Dentistry, Gynecology and Pediatrics, GB Rossi Hospital, University of Verona, Verona, Italy., Ruzzenente A; General and Hepatobiliary Surgery, Department of Surgery, Dentistry, Gynecology and Pediatrics, GB Rossi Hospital, University of Verona, Verona, Italy., Kingham TP; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Scatton O; Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, Sorbonne Universite, Paris, France., Liu R; Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China., Mejia A; The Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA., Mishima K; Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan., Wakabayashi G; Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan., Lopez-Ben S; Hepatobiliary and Pancreatic Surgery Unit, Department of Surgery, Dr. Josep Trueta Hospital, IdIBGi, Girona, Spain., Wang X; Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China., Ferrero A; Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy., Ettorre GM; Division of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy., Vivarelli M; HPB Surgery and Transplantation Unit, United Hospital of Ancona, Department of Experimental and Clinical Medicine Polytechnic, University of Marche, Ancona, Italy., Mazzaferro V; HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano and University of Milan, Milan, Italy., Giuliante F; Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy., Yong CC; Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan., Yin M; Department of Hepatobiliary Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China., Monden K; Department of Surgery, Fukuyama City Hospital, Hiroshima, Japan., Geller D; Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Chen KH; Division of General Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan., Sugioka A; Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan., Edwin B; The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Cheung TT; Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China., Long TCD; Department of Hepatopancreatobiliary Surgery, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam., Abu Hilal M; Department of Surgery, Fondazione Poliambulanza, Brescia, Italy.; Department of Surgery, University Hospital Southampton, Southampton, UK., Aldrighetti L; Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy., Soubrane O; Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France., Fuks D; Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France., Han HS; Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea., Cherqui D; Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France., Goh BKP; Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Center Singapore, Singapore, Singapore. brian.goh@singhealth.com.sg.; Surgery Academic Clinical Programme, Duke-National University Singapore Medical School, Singapore, Singapore. brian.goh@singhealth.com.sg.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Sep; Vol. 31 (9), pp. 5615-5630. Date of Electronic Publication: 2024 Jun 15.
DOI: 10.1245/s10434-024-15498-0
Abstrakt: Introduction: Despite the increasing widespread adoption and experience in minimally invasive liver resections (MILR), open conversion occurs not uncommonly even with minor resections and as been reported to be associated with inferior outcomes. We aimed to identify risk factors for and outcomes of open conversion in patients undergoing minor hepatectomies. We also studied the impact of approach (laparoscopic or robotic) on outcomes.
Methods: This is a post-hoc analysis of 20,019 patients who underwent RLR and LLR across 50 international centers between 2004-2020. Risk factors for and perioperative outcomes of open conversion were analysed. Multivariate and propensity score-matched analysis were performed to control for confounding factors.
Results: Finally, 10,541 patients undergoing either laparoscopic (LLR; 89.1%) or robotic (RLR; 10.9%) minor liver resections (wedge resections, segmentectomies) were included. Multivariate analysis identified LLR, earlier period of MILR, malignant pathology, cirrhosis, portal hypertension, previous abdominal surgery, larger tumor size, and posterosuperior location as significant independent predictors of open conversion. The most common reason for conversion was technical issues (44.7%), followed by bleeding (27.2%), and oncological reasons (22.3%). After propensity score matching (PSM) of baseline characteristics, patients requiring open conversion had poorer outcomes compared with successful MILR cases as evidenced by longer operative times, more blood loss, higher requirement for perioperative transfusion, longer duration of hospitalization and higher morbidity, reoperation, and 90-day mortality rates.
Conclusions: Multiple risk factors were associated with conversion of MILR even for minor hepatectomies, and open conversion was associated with significantly poorer perioperative outcomes.
(© 2024. Society of Surgical Oncology.)
Databáze: MEDLINE
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