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Kuemmerli C, Sijberden JP, Cipriani F, Osei-Bordom D, Aghayan D, Lanari J, de Meyere C, Cacciaguerra AB, Rotellar F, Fuks D, Liu R, Besselink MG, Zimmitti G, Ruzzenente A, di Benedetto F, Succandy I, Efanov M, Memeo R, Jovine E, Vrochides D, Dagher I, Croner R, Lopez-Ben S, Geller D, Ahmad J, Gallagher T, White S, Alseidi A, Goh BKP, Sparrelid E, Ratti F, Marudanayagam R, Fretland ÅA, Vivarelli M, D'Hondt M, Cillo U, Edwin B, Sutcliffe RP, Aldrighetti LA, Hilal MA. Is prolonged operative time associated with postoperative complications in liver surgery? An international multicentre cohort study of 5424 patients. Surg Endosc 2024:10.1007/s00464-024-11276-x. [PMID: 39347957 DOI: 10.1007/s00464-024-11276-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 09/11/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND The relation between operative time and postoperative complications in liver surgery is unclear. The aim of this study is to assess the impact of operative time on the development of postoperative complications in patients who underwent minimally invasive or open liver resections of various anatomical extent and technical difficulty levels. METHODS In this retrospective cohort study, patients that underwent a right hemihepatectomy (RH), technically major resection (anatomically minor resection in segment 1, 4a, 7 or 8; TMR) or left lateral sectionectomy (LLS) between 2000 and 2022 were extracted from a multicenter database comprising the prospectively maintained databases of 31 centers in 13 countries. Minimally invasive procedures performed during the learning curve were omitted. Logistic regression models, performed separately for 9 different groups based on stratification by procedure type and allocated surgical approach, were used to assess the association between the fourth quartile of operative time (25% of patients with the longest operative time) and postoperative complications. RESULTS Overall, 5424 patients were included: 1351 underwent RH (865 open, 373 laparoscopic and 113 robotic), 2821 TMR (1398 open, 1225 laparoscopic and 198 robotic), and 1252 LLS (241 open, 822 laparoscopic and 189 robotic). After adjusting for potential confounders (age, BMI, gender, ASA grade, previous abdominal surgery, disease type and extent, blood loss, Pringle, intraoperative transfusions and incidents), the fourth quartile of operative time, compared to the first three quartiles, was associated with an increased risk of postoperative complications after open, laparoscopic and robotic TMR (aOR 1.35, p = 0.031; aOR 1.74, p = 0.001 and aOR 3.11, p = 0.014, respectively), laparoscopic and robotic RH (aOR 1.98, p = 0.018 and aOR 3.28, p = 0.055, respectively) and solely laparoscopic LLS (aOR 1.69, p = 0.019). CONCLUSIONS A prolonged operative time is associated with an increased risk of postoperative complications, although it remains to be defined if this is a causal relationship.
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Affiliation(s)
- Christoph Kuemmerli
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati, 57, 25124, Brescia, Italy.
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Jasper P Sijberden
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati, 57, 25124, Brescia, Italy
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Davit Aghayan
- The Intervention Center, Department of HPB Surgery, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Jacopo Lanari
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, Padova University Hospital, Padova, Italy
| | - Celine de Meyere
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Andrea Benedetti Cacciaguerra
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Fernando Rotellar
- HPB and Liver Transplantation Unit, Department of Surgery, Institute of Health Research of Navarra (IdisNA), University Clinic, Universidad de Navarra, Pamplona, Spain
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Giuseppe Zimmitti
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati, 57, 25124, Brescia, Italy
| | | | - Fabrizio di Benedetto
- Hepato-Pancreatic-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Mikhail Efanov
- Department of Hepato-Pancreatic-Biliary Surgery, Moscow Clinical Research Centre, Moscow, Russia
| | - Riccardo Memeo
- Hepato-Pancreato-Biliary Surgery Unit, Miulli Hospital, Acquaviva Delle Fonti, Bari, Italy
| | - Elio Jovine
- Department of Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Dionisios Vrochides
- Division of Abdominal Transplantation, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Ibrahim Dagher
- Department of Digestive Minimally Invasive Surgery, Antoine Béclère Hospital, Paris, France
| | - Roland Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Santi Lopez-Ben
- Department of Surgery, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - David Geller
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jawad Ahmad
- University Hospitals Coventry and Warwickshire, Clifford Bridges Road, Coventry, UK
| | - Tom Gallagher
- Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Steven White
- Department of Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Department of Surgery, Virginia Mason Medical Center, Seattle, USA
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore
| | - Ernesto Sparrelid
- Division of Surgery, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Åsmund Avdem Fretland
- The Intervention Center, Department of HPB Surgery, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Marco Vivarelli
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, Padova University Hospital, Padova, Italy
| | - Bjørn Edwin
- The Intervention Center, Department of HPB Surgery, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | | | - Luca A Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Mohammed Abu Hilal
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati, 57, 25124, Brescia, Italy.
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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Watson MD, Baimas-George MR, Thompson KJ, Iannitti DA, Ocuin LM, Baker EH, Martinie JB, Vrochides D. Improved oncologic outcomes for minimally invasive left pancreatectomy: Propensity-score matched analysis of the National Cancer Database. J Surg Oncol 2020; 122:1383-1392. [PMID: 32772366 DOI: 10.1002/jso.26147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/17/2020] [Accepted: 07/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Minimally invasive (MIS) left pancreatectomy (LP) is increasingly used to treat pancreatic adenocarcinoma (PDAC). Despite improved short-term outcomes, no studies have demonstrated long-term benefits over open resection. METHODS The National Cancer Database was queried between 2010 and 2016 for patients with PDAC, grouped by surgical approach (MIS vs open). Demographics, comorbidities, clinical staging, and pathologic staging were used for propensity-score matching. Perioperative, short-term oncologic, and survival outcomes were compared. RESULTS After matching, both cohorts included 805 patients. There were no differences in baseline characteristics, staging, or preoperative therapy between cohorts. The MIS cohort had a shorter length of stay (6.8 ± 5.5 vs 8.5 ± 7.3 days; P < .0001) with the trend toward improved time to chemotherapy (53.9 ± 26.1 vs 57.9 ± 29.9 days; P = .0511) and margin-positive resection rate (15.3% vs 18.9%; P = .0605). Lymph node retrieval and receipt of chemotherapy were similar. The MIS cohort had higher median overall survival (28.0 vs 22.1 months; P = .0067). Subgroup analysis demonstrated the highest survival for robotic compared with laparoscopic and open LP (41.9 vs 26.6 vs 22.1 months; P < .0001). CONCLUSIONS This study demonstrates the safety of MIS LP and favorable long-term oncologic outcomes. The improved survival after MIS LP warrants further study with prospective, randomized trials.
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Affiliation(s)
- Michael D Watson
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Maria R Baimas-George
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Kyle J Thompson
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - David A Iannitti
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Lee M Ocuin
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Erin H Baker
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - John B Martinie
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Dionisios Vrochides
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Charlotte, North Carolina
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