Francesca Ratti1, Matteo Serenari2,3, Matteo Zanello4, David Fuks5, Matteo Rottoli3,6, Michele Masetti4, Ecoline Tribillon5, Matteo Ravaioli2,3, Ugo Elmore7, Riccardo Rosati7, Brice Gayet5, Matteo Cescon2,3, Elio Jovine4, Luca Aldrighetti8. 1. Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milano, Italy. ratti.francesca@hsr.it. 2. General Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy. 3. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 4. Department of General Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Maggiore Hospital, Bologna, Italy. 5. Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France. 6. Surgery of the Alimentary Tract, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy. 7. Division of Gastrointestinal Surgery, Azienda Ospedaliero-Universitaria di Bologna, San Raffaele Hospital, Milano, Italy. 8. Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milano, Italy.
Abstract
BACKGROUND: The aim of the study was to evaluate perioperative outcomes and to evaluate factors influencing rative morbidity and adoption of minimally invasive technique in 1-team (1-T) versus two teams (2-T) management of synchronous colorectal liver metastases. METHODS: Within four referral centers, a group of 234 patients treated in 1-T centers was identified and compared with a group of 253 patients treated in 2-T. A nonparametric bootstrap process was applied to the original cohorts of 1-T group and 2-T group as a resampling method to obtain bootstrapped cohorts (155 patients per group). RESULTS: 33.5% of patients in 1-T boot group and 38.1% in the 2-T boot group were operated by laparoscopic approach. Multivariate analysis revealed that approach to primary tumor (laparoscopic or open) and intraoperative blood loss were independent prognostic factors for morbidity. Team approach did not show any significant correlation with incidence of postoperative complications nor with choice for laparoscopic approach. CONCLUSION: The optimization of team strategy for patients with SCRLM is not solely based on the adoption of a 1-T or 2-T approach, but should instead be based on the implementation of a standard protocol for management of these patients.
BACKGROUND: The aim of the study was to evaluate perioperative outcomes and to evaluate factors influencing rative morbidity and adoption of minimally invasive technique in 1-team (1-T) versus two teams (2-T) management of synchronous colorectal liver metastases. METHODS: Within four referral centers, a group of 234 patients treated in 1-T centers was identified and compared with a group of 253 patients treated in 2-T. A nonparametric bootstrap process was applied to the original cohorts of 1-T group and 2-T group as a resampling method to obtain bootstrapped cohorts (155 patients per group). RESULTS: 33.5% of patients in 1-T boot group and 38.1% in the 2-T boot group were operated by laparoscopic approach. Multivariate analysis revealed that approach to primary tumor (laparoscopic or open) and intraoperative blood loss were independent prognostic factors for morbidity. Team approach did not show any significant correlation with incidence of postoperative complications nor with choice for laparoscopic approach. CONCLUSION: The optimization of team strategy for patients with SCRLM is not solely based on the adoption of a 1-T or 2-T approach, but should instead be based on the implementation of a standard protocol for management of these patients.
Authors: Stefano Ferretti; Hadrien Tranchart; Joseph F Buell; Constantino Eretta; Alberto Patriti; Marcello Giuseppe Spampinato; Jung Wook Huh; Luca Vigano; Ho Seong Han; Giuseppe Maria Ettorre; Elio Jovine; Thomas Clark Gamblin; Giulio Belli; Go Wakabayashi; Brice Gayet; Ibrahim Dagher Journal: World J Surg Date: 2015-08 Impact factor: 3.352