Rebecca Marino1,2, Pim B Olthof3, Hong J Shi3, Khe T C Tran3, Jan N M Ijzermans3, Türkan Terkivatan3. 1. Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy. marino.rebecca@hsr.it. 2. Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Erasmus MC, 3015 GD, Rotterdam, The Netherlands. marino.rebecca@hsr.it. 3. Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Erasmus MC, 3015 GD, Rotterdam, The Netherlands.
Abstract
BACKGROUND: Minimally invasive liver surgery (MILS) has been progressively adopted on a nationwide scale. The aim of this study is to investigate MILS implementation in a high-volume Dutch hepato-pancreato-biliary and transplant center, which is considered a moderate to low-volume center from a European standpoint. METHODS: All patients who underwent MILS at Erasmus Medical Center between April 2010 and December 2021 were retrospectively reviewed. Patients' surgical outcomes were compared after stratification according to resections' difficulty and liver cirrhosis. RESULTS: A total of 212 cases were included. Major liver resections were performed in 24 patients (11%), while minor resections were performed in 188 patients (89%). Among those, 177 (94%) resections were classified as technically minor and 11 (6%) as technically major. Major morbidity was reported in 14/177 patients (8%) after technically minor resections and in 3/24 patients (13%) after major resections. Anatomically and technically major resections had higher intraoperative blood losses (425 (0-2100) vs. 240 (50-110) vs. 100 (0-2400) mL; p-value < 0.001) and longer hospital stay (6 (3-25) vs. 5 (2-9) vs. 3 (1-44); p-value < 0.001) when compared with the technically minor counterpart. Perioperative outcomes were similar when comparing cirrhotic MILS with the non-cirrhotic cohort. CONCLUSION: MILS program implementation can lead to encouraging surgical outcomes even in low- to moderate-volume centers. Although low procedural volume might be predictive of impaired outcomes, long-standing experience in the HPB and liver transplant field could mitigate low-case volume effects on surgical outcomes.
BACKGROUND: Minimally invasive liver surgery (MILS) has been progressively adopted on a nationwide scale. The aim of this study is to investigate MILS implementation in a high-volume Dutch hepato-pancreato-biliary and transplant center, which is considered a moderate to low-volume center from a European standpoint. METHODS: All patients who underwent MILS at Erasmus Medical Center between April 2010 and December 2021 were retrospectively reviewed. Patients' surgical outcomes were compared after stratification according to resections' difficulty and liver cirrhosis. RESULTS: A total of 212 cases were included. Major liver resections were performed in 24 patients (11%), while minor resections were performed in 188 patients (89%). Among those, 177 (94%) resections were classified as technically minor and 11 (6%) as technically major. Major morbidity was reported in 14/177 patients (8%) after technically minor resections and in 3/24 patients (13%) after major resections. Anatomically and technically major resections had higher intraoperative blood losses (425 (0-2100) vs. 240 (50-110) vs. 100 (0-2400) mL; p-value < 0.001) and longer hospital stay (6 (3-25) vs. 5 (2-9) vs. 3 (1-44); p-value < 0.001) when compared with the technically minor counterpart. Perioperative outcomes were similar when comparing cirrhotic MILS with the non-cirrhotic cohort. CONCLUSION: MILS program implementation can lead to encouraging surgical outcomes even in low- to moderate-volume centers. Although low procedural volume might be predictive of impaired outcomes, long-standing experience in the HPB and liver transplant field could mitigate low-case volume effects on surgical outcomes.
Authors: Go Wakabayashi; Daniel Cherqui; David A Geller; Joseph F Buell; Hironori Kaneko; Ho Seong Han; Horacio Asbun; Nicholas OʼRourke; Minoru Tanabe; Alan J Koffron; Allan Tsung; Olivier Soubrane; Marcel Autran Machado; Brice Gayet; Roberto I Troisi; Patrick Pessaux; Ronald M Van Dam; Olivier Scatton; Mohammad Abu Hilal; Giulio Belli; Choon Hyuck David Kwon; Bjørn Edwin; Gi Hong Choi; Luca Antonio Aldrighetti; Xiujun Cai; Sean Cleary; Kuo-Hsin Chen; Michael R Schön; Atsushi Sugioka; Chung-Ngai Tang; Paulo Herman; Juan Pekolj; Xiao-Ping Chen; Ibrahim Dagher; William Jarnagin; Masakazu Yamamoto; Russell Strong; Palepu Jagannath; Chung-Mau Lo; Pierre-Alain Clavien; Norihiro Kokudo; Jeffrey Barkun; Steven M Strasberg Journal: Ann Surg Date: 2015-04 Impact factor: 12.969
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Authors: B Görgec; R S Fichtinger; F Ratti; D Aghayan; M J Van der Poel; R Al-Jarrah; T Armstrong; F Cipriani; Å A Fretland; A Suhool; M Bemelmans; K Bosscha; A E Braat; M T De Boer; C H C Dejong; P G Doornebosch; W A Draaisma; M F Gerhards; P D Gobardhan; J Hagendoorn; G Kazemier; J Klaase; W K G Leclercq; M S Liem; D J Lips; H A Marsman; J S D Mieog; Q I Molenaar; V B Nieuwenhuijs; C L Nota; G A Patijn; A M Rijken; G D Slooter; M W J Stommel; R J Swijnenburg; P J Tanis; W W Te Riele; T Terkivatan; P M P Van den Tol; P B Van den Boezem; J A Van der Hoeven; M Vermaas; B Edwin; L A Aldrighetti; R M Van Dam; M Abu Hilal; M G Besselink Journal: Br J Surg Date: 2021-08-19 Impact factor: 6.939