Lu Qiang, Li Qing-Shan, Zhang Wei, Liu Kang, Li Tao, Yu Jia-Wei, Lv Yi, Zhang Xu-Feng
Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Province, China.
Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi Province, China.
Ann Surg Treat Res. 2020 Jul;99(1):1-7. doi: 10.4174/astr.2020.99.1.1. Epub 2020 Jun 29.
The objective of the current study was to examine the potential effects of surgery start times (morning afternoon) on the long-term prognosis of patients after hepatic resection (HR) for hepatocellular carcinoma (HCC).
All eligible patients were divided into 2 groups according to the start time of surgery: group M (morning surgery, 8 AM-1 PM) and group A (afternoon surgery, 1 PM-6 PM). Clinicopathologic and surgical parameters, as well as oncologic outcomes were compared between the 2 groups.
In total, 231 patients were included in the study. There was no difference in age, body mass index, comorbidities, tumor size, tumor location, tumor stages, surgical procedures, or surgical margin between morning and afternoon surgery (all P > 0.05). In contrast, patients in group M experienced longer operation duration than those in group A (median, 240 minutes 195 minutes, P = 0.004). However, no differences of overall survival were observed between morning and afternoon surgery groups in the whole cohort or stratified by surgical margin (all P > 0.05).
Surgery start times during the work day have no measurable influence on patient outcome following curative HR for HCC, indicating good self-regulation and professional judgment of surgeons for progressive fatigue during surgery.
本研究的目的是探讨手术开始时间（上午 vs 下午）对肝细胞癌（HCC）肝切除（HR）术后患者长期预后的潜在影响。
根据手术开始时间将所有符合条件的患者分为两组：M组（上午手术，上午8点至下午1点）和A组（下午手术，下午1点至下午6点）。比较两组的临床病理和手术参数以及肿瘤学结局。
本研究共纳入231例患者。上午手术和下午手术在年龄、体重指数、合并症、肿瘤大小、肿瘤位置、肿瘤分期、手术方式或手术切缘方面均无差异（所有P>0.05）。相比之下，M组患者的手术时间比A组更长（中位数，240分钟 vs 195分钟，P = 0.004）。然而，在整个队列中或按手术切缘分层时，上午和下午手术组之间未观察到总生存期的差异（所有P>0.05）。
工作日的手术开始时间对HCC根治性HR术后的患者结局没有可测量的影响，这表明外科医生在手术过程中对渐进性疲劳具有良好的自我调节和专业判断能力。
