Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Electronic address: https://twitter.com/WJChoiMD.
University Health Network, HPB Surgical Oncology, Toronto, Ontario, Canada.
Surgery. 2023 Dec;174(6):1393-1400. doi: 10.1016/j.surg.2023.09.009. Epub 2023 Oct 18.
The global benchmark cut-offs were set for laparoscopic liver resection procedures: left lateral sectionectomy, left hepatectomy, and right hepatectomy. We aimed to compare the performance of our North American center with the established global benchmarks.
This is a single-center study of adults who underwent laparoscopic liver resection between 2010 to 2022 at the Toronto General Hospital. Fourteen benchmarking outcomes were assessed: operation time, intraoperative blood transfusion, estimated blood loss, blood loss ≥500 mL, blood loss ≥1000mL, open-conversion, postoperative length of stay, return to operation, postoperative morbidity, postoperative major-morbidity, 30-day mortality, 90-day mortality, R1 resection, and failure to rescue. Low-risk benchmark cases were defined as follows: patients aged 18 to 70 years, American Society of Anesthesiologist score ≤ 2, tumor size <10 cm, and Child-Pugh score ≤A. Cases involving bilio-enteric anastomosis, hilar dissection, or concomitant major procedures were excluded from the low-risk category. Cases that did not meet the criteria for low-risk selection were considered high-risk cases.
A total of 178 laparoscopic liver resection cases were analyzed (109 left lateral sectionectomies, 45 left hepatectomies, 24 right hepatectomies). Forty-four (25%) cases qualified as low-risk cases (23 left lateral sectionectomies, 16 left hepatectomies, 5 right hepatectomies). The postoperative major morbidity and 90-day mortality after left lateral sectionectomy, left hepatectomy, and right hepatectomy for the low-risk cases were 0%, 0%, and 0%, and 0%, 0%, and 0%, respectively. For the high-risk cases post-2017, the outcomes in the same order were 0%, 0%, and 12%; 0%, 0%, and 0%, respectively. For the high-risk cases operated pre2017, the outcomes in the same order were 9%∗, 16%∗, and 18%; 2%∗, 0%, and 9%∗ (asterisks indicate not meeting the global cut-off), respectively.
A North American center was able to achieve outcomes comparable to the established global benchmark for laparoscopic liver resection.
全球基准截止值被设定用于腹腔镜肝切除术：左外叶切除术、左半肝切除术和右半肝切除术。我们旨在比较我们的北美中心与既定的全球基准之间的表现。
这是一项单中心研究，纳入了 2010 年至 2022 年在多伦多总医院接受腹腔镜肝切除术的成年人。评估了 14 项基准结果：手术时间、术中输血、估计失血量、出血量≥500ml、出血量≥1000ml、中转开腹、术后住院时间、再次手术、术后发病率、术后主要并发症、30 天死亡率、90 天死亡率、R1 切除和抢救失败。低危基准病例定义为：年龄 18 至 70 岁、美国麻醉医师协会评分≤2、肿瘤大小<10cm 和 Child-Pugh 评分≤A。不包括涉及胆肠吻合、肝门部解剖或同时进行主要手术的病例。不符合低危选择标准的病例被认为是高危病例。
共分析了 178 例腹腔镜肝切除术病例（109 例左外叶切除术、45 例左半肝切除术、24 例右半肝切除术）。44 例（25%）病例符合低危病例标准（23 例左外叶切除术、16 例左半肝切除术、5 例右半肝切除术）。低危病例左外叶切除术、左半肝切除术和右半肝切除术的术后主要并发症和 90 天死亡率分别为 0%、0%和 0%和 0%、0%和 0%。对于 2017 年后的高危病例，同样的顺序为 0%、0%和 12%；0%、0%和 0%。对于 2017 年前手术的高危病例，同样的顺序为 9%∗、16%∗和 18%；2%∗、0%和 9%∗（星号表示未达到全球截止值）。
一个北美的中心能够达到与既定的全球腹腔镜肝切除术基准相当的结果。
