Hołówko Wacław, Rykowski Paweł, Wyporski Anya, Serednicki Wojciech, Mielko Jerzy, Pierściński Stanisław, Durczyński Adam, Tarasik Aleksander, Wróblewski Tadeusz, Budzyński Andrzej, Pędziwiatr Michał, Grąt Michał
Department of General Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
Wideochir Inne Tech Maloinwazyjne. 2024 Mar;19(1):60-67. doi: 10.5114/wiitm.2024.135446. Epub 2024 Feb 14.
Laparoscopic liver resection is a challenging surgical procedure that may require prolonged operation time, particularly during the learning curve. Operation time significantly decreases with increasing experience; however, prolonged operation time may significantly increase the risk of postoperative complications.
To assess whether prolonged operation time over the benchmark value influences short-term postoperative outcomes after laparoscopic liver resection.
A retrospective cohort study based on data from the National Polish Registry of Minimally Invasive Liver Surgery was performed. A total of 197 cases consisting of left lateral sectionectomy (LLS), left hemihepatectomy (LH), and right hemihepatectomy (RH) with established benchmark values for operation time were included. Data about potential confounders for prolonged operation time and worse short-term outcomes were exported.
Most cases (129; 65.5%) were performed during the learning curve, while the largest rate was observed in LLS (57; 78.1%). Median operation time exceeded the benchmark value in LLS (Me = 210 min) and LH (Me = 350 min), while in RH the benchmark value was exceeded in 39 (44.3%) cases. Textbook outcomes were achieved in 138 (70.1%) cases. Univariate analysis (OR = 1.11; 95% CI: 0.61-2.06; p = 0.720) and multivariate analysis (OR = 1.16; 95% CI: 0.50-2.68; p = 0.734) did not reveal a significant impact of prolonged surgery on failing to achieve a textbook outcome.
Prolonging the time of laparoscopic liver resection does not significantly impair postoperative results. There is no reason related to the patients' safety to avoid prolonging the time of laparoscopic liver resection over the benchmark value.
腹腔镜肝切除术是一项具有挑战性的外科手术，可能需要较长的手术时间，尤其是在学习曲线阶段。随着经验的增加，手术时间会显著缩短；然而，延长的手术时间可能会显著增加术后并发症的风险。
评估超过基准值的延长手术时间是否会影响腹腔镜肝切除术后的短期预后。
基于波兰国家微创肝脏手术登记处的数据进行了一项回顾性队列研究。纳入了197例包括左外叶切除术（LLS）、左半肝切除术（LH）和右半肝切除术（RH）且有既定手术时间基准值的病例。导出了关于延长手术时间和较差短期预后的潜在混杂因素的数据。
大多数病例（129例；65.5%）是在学习曲线阶段进行的，其中LLS的比例最高（57例；78.1%）。LLS（中位数=210分钟）和LH（中位数=350分钟）的中位手术时间超过了基准值，而RH中有39例（44.3%）超过了基准值。138例（70.1%）病例达到了教科书式的预后。单因素分析（OR = 1.11；95% CI：0.61 - 2.06；p = 0.720）和多因素分析（OR = 1.16；95% CI：0.50 - 2.68；p = 0.734）均未显示延长手术对未达到教科书式预后有显著影响。
延长腹腔镜肝切除术的时间不会显著损害术后结果。没有与患者安全相关的理由避免将腹腔镜肝切除术的时间延长超过基准值。
