Pilz da Cunha Gabriela, Sijberden Jasper P, Gobardhan Paul, Lips Daan J, Terkivatan Türkan, Marsman Hendrik A, Patijn Gijs A, Leclercq Wouter K G, Bosscha Koop, Mieog J Sven D, van den Boezem Peter B, Vermaas Maarten, Kok Niels F M, Belt Eric J T, de Boer Marieke T, Derksen Wouter J M, Torrenga Hans, Verheijen Paul M, Oosterling Steven J, de Graaff Michelle R, Rijken Arjen M, Coolsen Marielle M E, Liem Mike S L, Tran T C Khé, Gerhards Michael F, Nieuwenhuijs Vincent, van Dieren Susan, Abu Hilal Mohammad, Besselink Marc G, van Dam Ronald M, Hagendoorn Jeroen, Swijnenburg Rutger-Jan
Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
Department of Surgery, Amphia Medical Center, Breda, the Netherlands.
Surgery. 2025 Feb;178:108820. doi: 10.1016/j.surg.2024.09.004. Epub 2024 Oct 8.
Unfavorable intraoperative findings or incidents during minimally invasive liver surgery may necessitate conversion to open surgery. This study aimed to identify predictors for conversion in minimally invasive liver surgery and gain insight into outcomes following conversions.
This nationwide, retrospective cohort study compared converted and non-converted minimally invasive liver surgery procedures using data from 20 centers in the Dutch Hepatobiliary Audit (2014-2022). Propensity score matching was applied. Subgroup analyses of converted robotic liver resection versus laparoscopic liver resection and emergency versus non-emergency conversions were performed. Predictors for conversions were identified using backward stepwise multivariable logistic regression.
Of 3,530 patients undergoing minimally invasive liver surgery (792 robotic liver resection, 2,738 laparoscopic liver resection), 408 (11.6%) were converted (4.9% robotic liver resection, 13.5% laparoscopic liver resection). Conversion was associated with increased blood loss (580 mL [interquartile range 250-1,200] vs 200 mL [interquartile range 50-500], P < .001), major blood loss (≥500 mL, 58.8% vs 26.7%, P < .001), intensive care admission (19.0% vs 8.4%, P = .005), overall morbidity (38.9% vs 21.0%, P < .001), severe morbidity (17.9% vs 9.6%, P = .002), and a longer hospital stay (6 days [interquartile range 5-8] vs 4 days [interquartile range 2-5], P < .001) but not mortality (2.2% vs 1.2%, P = .387). Emergency conversions had increased intraoperative blood loss (1,500 mL [interquartile range 700-2,800] vs 525 mL [interquartile range 208-1,000], P < .001), major blood loss (87.5% vs 59.3%, P = .005), and intensive care admission (27.9% vs 10.6%, P = .029), compared with non-emergency conversions. Robotic liver resection was linked to lower conversion risk, whereas American Society of Anesthesiologists grade ≥3, larger lesion size, concurrent ablation, technically major, and anatomically major resections were risk factors.
Both emergency and non-emergency conversions negatively impact perioperative outcomes in minimally invasive liver surgery. Robotic liver resection reduces conversion risk compared to laparoscopic liver resection.
微创肝脏手术中出现不良的术中发现或事件可能需要转为开放手术。本研究旨在确定微创肝脏手术中转开腹的预测因素，并深入了解转开腹后的结局。
这项全国性的回顾性队列研究使用荷兰肝胆审计（2014 - 2022年）中20个中心的数据，比较了转开腹和未转开腹的微创肝脏手术。应用倾向评分匹配。对转开腹的机器人肝脏切除术与腹腔镜肝脏切除术以及急诊与非急诊转开腹进行亚组分析。使用向后逐步多变量逻辑回归确定转开腹的预测因素。
在3530例行微创肝脏手术的患者中（792例行机器人肝脏切除术，2738例行腹腔镜肝脏切除术），408例（11.6%）转为开放手术（机器人肝脏切除术为4.9%，腹腔镜肝脏切除术为13.5%）。转开腹与失血量增加相关（580 mL[四分位间距250 - 1200] vs 200 mL[四分位间距50 - 500]，P <.001）、大出血（≥500 mL，58.8% vs 26.7%，P <.001）、入住重症监护病房（19.0% vs 8.4%，P =.005）、总体并发症发生率（38.9% vs 21.0%，P <.001）、严重并发症发生率（17.9% vs 9.6%，P =.002）以及住院时间延长（6天[四分位间距5 - 8] vs 4天[四分位间距2 - 5]，P <.001），但与死亡率无关（2.2% vs 1.2%，P =.387）。与非急诊转开腹相比，急诊转开腹术中失血量增加（1500 mL[四分位间距700 - 2800] vs 525 mL[四分位间距208 - 1000]，P <.001）、大出血（87.5% vs 59.3%，P =.005）以及入住重症监护病房（2
