机器人和腹腔镜肝脏切除术中转换的风险因素和结果：全国性分析。

IF 3.2 2区医学 Q1 SURGERY

Surgery Pub Date : 2025-02-01 Epub Date: 2024-10-08 DOI:10.1016/j.surg.2024.09.004

Gabriela Pilz da Cunha, Jasper P Sijberden, Paul Gobardhan, Daan J Lips, Türkan Terkivatan, Hendrik A Marsman, Gijs A Patijn, Wouter K G Leclercq, Koop Bosscha, J Sven D Mieog, Peter B van den Boezem, Maarten Vermaas, Niels F M Kok, Eric J T Belt, Marieke T de Boer, Wouter J M Derksen, Hans Torrenga, Paul M Verheijen, Steven J Oosterling, Michelle R de Graaff, Arjen M Rijken, Marielle M E Coolsen, Mike S L Liem, T C Khé Tran, Michael F Gerhards, Vincent Nieuwenhuijs, Susan van Dieren, Mohammad Abu Hilal, Marc G Besselink, Ronald M van Dam, Jeroen Hagendoorn, Rutger-Jan Swijnenburg

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引用次数: 0

摘要

背景：微创肝脏手术过程中出现的术中不利发现或事故可能导致必须转为开放手术。本研究旨在确定微创肝脏手术转流的预测因素，并深入了解转流后的结果：这项全国性的回顾性队列研究利用荷兰肝胆审计（2014-2022 年）中 20 个中心的数据，比较了转为开放手术和未转为开放手术的微创肝脏外科手术。研究采用倾向得分匹配法。对已转换的机器人肝切除术与腹腔镜肝切除术、急诊与非急诊转换进行了分组分析。采用逆向逐步多变量逻辑回归法确定了转归的预测因素：在接受微创肝脏手术（792例机器人肝脏切除术，2738例腹腔镜肝脏切除术）的3530名患者中，有408人（11.6%）转为急诊（4.9%为机器人肝脏切除术，13.5%为腹腔镜肝脏切除术）。转院与失血量增加（580 mL [四分位数间距 250-1,200] vs 200 mL [四分位数间距 50-500]，P < .001）、大失血（≥500 mL，58.8% vs 26.7%，P < .001）、重症监护入院（19.0% vs 8.4%，P = .005）、总体发病率（38.9% vs 21.0%，P < .001）、严重发病率（17.9% vs 9.6%，P = .002）、住院时间延长（6 天 [四分位间范围 5-8] vs 4 天 [四分位间范围 2-5]，P < .001），但死亡率（2.2% vs 1.2%，P = .387）没有增加。与非急诊转流手术相比，急诊转流手术的术中失血量（1,500 mL [四分位数范围700-2,800] vs 525 mL [四分位数范围208-1,000]，P < .001）、大失血率（87.5% vs 59.3%，P = .005）和重症监护入院率（27.9% vs 10.6%，P = .029）均有所增加。机器人肝脏切除术与较低的转流风险有关，而美国麻醉医师协会等级≥3级、病变面积较大、同时进行消融术、技术上的重大切除术和解剖学上的重大切除术则是风险因素：结论：紧急和非紧急转换对微创肝脏手术的围手术期结果均有负面影响。与腹腔镜肝脏切除术相比，机器人肝脏切除术可降低转换风险。

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Risk factors and outcomes of conversions in robotic and laparoscopic liver resections: A nationwide analysis.

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.