Assessment of Textbook Outcome in Laparoscopic and Open Liver Surgery

Abstract

IMPORTANCE Textbook outcome (TO) is a composite measure that captures the most desirable surgical outcomes as a single indicator, yet to date TO has not been defined and assessed in the field of laparoscopic liver resection (LLR) and open liver resection (OLR).OBJECTIVE To obtain international agreement on the definition of TO in liver surgery (TOLS) and to assess the incidence of TO in LLR and OLR in a large international multicenter database using a propensity-score matched analysis.DESIGN, SETTING, AND PARTICIPANTS Patients undergoing LLR or OLR for all liver diseases between January 2011 and October 2019 were analyzed using a large international multicenter liver surgical database. An international survey was conducted among all members of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) and International Hepato-Pancreato-Biliary Association (IHPBA) to reach agreement on the definition of TOLS. The rate of TOLS was assessed for LLR and OLR before and after propensity-score matching. Factors associated with achieving TOLS were investigated.MAIN OUTCOMES AND MEASURES Textbook outcome, with TOLS defined as the absence of intraoperative incidents of grade 2 or higher, postoperative bile leak grade B or C, severe postoperative complications, readmission within 30 days after discharge, in-hospital mortality, and the presence of R0 resection margin.RESULTS A total of 8188 patients (4559 LLR; median age, 65 years [interquartile range, 55-73 years]; 2529 were male [55.8%] and 3629 OLR; median age, 64 years [interquartile range, 56-71 years]; 2204 were male [60.7%]) were included in the analysis of whom 69.1% achieved TOLS; 74.8% for LLR and 61.9% for OLR (P < .001). On multivariable analysis, American Society of Anesthesiologists grade III, previous abdominal surgery, histological diagnosis of colorectal liver metastases (odds ratio [OR], 0.656 [95% CI, 0.457-0.940]; P = .02), cholangiocarcinoma, non-CRLM, a tumor size of 30 mm or more, minor resection of posterior/superior segments (OR, 0.716 [95% CI, 0.577-0.887]; P = .002), anatomically major resection (OR, 0.579 [95% CI, 0.418-0.803]; P = .001), and nonanatomical resection (OR, 0.612 [95% CI, 0.476-0.788]; P < .001) were associated with a worse TOLS rate after LLR. For OLR, only histological diagnosis of cholangiocarcinoma (OR, 0.360 [95% CI, 0.214-0.607]; P < .001) and a tumor size of 30 mm or more (30-50 mm = OR, 0.718 [95% CI, 0.565-0.911]; P = .01; 50.1-100 mm = OR, 0.729 [95% CI, 0.554-0.960]; P = .02; >10 cm = OR, 0.550 [95% CI, 0.366-0.826]; P = .004) were associated with a worse TOLS rate. CONCLUSIONS AND RELEVANCEIn this multicenter study, TOLS was found to be a useful tool for assessing patient-level hospital performance and may have utility in optimizing patient outcomes after LLR and OLR.

Safety of intermittent Pringle maneuver during minimally invasive liver resection in patients with hepatocellular carcinoma with and without cirrhosis

“… Data presented as number (percent) for categorical or median (minimum–maximum) for continuous variables. PHLF post-hepatectomy liver failure [ 27 ], LOS length of stay, ICU intensive care unit, R0 resection status (no residual tumor) a Defined as no severe complication (≥ 3 according to Clavien-Dindo classification of postoperative complications) [ 25 ]; no intraoperative complication ≥ 2 (according to the Oslo classification of intraoperative complications [ 28 ]); R0 resection status achieved; no re-admission in 30 days post-discharge; no in-hospital mortality; absence of bile leak grades B or C[ 26 ] b Within 90 days after surgery c ≥ 3a according to Clavien-Dindo classification of postoperative complications[ 25 ] …”

“…a Defined as no severe complication (≥ 3 according to Clavien-Dindo classification of postoperative complications) [ 25 ]; no intraoperative complication ≥ 2 (according to the Oslo classification of intraoperative complications [ 28 ]); R0 resection status achieved; no re-admission in 30 days post-discharge; no in-hospital mortality; absence of bile leak grades B or C[ 26 ]…”

“…After PSM, cases with and without use of IPM were compared with respect to the duration of surgery, need for blood transfusion, length of stay in the hospital after surgery (LOS), length of stay in the intensive care unit (ICU-LOS), postoperative complications (according to Clavien-Dindo classification [ 25 ]), textbook outcome [ 26 ], post-hepatectomy liver failure (PHLF) as graded according to the International Study Group of Liver Surgery (ISGLS) criteria [ 27 ], and resection status (R-classification by pathology). Liver function and hemostatic parameters were assessed by perioperative serum levels of aspartate aminotransferase (AST), aspartate alaninotransferase (ALT), bilirubin, platelet counts, partial thromboplastin time (PTT), and the international normalized ratio (INR).…”

Effect of Preoperative Body Mass Index on Surgical Textbook Outcomes Following Curative-intent Resection for Perihilar Cholangiocarcinoma

“…Therefore, several studies have pointed out that summarizing the individual outcome metrics by using multiple variables for assessing the short-term prognosis as a comprehensive measure may better re ect the whole surgical care quality of the hospital [13][14][15][16]. In particular, textbook outcome (TO) is a new popular measure 8 that attempts to use a single metric to cover the entire surgical procedure, which provides a comprehensive summary of the hospital performance.…”

Pure laparoscopic major liver resection after yttrium90 radioembolization: a case-matched series analysis of feasibility and outcomes

“…The main aim of this observational, retrospective study is to describe the feasibility, short- and long-term outcomes, for pure major laparoscopic liver resection post-RE (MLLR-RE). The secondary aims are to compare these results with a case-matched cohort of patients undergoing major laparoscopic liver resection (Ct-MLLR) for the same hepatic malignancies but without previous RE, and to compare the results of the MLLR-RE series with the recently defined textbook outcomes for laparoscopic major liver surgery (TOLS)[ 17 ].…”