Factors Related to Textbook Outcome in Laparoscopic Liver Resections: a Single Western Centre Analysis

Abstract

Introduction The selection of the most informative quality of care indicator for laparoscopic liver surgery (LLS) is still debated; among those proposed, textbook outcome (TO) seems to provide a compositive measure of the outcomes of surgery. The aim of this study was to investigate the factors related with the TO in a cohort of patients who underwent LLS. Methods Patients who underwent LLS from 2014 to 2021 were included. TO for LLS (TOLLS) was defined as: R0 resection, absence of intraoperative incidents, severe complications, reintervention, 30-day readmission and in-hospital mortality. When also considering no prolonged length of hospital stay (LOS), the outcome was called TOLLS+. Results Four hundred twenty-one patients were included; TOLLS was achieved in 80.5%, TOLLS+ in 60.8% cases. R0 resection was obtained in 90.2% cases, intraoperative incidents occurred in 7.8%, severe complications in 5.0%, reintervention in 0.7%, readmission in 1.4% and in-hospital mortality in 0.2%. 32.5% of patients showed prolonged LOS. After univariate and multivariate analysis, factors influencing TOLLS were age (OR 0.967; p=0.003), concomitant surgery (OR 0.380; p=0.003), operative time (OR 0.996; p=0.008) and blood loss (OR 0.241; p<0.001); factors influencing TOLLS+ were ASA-score (OR 0.533; p=0.008), tumour histology (OR 0.421; p=0.021), concomitant surgery (OR 0.293; p<0.001), operative time (OR 0.997; p=0.016) and blood loss (OR 0.361; p=0.003). Conclusions TOLLS can be achieved in most patients undergoing LLR, and it seems to be influenced mostly by surgery-related factors; conversely, TOLLS+ is achieved less frequently and seems to be influenced also by patient- and tumour-related factors.

Defining and predicting textbook outcomes for perihilar cholangiocarcinoma: analysis of factors improving of achievement of desired post-operative outcomes. retrospective cohort study

“…Even if the need to use a different definition of TO for PHC patients hinders a comparison with already existing reports regarding TO in the setting of conventional liver surgery (TO-achievement rates are between 48 and 80.5%) 14 , 29 – 31 , it seems that the possibility to achieve TO in PHC is generally reduced, as suggested even in other reports focusing on biliary tract cancer 12 , 28 , 32 . This emphasizes the greater complexity of surgical procedures for biliary tract cancer, especially in cases of PHC, where the association between major or extended liver surgery with biliary reconstruction creates a dangerous synergy between parenchymal demolition and risk of septic complications.…”

“…Several studies have investigated TOs in liver surgery 11 – 14 . However, surgical treatment of PHC is more challenging than liver resection for others malignancies both because of baseline characteristics of patients and challenges of required surgical procedures.…”

Textbook outcomes for liver resection: can a medium sized centre have acceptable outcomes?

“…11 The authors opinion is that cut off levels for LOS are often arbitrary and are prone to bias, therefore they were not included in the current TO parameters. 21 LOS is an important measure for health systems, but may be better used to compare local data rather than between health systems with numerous cultural and social differences.…”

“…The Delphi consensus on TO in liver surgery proposed an extended TO including length of stay, with varying cut offs depending on whether surgery was open or laparoscopic, as well as by region 11 . The authors opinion is that cut off levels for LOS are often arbitrary and are prone to bias, therefore they were not included in the current TO parameters 21 . LOS is an important measure for health systems, but may be better used to compare local data rather than between health systems with numerous cultural and social differences.…”