Multicentre analysis of the learning curve for laparoscopic liver resection of the posterosuperior segments

Berardi, Giammauro; Fretland, Å.A.; Elberm, Hassan; Cipriani, Federica; Spagnoli, Alessandra; Montalti, Roberto; Ceelen, Wim; Aldrighetti, Luca; Hilal, Mohammed Abu; Edwin, Bjørn; Troisi, Roberto

doi:10.1002/bjs.11286

Cited by 42 publications

(24 citation statements)

References 38 publications

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“…Whereas for minor laparoscopic liver resections the learning curve was 22 procedures [23], for major hepatectomy this was 45-55 procedure [24,25]. A recent study specifically assessing the learning curve for the posterosuperior segments concluded that the learning curve was estimated to be a total of 65 procedures for anatomical resections [26]. A factor that could shorten the learning curve is the use of specific training.…”

Section: Multivariable Regression Analysismentioning

confidence: 99%

Laparoscopic versus open right posterior sectionectomy: an international, multicenter, propensity score-matched evaluation

Heijde

Ratti²,

Aldrighetti³

et al. 2020

Surg Endosc

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Background Although laparoscopic liver resection has become the standard for minor resections, evidence is lacking for more complex resections such as the right posterior sectionectomy (RPS). We aimed to compare surgical outcomes between laparoscopic (LRPS) and open right posterior sectionectomy (ORPS). Methods An international multicenter retrospective study comparing patients undergoing LRPS or ORPS (January 2007—December 2018) was performed. Patients were matched based on propensity scores in a 1:1 ratio. Primary endpoint was major complication rate defined as Accordion ≥ 3 grade. Secondary endpoints included blood loss, length of hospital stay (LOS) and resection status. A sensitivity analysis was done excluding the first 10 LRPS patients of each center to correct for the learning curve. Additionally, possible risk factors were explored for operative time, blood loss and LOS. Results Overall, 399 patients were included from 9 centers from 6 European countries of which 150 LRPS could be matched to 150 ORPS. LRPS was associated with a shorter operative time [235 (195–285) vs. 247 min (195–315) p = 0.004], less blood loss [260 (188–400) vs. 400 mL (280–550) p = 0.009] and a shorter LOS [5 (4–7) vs. 8 days (6–10), p = 0.002]. Major complication rate [n = 8 (5.3%) vs. n = 9 (6.0%) p = 1.00] and R0 resection rate [144 (96.0%) vs. 141 (94.0%), p = 0.607] did not differ between LRPS and ORPS, respectively. The sensitivity analysis showed similar findings in the previous mentioned outcomes. In multivariable regression analysis blood loss was significantly associated with the open approach, higher ASA classification and malignancy as diagnosis. For LOS this was the open approach and a malignancy. Conclusion This international multicenter propensity score-matched study showed an advantage in favor of LRPS in selected patients as compared to ORPS in terms of operative time, blood loss and LOS without differences in major complications and R0 resection rate.

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Section: Multivariable Regression Analysismentioning

confidence: 99%

Laparoscopic versus open right posterior sectionectomy: an international, multicenter, propensity score-matched evaluation

Heijde

Ratti²,

Aldrighetti³

et al. 2020

Surg Endosc

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“…A recently published multicentre study evaluating the learning curve of LLRs in the postero-superior segments by CUSUM analysis of 464 patients, found that 40 and 65 procedures were needed to complete the learning curve for atypical and anatomical resections, respectively(93). This shows the complexity of these procedures.In a nationwide analysis from the Netherlands, reporting the data of 6951 procedures from 27 centres, the authors discovered that these 'technically major' liver resections are mostly limited to experienced surgeons, and are associated with greater operation time, blood loss, postoperative complications and postoperative hospital stay than resections in the antero-lateral segments (94).Several retrospective studies, a propensity score matched analysis and a meta-analysis, have shown, that in selected patients, LPSLR in the postero-superior segments provides similar or better perioperative outcomes when compared to open surgery(95)(96)(97)(98).…”

mentioning

confidence: 99%

Long-Term Oncologic Outcomes After Laparoscopic Versus Open Resection for Colorectal Liver Metastases

et al. 2021

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My special appreciation goes to a talented surgeon, my colleague and friend Dr. Åsmund Fretland, who has been a remarkable co-supervisor to me. Your research and surgical skills, positiveness and the ability to solve problems quickly have always impressed me. Thank you for letting me to take over your work in the OSLO-COMET trial and for introducing me to all the details. It is always my great pleasure to draft articles together with you, be your assistant at liver surgery and attend conferences together with you. My classmate, colleague and friend Dr. Mushegh Sahakyan deserves my deepest gratitude. You are a role model for me as a young talented and hard-working researcher. I have learned a lot from our discussions about surgical procedures, article drafting, methodologies and statistics in research. I am very glad that you are back to Norway and our research group. I look forward to continuing our fruitful cooperation and Armenian barbeques together. I would like to thank Prof. Erik Fosse for the opportunity to work at the Intervention Centre, where you have created an outstanding multi-speciality research team. Communication with multidisciplinary research teams and professionals at IVS have extended my horizons. It was my pleasure to work alongside Marianne Berg, Linda Engvik, nurses and radiology team.

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“…Scientific literature has so far targeted the need to demonstrate that the laparoscopic approach overall confers short term benefits over the open counterpart while maintaining an adequate standard of care in terms of oncological results (1)(2)(3)(4)(5). A large amount of literature has indeed been published during the last 15 years, comparing mixed series of laparoscopic and open liver resections or series selected by single or few items, from the technical (minor and major, type of resections, topography of lesions) (1,3,16) or the pathological point of view (HCC, colorectal liver metastases, intrahepatic cholangiocarcinoma) (17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Have we really understood when the efforts of laparoscopic liver resection are justified?—a complexity-based appraisal of the differential benefit

Ratti¹,

Cipriani²,

Fiorentini³

et al. 2022

Hepatobiliary Surg Nutr

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Background: The implementation of minimally invasive liver resection surgery (MILS) programs starts from procedures with a low degree of technical difficulty. Data regarding the real short-term advantage of laparoscopy according to technical difficulty are still lacking. The aim of the present study is to evaluate the differential benefit of laparoscopic over open technique according to the technical difficulty of the procedures and to investigate if efforts associated with laparoscopic approach are always justified. Methods: Nine hundred and thirty-six MILS resections performed between 2005 and 2018 were stratified according to technical complexity (low, intermediate and high difficulty) and to approach (MILS or open) and matched in a 1:1 ratio using propensity scores to obtain three pairs of groups (Pair 1: Low-MILS and Low-Open, including 274 cases respectively; Pair 2: Int-MILS and Int-Open, including 237 patients respectively; Pair 3: High-MILS and High-Open, including 226 patients respectively).Results: MILS approach resulted in a statistically significant lower blood loss, reduced morbidity, reduced and shorter time for functional recover and length of stay within all pairs. The evaluation of the differential benefit showed a greater advantage of laparoscopic approach in high degree procedures compared with intermediate and low degree, both in terms of blood loss (-250 and -200 mL respectively) and morbidity rate (-5.7% and -4.1% respectively). Conclusions:The favorable biological scenario associated with laparoscopic approach allows to obtain significant benefits in the setting of technically complex procedures. The commitment towards MILS approach should be therefore stronger in this setting, where the advantage of laparoscopy seems to be enhanced.

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Multicentre analysis of the learning curve for laparoscopic liver resection of the posterosuperior segments

Cited by 42 publications

References 38 publications

Laparoscopic versus open right posterior sectionectomy: an international, multicenter, propensity score-matched evaluation

Laparoscopic versus open right posterior sectionectomy: an international, multicenter, propensity score-matched evaluation

Long-Term Oncologic Outcomes After Laparoscopic Versus Open Resection for Colorectal Liver Metastases

Have we really understood when the efforts of laparoscopic liver resection are justified?—a complexity-based appraisal of the differential benefit

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