Is prolonged operative time associated with postoperative complications in liver surgery? An international multicentre cohort study of 5424 patients.

Hepatectomy Minimally invasive surgery Operative time Postoperative complications

Journal

Surgical endoscopy

ISSN: 1432-2218

Titre abrégé: Surg Endosc

Pays: Germany

ID NLM: 8806653

Informations de publication

Date de publication:
30 Sep 2024

Historique:

received: 09 07 2024

accepted: 11 09 2024

medline: 30 9 2024

pubmed: 30 9 2024

entrez: 30 9 2024

Statut: aheadofprint

Résumé

The relation between operative time and postoperative complications in liver surgery is unclear. The aim of this study is to assess the impact of operative time on the development of postoperative complications in patients who underwent minimally invasive or open liver resections of various anatomical extent and technical difficulty levels. In this retrospective cohort study, patients that underwent a right hemihepatectomy (RH), technically major resection (anatomically minor resection in segment 1, 4a, 7 or 8; TMR) or left lateral sectionectomy (LLS) between 2000 and 2022 were extracted from a multicenter database comprising the prospectively maintained databases of 31 centers in 13 countries. Minimally invasive procedures performed during the learning curve were omitted. Logistic regression models, performed separately for 9 different groups based on stratification by procedure type and allocated surgical approach, were used to assess the association between the fourth quartile of operative time (25% of patients with the longest operative time) and postoperative complications. Overall, 5424 patients were included: 1351 underwent RH (865 open, 373 laparoscopic and 113 robotic), 2821 TMR (1398 open, 1225 laparoscopic and 198 robotic), and 1252 LLS (241 open, 822 laparoscopic and 189 robotic). After adjusting for potential confounders (age, BMI, gender, ASA grade, previous abdominal surgery, disease type and extent, blood loss, Pringle, intraoperative transfusions and incidents), the fourth quartile of operative time, compared to the first three quartiles, was associated with an increased risk of postoperative complications after open, laparoscopic and robotic TMR (aOR 1.35, p = 0.031; aOR 1.74, p = 0.001 and aOR 3.11, p = 0.014, respectively), laparoscopic and robotic RH (aOR 1.98, p = 0.018 and aOR 3.28, p = 0.055, respectively) and solely laparoscopic LLS (aOR 1.69, p = 0.019). A prolonged operative time is associated with an increased risk of postoperative complications, although it remains to be defined if this is a causal relationship.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

In this retrospective cohort study, patients that underwent a right hemihepatectomy (RH), technically major resection (anatomically minor resection in segment 1, 4a, 7 or 8; TMR) or left lateral sectionectomy (LLS) between 2000 and 2022 were extracted from a multicenter database comprising the prospectively maintained databases of 31 centers in 13 countries. Minimally invasive procedures performed during the learning curve were omitted. Logistic regression models, performed separately for 9 different groups based on stratification by procedure type and allocated surgical approach, were used to assess the association between the fourth quartile of operative time (25% of patients with the longest operative time) and postoperative complications.

RESULTS RESULTS

Overall, 5424 patients were included: 1351 underwent RH (865 open, 373 laparoscopic and 113 robotic), 2821 TMR (1398 open, 1225 laparoscopic and 198 robotic), and 1252 LLS (241 open, 822 laparoscopic and 189 robotic). After adjusting for potential confounders (age, BMI, gender, ASA grade, previous abdominal surgery, disease type and extent, blood loss, Pringle, intraoperative transfusions and incidents), the fourth quartile of operative time, compared to the first three quartiles, was associated with an increased risk of postoperative complications after open, laparoscopic and robotic TMR (aOR 1.35, p = 0.031; aOR 1.74, p = 0.001 and aOR 3.11, p = 0.014, respectively), laparoscopic and robotic RH (aOR 1.98, p = 0.018 and aOR 3.28, p = 0.055, respectively) and solely laparoscopic LLS (aOR 1.69, p = 0.019).

CONCLUSIONS CONCLUSIONS

A prolonged operative time is associated with an increased risk of postoperative complications, although it remains to be defined if this is a causal relationship.

Identifiants

DOI: 10.1007/s00464-024-11276-x PMID: 39347957

pubmed: 39347957

doi: 10.1007/s00464-024-11276-x

pii: 10.1007/s00464-024-11276-x

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Informations de copyright

Références

Russolillo N, Aldrighetti L, Cillo U, Guglielmi A, Ettorre GM, Giuliante F, Mazzaferro V, Dalla Valle R, De Carlis L, Jovine E, Ferrero A (2020) Risk-adjusted benchmarks in laparoscopic liver surgery in a national cohort. Br J Surg 107:845–853

pubmed: 31925777 doi: 10.1002/bjs.11404

van der Poel MJ, Fichtinger RS, Bemelmans M, Bosscha K, Braat AE, de Boer MT, Dejong CHC, Doornebosch PG, Draaisma WA, Gerhards MF, Gobardhan PD, Gorgec B, Hagendoorn J, Kazemier G, Klaase J, Leclercq WKG, Liem MS, Lips DJ, Marsman HA, Mieog JSD, Molenaar QI, Nieuwenhuijs VB, Nota CL, Patijn GA, Rijken AM, Slooter GD, Stommel MWJ, Swijnenburg RJ, Tanis PJ, Te Riele WW, Terkivatan T, van den Tol PM, van den Boezem PB, van der Hoeven JA, Vermaas M, Abu Hilal M, van Dam RM, Besselink MG (2019) Implementation and outcome of minor and major minimally invasive liver surgery in the Netherlands. HPB (Oxford) 21:1734–1743

pubmed: 31235430 doi: 10.1016/j.hpb.2019.05.002

Okunrintemi V, Gani F, Pawlik TM (2016) National trends in postoperative outcomes and cost comparing minimally invasive versus open liver and pancreatic surgery. J Gastrointest Surg 20:1836–1843

pubmed: 27613735 doi: 10.1007/s11605-016-3267-z

Berardi G, Van Cleven S, Fretland AA, Barkhatov L, Halls M, Cipriani F, Aldrighetti L, Abu Hilal M, Edwin B, Troisi RI (2017) Evolution of laparoscopic liver surgery from innovation to implementation to mastery: perioperative and oncologic outcomes of 2,238 patients from 4 European Specialized Centers. J Am Coll Surg 225:639–649

pubmed: 28838869 doi: 10.1016/j.jamcollsurg.2017.08.006

van der Poel MJ, Besselink MG, Cipriani F, Armstrong T, Takhar AS, van Dieren S, Primrose JN, Pearce NW, Abu Hilal M (2016) Outcome and learning curve in 159 consecutive patients undergoing total laparoscopic hemihepatectomy. JAMA Surg 151:923–928

pubmed: 27383568 doi: 10.1001/jamasurg.2016.1655

Ciria R, Ocana S, Gomez-Luque I, Cipriani F, Halls M, Fretland AA, Okuda Y, Aroori S, Briceno J, Aldrighetti L, Edwin B, Hilal MA (2020) A systematic review and meta-analysis comparing the short- and long-term outcomes for laparoscopic and open liver resections for liver metastases from colorectal cancer. Surg Endosc 34:349–360

pubmed: 30989374 doi: 10.1007/s00464-019-06774-2

Giovinazzo F, Kuemmerli C, Moekotte A, Rawashdeh A, Suhool A, Armstrong T, Primrose J, Abu Hilal M (2020) The impact of enhanced recovery on open and laparoscopic liver resections. Updates Surg 72:649–657

pubmed: 32418169 doi: 10.1007/s13304-020-00786-7

Martinez-Cecilia D, Cipriani F, Shelat V, Ratti F, Tranchart H, Barkhatov L, Tomassini F, Montalti R, Halls M, Troisi RI, Dagher I, Aldrighetti L, Edwin B, Abu Hilal M (2017) Laparoscopic versus open liver resection for colorectal metastases in elderly and octogenarian patients: a multicenter propensity score based analysis of short- and long-term outcomes. Ann Surg 265:1192–1200

pubmed: 28151797 doi: 10.1097/SLA.0000000000002147

van der Poel MJ, Barkhatov L, Fuks D, Berardi G, Cipriani F, Aljaiuossi A, Lainas P, Dagher I, D’Hondt M, Rotellar F, Besselink MG, Aldrighetti L, Troisi RI, Gayet B, Edwin B, Abu Hilal M (2019) Multicentre propensity score-matched study of laparoscopic versus open repeat liver resection for colorectal liver metastases. Br J Surg 106:783–789

pubmed: 30706451 doi: 10.1002/bjs.11096

van der Heijde N, Ratti F, Aldrighetti L, Benedetti Cacciaguerra A, Can MF, D’Hondt M, Di Benedetto F, Ivanecz A, Magistri P, Menon K, Papoulas M, Vivarelli M, Besselink MG, Abu Hilal M (2021) Laparoscopic versus open right posterior sectionectomy: an international, multicenter, propensity score-matched evaluation. Surg Endosc 35:6139–6149

pubmed: 33140153 doi: 10.1007/s00464-020-08109-y

Cipriani F, Alzoubi M, Fuks D, Ratti F, Kawai T, Berardi G, Barkhatov L, Lainas P, Van der Poel M, Faoury M, Besselink MG, D’Hondt M, Dagher I, Edwin B, Troisi RI, Scatton O, Gayet B, Aldrighetti L, Abu Hilal M (2020) Pure laparoscopic versus open hemihepatectomy: a critical assessment and realistic expectations - a propensity score-based analysis of right and left hemihepatectomies from nine European tertiary referral centers. J Hepatobiliary Pancreat Sci 27:3–15

pubmed: 31419040 doi: 10.1002/jhbp.662

Gao Y, Qiao Y, Kreutzer DL, Novitsky YW (2012) Decreased expression of hepatic signaling phosphoproteins after laparoscopic and hand-assisted surgery in a porcine model. J Surg Res 176:608–613

pubmed: 22099598 doi: 10.1016/j.jss.2011.09.051

Burpee SE, Kurian M, Murakame Y, Benevides S, Gagner M (2002) The metabolic and immune response to laparoscopic versus open liver resection. Surg Endosc 16:899–904

pubmed: 12163951 doi: 10.1007/s00464-001-8122-x

Badia JM, Ayton LC, Evans TJ, Carpenter AJ, Nawfal G, Kinderman H, Zografos G, Uemoto S, Cohen J, Habib NA (1998) Systemic cytokine response to hepatic resections under total vascular exclusion. Eur J Surg 164:185–190

pubmed: 9562278 doi: 10.1080/110241598750004625

Schwarz C, Fitschek F, Bar-Or D, Klaus DA, Tudor B, Fleischmann E, Roth G, Tamandl D, Wekerle T, Gnant M, Bodingbauer M, Kaczirek K (2017) Inflammatory response and oxidative stress during liver resection. PLoS ONE 12:e0185685

pubmed: 29045432 pmcid: 5646773 doi: 10.1371/journal.pone.0185685

Maruyama H, Harada A, Kurokawa T, Nonami T, Nakao A, Takagi H (1994) Interleukin-6 as a marker of hepatic metabolism following hepatectomy. Hepatogastroenterology 41:222–224

pubmed: 7959542

Schwarz C, Klaus DA, Tudor B, Fleischmann E, Wekerle T, Roth G, Bodingbauer M, Kaczirek K (2015) Transection speed and impact on perioperative inflammatory response - a randomized controlled trial comparing stapler hepatectomy and CUSA Resection. PLoS ONE 10:e0140314

pubmed: 26452162 pmcid: 4599945 doi: 10.1371/journal.pone.0140314

Shirabe K, Takenaka K, Yamatomto K, Kawahara N, Itasaka H, Nishizaki T, Yanaga K, Sugimachi K (1997) Impaired systemic immunity and frequent infection in patients with Candida antigen after hepatectomy. Hepatogastroenterology 44:199–204

pubmed: 9058144

Richardson AJ, Laurence JM, Lam VW (2014) Use of pre-operative steroids in liver resection: a systematic review and meta-analysis. HPB (Oxford) 16:12–19

pubmed: 23461716 doi: 10.1111/hpb.12066

Robinson SM, Saif R, Sen G, French JJ, Jaques BC, Charnley RM, Manas DM, White SA (2013) N-acetylcysteine administration does not improve patient outcome after liver resection. HPB (Oxford) 15:457–462

pubmed: 23458723 doi: 10.1111/hpb.12005

Chacon E, Eman P, Dugan A, Davenport D, Marti F, Ancheta A, Gupta M, Shah M, Gedaly R (2019) Effect of operative duration on infectious complications and mortality following hepatectomy. HPB (Oxford) 21:1727–1733

pubmed: 31229489 doi: 10.1016/j.hpb.2019.05.001

Schroeder RA, Marroquin CE, Bute BP, Khuri S, Henderson WG, Kuo PC (2006) Predictive indices of morbidity and mortality after liver resection. Ann Surg 243:373–379

pubmed: 16495703 pmcid: 1448949 doi: 10.1097/01.sla.0000201483.95911.08

Kokudo T, Uldry E, Demartines N, Halkic N (2015) Risk factors for incisional and organ space surgical site infections after liver resection are different. World J Surg 39:1185–1192

pubmed: 25561190 doi: 10.1007/s00268-014-2922-3

Sadamori H, Yagi T, Shinoura S, Umeda Y, Yoshida R, Satoh D, Nobuoka D, Utsumi M, Fujiwara T (2013) Risk factors for major morbidity after liver resection for hepatocellular carcinoma. Br J Surg 100:122–129

pubmed: 23175234 doi: 10.1002/bjs.8957

Mentor K, Ratnayake B, Akter N, Alessandri G, Sen G, French JJ, Manas DM, Hammond JS, Pandanaboyana S (2020) Meta-analysis and meta-regression of risk factors for surgical site infections in hepatic and pancreatic resection. World J Surg 44(12):4221-4230. https://doi.org/10.1007/s00268-020-05741-6

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Prev Med 45:247–251

doi: 10.1016/j.ypmed.2007.08.012

Di Fabio F, Samim M, Di Gioia P, Godeseth R, Pearce NW, Abu Hilal M (2014) Laparoscopic major hepatectomies: clinical outcomes and classification. World J Surg 38:3169–3174

pubmed: 25159116 doi: 10.1007/s00268-014-2724-7

Halls MC, Berardi G, Cipriani F, Barkhatov L, Lainas P, Harris S, D’Hondt M, Rotellar F, Dagher I, Aldrighetti L, Troisi RI, Edwin B, Abu Hilal M (2018) Development and validation of a difficulty score to predict intraoperative complications during laparoscopic liver resection. Br J Surg 105:1182–1191

pubmed: 29737513 doi: 10.1002/bjs.10821

Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830

pubmed: 19916210 doi: 10.1097/SLA.0b013e3181b3b2d8

Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R, Aroori S, Belli G, Besselink M, Briceno J, Gayet B, D’Hondt M, Lesurtel M, Menon K, Lodge P, Rotellar F, Santoyo J, Scatton O, Soubrane O, Sutcliffe R, Van Dam R, White S, Halls MC, Cipriani F, Van der Poel M, Ciria R, Barkhatov L, Gomez-Luque Y, Ocana-Garcia S, Cook A, Buell J, Clavien PA, Dervenis C, Fusai G, Geller D, Lang H, Primrose J, Taylor M, Van Gulik T, Wakabayashi G, Asbun H, Cherqui D (2018) The Southampton consensus guidelines for laparoscopic liver surgery: from indication to implementation. Ann Surg 268:11–18

pubmed: 29064908 doi: 10.1097/SLA.0000000000002524

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

pubmed: 19638912 doi: 10.1097/SLA.0b013e3181b13ca2

Nomi T, Fuks D, Kawaguchi Y, Mal F, Nakajima Y, Gayet B (2015) Learning curve for laparoscopic major hepatectomy. Br J Surg 102:796–804

pubmed: 25873161 doi: 10.1002/bjs.9798

Berardi G, Aghayan D, Fretland AA, Elberm H, Cipriani F, Spagnoli A, Montalti R, Ceelen WP, Aldrighetti L, Abu Hilal M, Edwin B, Troisi RI (2019) Multicentre analysis of the learning curve for laparoscopic liver resection of the posterosuperior segments. Br J Surg 106:1512–1522

pubmed: 31441944 doi: 10.1002/bjs.11286

Ratti F, Barkhatov LI, Tomassini F, Cipriani F, Kazaryan AM, Edwin B, Abu Hilal M, Troisi RI, Aldrighetti L (2016) Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases. Surg Endosc 30:3618–3629

pubmed: 26572765 doi: 10.1007/s00464-015-4665-0

Chua D, Syn N, Koh YX, Goh BKP (2021) Learning curves in minimally invasive hepatectomy: systematic review and meta-regression analysis. Br J Surg 108:351–358

pubmed: 33779690 doi: 10.1093/bjs/znaa118

van Buuren S, Groothuis-Oudshoorn K (2011) mice: multivariate imputation by chained equations in R. J Stat Softw 45:67

doi: 10.18637/jss.v045.i03

Hasegawa Y, Wakabayashi G, Nitta H, Takahara T, Katagiri H, Umemura A, Makabe K, Sasaki A (2017) A novel model for prediction of pure laparoscopic liver resection surgical difficulty. Surg Endosc 31:5356–5363

pubmed: 28593408 doi: 10.1007/s00464-017-5616-8

Kawaguchi Y, Fuks D, Kokudo N, Gayet B (2018) Difficulty of laparoscopic liver resection: proposal for a new classification. Ann Surg 267:13–17

pubmed: 28187043 doi: 10.1097/SLA.0000000000002176

Abu Hilal M, Tschuor C, Kuemmerli C, López-Ben S, Lesurtel M, Rotellar F (2020) Laparoscopic posterior segmental resections: How i do it: tips and pitfalls. Int J Surg 82S:178–186

pubmed: 32738544 doi: 10.1016/j.ijsu.2020.06.052

Viganò L, Torzilli G, Troisi R, Aldrighetti L, Ferrero A, Majno P, Toso C, Figueras J, Cherqui D, Adam R, Kokudo N, Hasegawa K, Guglielmi A, Krawczyk M, Giuliante F, Hilal MA, Costa-Maia J, Pinna AD, Cescon M, De Santibanes E, Urbani L, Pawlik T, Costa G, Zugna D (2019) Minor hepatectomies: focusing a blurred picture: analysis of the outcome of 4471 open resections in patients without cirrhosis. Ann Surg 270:842–851

pubmed: 31569127 doi: 10.1097/SLA.0000000000003493

Moreno Elola-Olaso A, Davenport DL, Hundley JC, Daily MF, Gedaly R (2012) Predictors of surgical site infection after liver resection: a multicentre analysis using National Surgical Quality Improvement Program data. HPB (Oxford) 14:136–141

pubmed: 22221576 doi: 10.1111/j.1477-2574.2011.00417.x

Halls MC, Cipriani F, Berardi G, Barkhatov L, Lainas P, Alzoubi M, D’Hondt M, Rotellar F, Dagher I, Aldrighetti L, Troisi RI, Edwin B, Abu Hilal M (2018) Conversion for unfavorable intraoperative events results in significantly worse outcomes during laparoscopic liver resection: lessons learned from a multicenter review of 2861 cases. Ann Surg 268:1051–1057

pubmed: 28582270 doi: 10.1097/SLA.0000000000002332

Zwart MJW, van den Broek B, de Graaf N, Suurmeijer JA, Augustinus S, Te Riele WW, van Santvoort HC, Hagendoorn J, Borel Rinkes IHM, van Dam JL, Takagi K, Tran KTC, Schreinemakers J, van der Schelling G, Wijsman JH, de Wilde RF, Festen S, Daams F, Luyer MD, de Hingh I, Mieog JSD, Bonsing BA, Lips DJ, Abu Hilal M, Busch OR, Saint-Marc O, Zeh HJ 3rd, Zureikat AH, Hogg ME, Koerkamp BG, Molenaar IQ, Besselink MG (2023) The feasibility, proficiency, and mastery learning curves in 635 robotic pancreatoduodenectomies following a multicenter training program: “standing on the shoulders of giants.” Ann Surg 278:e1232–e1241

pubmed: 37288547

Pallister M, Ballas J, Kohn J, Eppes CS, Belfort M, Davidson C (2019) A standardized approach to cesarean surgical technique and its effect on operative time and surgical morbidity. Am J Perinatol 36:277–284

pubmed: 30081402 doi: 10.1055/s-0038-1667370

Hoefsmit PC, Cerfolio RJ, de Vries R, Dahele M, Zandbergen HR (2021) Systematic review of interventions to reduce operating time in lung cancer surgery. Clin Med Insights Oncol 15:1179554920987105

pubmed: 33795942 pmcid: 7970684 doi: 10.1177/1179554920987105

Kazaryan AM, Rosok BI, Edwin B (2013) Morbidity assessment in surgery: refinement proposal based on a concept of perioperative adverse events. ISRN Surg 2013:625093

pubmed: 23762627 pmcid: 3671541 doi: 10.1155/2013/625093

Strasberg SM (2019) A three-step conceptual roadmap for avoiding bile duct injury in laparoscopic cholecystectomy: an invited perspective review. J Hepatobiliary Pancreat Sci 26:123–127

pubmed: 30828991 doi: 10.1002/jhbp.616