Analysis of influencing factors for achieving textbook outcome after laparoscopic right posterior sectionectomy of hepatocellular carcinoma.

BACKGROUND

Textbook outcome (TO) is a comprehensive indicator used to assess postoperative outcomes and quality of care. This study analyzes the incidence and influencing factors of TO after laparoscopic right posterior sectionectomy (LRPS) in hepatocellular carcinoma (HCC) patients.

METHOD: A retrospective cohort study was conducted on HCC patients who underwent LRPS at Sun Yat-sen Memorial Hospital from January 2018 to June 2023. Patients were divided into TO and non-TO groups. Univariable and multivariable logistic regression analyses identified factors influencing TO achievement.

RESULT: A total of 115 HCC patients underwent LRPS, with 70.4 % (82/115) achieving TO. Univariable logistic regression analysis identified smoking history, preoperative alanine transaminase, preoperative R-glutaminase transferase, operative time, intraoperative blood loss, blood transfusion and lymphovascular invasion as risk factors. Multivariablelogistic regression analysis revealed smoking history (OR: 9.92, 95 % CI: 2.60-37.82, P = 0.001), preoperative alanine transaminase (OR: 3.43, 95 % CI: 1.11-10.57, P = 0.032), preoperative R-glutaminase transferase (OR: 3.34, 95 % CI: 1.16-9.65, P = 0.026), and intraoperative blood loss (OR: 1.25, 95 % CI: 1.07-1.47, P = 0.005) as independent risk factors. The combined index of these factors showed the greatest predictive value for TO (AUC: 0.821, 95 % CI: 0.74-0.90, P < 0.001).

CONCLUSION

TO is a reliable measure for LRPS outcomes. Factors such as no smoking history, preoperative alanine transaminase ≤50 U/L, preoperative R-glutaminase transferase ≤60 U/L, and intraoperative blood loss <325 mL are associated with higher TO achievement.