Risk Factors and Outcomes of Open Conversion During Minimally Invasive Major Hepatectomies: An International Multicenter Study on 3880 Procedures Comparing the Laparoscopic and Robotic Approaches.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Montalti Roberto, Giglio Mariano Cesare, Wu Andrew G R, Cipriani Federica, D'Silva Mizelle, Suhool Amal, Nghia Phan Phuoc, Kato Yutaro, Lim Chetana, Herman Paulo, Coelho Fabricio Ferreira, Schmelzle Moritz, Pratschke Johann, Aghayan Davit L, Liu Qiu, Marino Marco V, Belli Andrea, Chiow Adrian K H, Sucandy Iswanto, Ivanecz Arpad, Di Benedetto Fabrizio, Choi Sung Hoon, Lee Jae Hoon, Park James O, Prieto Mikel, Guzman Yoelimar, Fondevila Constantino, Efanov Mikhail, Rotellar Fernando, Choi Gi-Hong, Robles-Campos Ricardo, Wang Xiaoying, Sutcliffe Robert P, Tang Chung Ngai, Chong Charing C, D'Hondt Mathieu, Dalla Valle Bernardo, Ruzzenente Andrea, Kingham T Peter, Scatton Olivier, Liu Rong, Mejia Alejandro, Mishima Kohei, Wakabayashi Go, Lopez-Ben Santiago, Pascual Franco, Cherqui Daniel, Forchino Fabio, Ferrero Alessandro, Ettorre Giuseppe Maria, Levi Sandri Giovanni Battista, Sugioka Atsushi, Edwin Bjørn, Cheung Tan-To, Long Tran Cong Duy, Abu Hilal Mohammad, Aldrighetti Luca, Fuks David, Han Ho-Seong, Troisi Roberto I, Goh Brian K P, International Robotic and Laparoscopic Liver Resection Study Group Investigators
Аннотация
METHODS: Data on 3880 MI conventional and technical (right anterior and posterior sectionectomies) MHs were retrospectively collected. Risk factors and perioperative outcomes of open conversion were analyzed. Multivariate analysis, propensity score matching, and inverse probability treatment weighting analysis were performed to control for confounding factors.
RESULTS: Overall, 3211 laparoscopic MHs (LMHs) and 669 robotic MHs (RMHs) were included, of which 399 (10.28%) had an open conversion. Multivariate analyses demonstrated that male sex, laparoscopic approach, cirrhosis, previous abdominal surgery, concomitant other surgery, American Society of Anesthesiologists (ASA) score 3/4, larger tumor size, conventional MH, and Institut Mutualiste Montsouris classification III procedures were associated with an increased risk of conversion. After matching, patients requiring open conversion had poorer outcomes compared with non-converted cases, as evidenced by the increased operation time, blood transfusion rate, blood loss, hospital stay, postoperative morbidity/major morbidity and 30/90-day mortality. Although RMH showed a decreased risk of conversion compared with LMH, converted RMH showed increased blood loss, blood transfusion rate, postoperative major morbidity and 30/90-day mortality compared with converted LMH.
CONCLUSIONS: Multiple risk factors are associated with conversion. Converted cases, especially those due to intraoperative bleeding, have unfavorable outcomes. Robotic assistance seemed to increase the feasibility of the MI approach, but converted robotic procedures showed inferior outcomes compared with converted laparoscopic procedures.