Risk factors and outcomes of conversions in robotic and laparoscopic liver resections: A nationwide analysis.
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Pilz da Cunha Gabriela, Sijberden Jasper P, Gobardhan Paul, Lips Daan J, Terkivatan Türkan, Marsman Hendrik A, Patijn Gijs A, Leclercq Wouter K G, Bosscha Koop, Mieog J Sven D, van den Boezem Peter B, Vermaas Maarten, Kok Niels F M, Belt Eric J T, de Boer Marieke T, Derksen Wouter J M, Torrenga Hans, Verheijen Paul M, Oosterling Steven J, de Graaff Michelle R, Rijken Arjen M, Coolsen Marielle M E, Liem Mike S L, Tran T C Khé, Gerhards Michael F, Nieuwenhuijs Vincent, van Dieren Susan, Abu Hilal Mohammad, Besselink Marc G, van Dam Ronald M, Hagendoorn Jeroen, Swijnenburg Rutger-Jan, Dutch Hepatobiliary Audit Group
Аннотация
METHODS: This nationwide, retrospective cohort study compared converted and non-converted minimally invasive liver surgery procedures using data from 20 centers in the Dutch Hepatobiliary Audit (2014-2022). Propensity score matching was applied. Subgroup analyses of converted robotic liver resection versus laparoscopic liver resection and emergency versus non-emergency conversions were performed. Predictors for conversions were identified using backward stepwise multivariable logistic regression.
RESULTS: Of 3,530 patients undergoing minimally invasive liver surgery (792 robotic liver resection, 2,738 laparoscopic liver resection), 408 (11.6%) were converted (4.9% robotic liver resection, 13.5% laparoscopic liver resection). Conversion was associated with increased blood loss (580 mL [interquartile range 250-1,200] vs 200 mL [interquartile range 50-500], P < .001), major blood loss (≥500 mL, 58.8% vs 26.7%, P < .001), intensive care admission (19.0% vs 8.4%, P = .005), overall morbidity (38.9% vs 21.0%, P < .001), severe morbidity (17.9% vs 9.6%, P = .002), and a longer hospital stay (6 days [interquartile range 5-8] vs 4 days [interquartile range 2-5], P < .001) but not mortality (2.2% vs 1.2%, P = .387). Emergency conversions had increased intraoperative blood loss (1,500 mL [interquartile range 700-2,800] vs 525 mL [interquartile range 208-1,000], P < .001), major blood loss (87.5% vs 59.3%, P = .005), and intensive care admission (27.9% vs 10.6%, P = .029), compared with non-emergency conversions. Robotic liver resection was linked to lower conversion risk, whereas American Society of Anesthesiologists grade ≥3, larger lesion size, concurrent ablation, technically major, and anatomically major resections were risk factors.
CONCLUSION: Both emergency and non-emergency conversions negatively impact perioperative outcomes in minimally invasive liver surgery. Robotic liver resection reduces conversion risk compared to laparoscopic liver resection.