Novel Benchmark for Robotic Liver Resection - Bridging Tradition with Innovation.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Li Zhihao, Pfister Matthias, Raptis Dimitri A, Ma Yong, Yang Guangchao, Li Linqiang, Song Xuan, Millet Guillaume, Truant Stéphanie, Venezia Raphael, Jeddou Heithem, Le Floch Bastien, Valverde Alain, Peru Nicolas, Pessaux Patrick, Codiglione Fabio Giannone, Mabrut Jean-Yves, Mohkam Kayvan, Cunha Antonio Sa, Salloum Chady, Blanc Pierre Y, Roy Bertrand Le, Goumard Claire, Scatton Olivier, Tzedakis Stylianos, Fuks David, Chaoui Ismael, Rammohan Ashwin, da Silva Silvia Gomes, Sobral Mafalda S N, Lopez-Lopez Victor, Centonze Leonardo, Zhu Zhu, Ratti Francesca, Marino Rebecca, Rompianesi Gianluca, Dong Yawen, Shah Jimmy, Müller Philip C, Wakabayashi Taiga, Coelho Fabricio F, Castillo-Flores Samy, Lee Boram, Viti Virginia, Kato Yutaro, Boggi Ugo, Han Ho-Seong, Polanco Patricio, Goh Brian K P, Cheung Tan-To, Efanov Mikhail, Panaro Fabrizio, Machado Marcel, Herman Paulo, Wakabayashi Go, Ielpo Benedetto, Müller Beat P, Mejia Alejandro, Starlinger Patrick, Martinie John, Troisi Roberto I, Aldrighetti Luca, Chen Guodong, Robles-Campos Ricardo, Choi Gi Hong, Liu Rong, Di Benedetto Fabrizio, Marques Hugo Pinto, Sucandy Iswanto, Rela Mohamed, D'Hondt Mathieu, Brustia Raffaele, Soubrane Olivier, Broering Dieter C, Clavien Pierre-Alain
Аннотация
BACKGROUND: R-LR is a key advancement in minimally invasive liver surgery but lacks standardized benchmarks, especially for minor resections. While guidelines endorse R-LR, its role in optimizing outcomes remains unclear. This study establishes the first benchmarks for R-LR, enabling comparisons across surgical modalities and refining patient selection.
METHODS: This retrospective, multicenter study analyzed consecutive adult patients undergoing R-LR at 30 international centers (2020-2023). Benchmark centers had an annual case volume of ≥15 R-LR. Benchmark criteria included ASA ≤2, no major comorbidities, no prior liver resections, and Child-Pugh A status. Benchmark cutoffs for 14 key outcomes were set at the 50th and 75th percentiles of median values across benchmark centers. Multivariable logistic regression identified predictors of textbook outcomes.
RESULTS: Eighteen high-volume centers contributed 4028 cases with 2632 (65.3%) meeting benchmark criteria. Malignancy was the indication in 29.6%, most commonly hepatocellular carcinoma followed by colorectal liver metastases. Major liver resection was performed in 42.6%. The distribution of Iwate difficulty scores was low (25.4%), intermediate (53.9%), advanced (15.9%), and expert (4.9%). Benchmark cutoffs were established for minor and major resection, and stratified by Iwate low (0-3), intermediate (4-6) and high (7-12): Open conversion (≤6.5% minor, ≤10.5% major), major complications within 90 days (≤5.2% minor, ≤16.7% major), R1 resection (≤9.2% minor, ≤6.7% major). Benchmark cases performed at low-volume centers were able to achieve outcomes within the corresponding benchmark cutoffs. In fact, patient selection reflected by the proportion of benchmark patients, rather than case volume, was associated with textbook outcomes.
CONCLUSIONS: This study defines R-LR benchmarks, emphasizing patient selection over center volume for optimal outcomes. Benchmark cutoffs guide training and support the expansion of R-LR.