文章：

腹腔镜肝后上段切除术中实现教科书式结局：学习曲线的影响

Achieving Textbook Outcomes after Laparoscopic Resection in Posterosuperior Segments of the Liver: The Impact of the Learning Curve

原文发布日期：25 February 2024

DOI: 10.3390/cancers16050930

类型: Article

开放获取: 是

英文摘要：

Achieving textbook outcomes (TOs) improves the short-term and long-term performance of a hospital. Our objective was to assess TOs in the laparoscopic liver resection (LLR) of tumors in the PS (posterosuperior) section of the liver and identify the impact of the learning curve. We conducted a retrospective cohort study analyzing patients who underwent LLR for lesions located in the PS segments. Patients were divided into a TO and no-TO group. TOs were defined as negative margins, no transfusion, no readmission, no major complications, no 30-day mortality, and a length of stay ≤ 50th percentile. Patients’ outcomes were assessed in two study periods before and after 2015. TOs were achieved in 47.6% (n= 117). In multivariable analysis, obesity (p= 0.001), shorter operation time (p< 0.001), less blood loss (p< 0.001), normal albumin (p= 0.003), and minor resection (p= 0.046) were significantly associated with achieving TOs. Although the 5-year recurrence-free survival rate (p= 0.096) was not significantly different, the 5-year overall survival rate was significantly greater in the TO group (p= 0.001). Body mass index > 25 kg/m2(p= 0.020), age > 65 years (p= 0.049), and achievement of TOs (p= 0.024) were independently associated with survival. The proportion of patients who achieved a TO was higher after 2015 than before 2015 (52.3% vs. 36.1%;p= 0.022). TOs are important markers not only for assessing hospital and surgeon performance but also as predictors of overall survival. As the number of surgeons who achieve the learning curve increases, the number of patients with TOs will gradually increase with a subsequent improvement in overall survival.

摘要翻译： 

实现教科书式结局（TOs）可提升医院的短期与长期绩效。本研究旨在评估肝脏后上段（PS）肿瘤腹腔镜肝切除术（LLR）中TOs的达成情况，并探讨学习曲线的影响。我们开展了一项回顾性队列研究，分析因PS段病灶接受LLR治疗的患者。将患者分为TO组与非TO组。TOs定义为：切缘阴性、无需输血、无再入院、无严重并发症、无30天死亡率、住院时长≤中位数。以2015年为界，分两个研究阶段评估患者结局。TOs达成率为47.6%（n=117）。多变量分析显示，肥胖（p=0.001）、较短手术时间（p<0.001）、较少失血量（p<0.001）、正常白蛋白水平（p=0.003）及局部切除（p=0.046）与达成TOs显著相关。虽然5年无复发生存率无显著差异（p=0.096），但TO组的5年总生存率显著更高（p=0.001）。体重指数>25 kg/m²（p=0.020）、年龄>65岁（p=0.049）及达成TOs（p=0.024）是总生存率的独立影响因素。2015年后患者TOs达成比例高于2015年前（52.3% vs. 36.1%；p=0.022）。TOs不仅是评估医院与外科医生绩效的重要指标，更是总生存率的预测因子。随着跨越学习曲线的外科医生数量增加，达成TOs的患者比例将逐步上升，进而改善总生存率。

原文链接：

Achieving Textbook Outcomes after Laparoscopic Resection in Posterosuperior Segments of the Liver: The Impact of the Learning Curve