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Multicenter Study
. 2024 Dec;38(12):7118-7130.
doi: 10.1007/s00464-024-11276-x. Epub 2024 Sep 30.

Is prolonged operative time associated with postoperative complications in liver surgery? An international multicentre cohort study of 5424 patients

Christoph Kuemmerli #  1   2 , Jasper P Sijberden #  3   4   5 , Federica Cipriani  6 , Daniel Osei-Bordom  7 , Davit Aghayan  8 , Jacopo Lanari  9 , Celine de Meyere  10 , Andrea Benedetti Cacciaguerra  11 , Fernando Rotellar  12 , David Fuks  13 , Rong Liu  14 , Marc G Besselink  4   5 , Giuseppe Zimmitti  3 , Andrea Ruzzenente  15 , Fabrizio di Benedetto  16 , Iswanto Succandy  17 , Mikhail Efanov  18 , Riccardo Memeo  19 , Elio Jovine  20 , Dionisios Vrochides  21 , Ibrahim Dagher  22 , Roland Croner  23 , Santi Lopez-Ben  24 , David Geller  25 , Jawad Ahmad  26 , Tom Gallagher  27 , Steven White  28   29 , Adnan Alseidi  30 , Brian K P Goh  31 , Ernesto Sparrelid  32 , Francesca Ratti  6 , Ravi Marudanayagam  7 , Åsmund Avdem Fretland  8 , Marco Vivarelli  11 , Mathieu D'Hondt  10 , Umberto Cillo  9 , Bjørn Edwin  8 , Robert P Sutcliffe  7 , Luca A Aldrighetti  6 , Mohammed Abu Hilal  33   34 ; International Consortium on Minimally Invasive Liver Surgery (I-MILS)
Affiliations
Multicenter Study

Is prolonged operative time associated with postoperative complications in liver surgery? An international multicentre cohort study of 5424 patients

Christoph Kuemmerli et al. Surg Endosc. 2024 Dec.

Abstract

Background: The relation between operative time and postoperative complications in liver surgery is unclear. The aim of this study is to assess the impact of operative time on the development of postoperative complications in patients who underwent minimally invasive or open liver resections of various anatomical extent and technical difficulty levels.

Methods: In this retrospective cohort study, patients that underwent a right hemihepatectomy (RH), technically major resection (anatomically minor resection in segment 1, 4a, 7 or 8; TMR) or left lateral sectionectomy (LLS) between 2000 and 2022 were extracted from a multicenter database comprising the prospectively maintained databases of 31 centers in 13 countries. Minimally invasive procedures performed during the learning curve were omitted. Logistic regression models, performed separately for 9 different groups based on stratification by procedure type and allocated surgical approach, were used to assess the association between the fourth quartile of operative time (25% of patients with the longest operative time) and postoperative complications.

Results: Overall, 5424 patients were included: 1351 underwent RH (865 open, 373 laparoscopic and 113 robotic), 2821 TMR (1398 open, 1225 laparoscopic and 198 robotic), and 1252 LLS (241 open, 822 laparoscopic and 189 robotic). After adjusting for potential confounders (age, BMI, gender, ASA grade, previous abdominal surgery, disease type and extent, blood loss, Pringle, intraoperative transfusions and incidents), the fourth quartile of operative time, compared to the first three quartiles, was associated with an increased risk of postoperative complications after open, laparoscopic and robotic TMR (aOR 1.35, p = 0.031; aOR 1.74, p = 0.001 and aOR 3.11, p = 0.014, respectively), laparoscopic and robotic RH (aOR 1.98, p = 0.018 and aOR 3.28, p = 0.055, respectively) and solely laparoscopic LLS (aOR 1.69, p = 0.019).

Conclusions: A prolonged operative time is associated with an increased risk of postoperative complications, although it remains to be defined if this is a causal relationship.

Keywords: Hepatectomy; Minimally invasive surgery; Operative time; Postoperative complications.

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Conflict of interest statement

Declarations. Disclosures: The authors Christoph Kuemmerli, Jasper P. Sijberden, Federica Cipriani Daniel Osei-Bordom, Davit Aghayan, Jacopo Lanari, Celine de Meyere, Andrea Benedetti Cacciaguerra, Fernando Rotellar, David Fuks, Rong Liu, Marc G. Besselink, Giuseppe Zimmitti, Andrea Ruzzenente, Fabrizio di Benedetto, Iswanto Succandy, Mikhail Efanov, Riccardo Memeo, Elio Jovine, Dionisios Vrochides, Ibrahim Dagher, Roland Croner, Santi Lopez-Ben, David Geller, Jawad Ahmad, Tom Gallagher, Steven White, Adnan Alseidi, Brian K.P. Goh, Ernesto Sparrelid, Francesca Ratti, Ravi Marudanayagam, Åsmund Avdem Fretland, Marco Vivarelli, Mathieu D’Hondt, Umberto Cillo, Bjørn Edwin, Robert P. Sutcliffe, Luca A. Aldrighetti, Mohammed Abu Hilal have no conflicts of interest or financial ties to disclose.

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References

    1. Russolillo N, Aldrighetti L, Cillo U, Guglielmi A, Ettorre GM, Giuliante F, Mazzaferro V, Dalla Valle R, De Carlis L, Jovine E, Ferrero A (2020) Risk-adjusted benchmarks in laparoscopic liver surgery in a national cohort. Br J Surg 107:845–853 - PubMed - DOI
    1. van der Poel MJ, Fichtinger RS, Bemelmans M, Bosscha K, Braat AE, de Boer MT, Dejong CHC, Doornebosch PG, Draaisma WA, Gerhards MF, Gobardhan PD, Gorgec B, Hagendoorn J, Kazemier G, Klaase J, Leclercq WKG, Liem MS, Lips DJ, Marsman HA, Mieog JSD, Molenaar QI, Nieuwenhuijs VB, Nota CL, Patijn GA, Rijken AM, Slooter GD, Stommel MWJ, Swijnenburg RJ, Tanis PJ, Te Riele WW, Terkivatan T, van den Tol PM, van den Boezem PB, van der Hoeven JA, Vermaas M, Abu Hilal M, van Dam RM, Besselink MG (2019) Implementation and outcome of minor and major minimally invasive liver surgery in the Netherlands. HPB (Oxford) 21:1734–1743 - PubMed - DOI
    1. Okunrintemi V, Gani F, Pawlik TM (2016) National trends in postoperative outcomes and cost comparing minimally invasive versus open liver and pancreatic surgery. J Gastrointest Surg 20:1836–1843 - PubMed - DOI
    1. Berardi G, Van Cleven S, Fretland AA, Barkhatov L, Halls M, Cipriani F, Aldrighetti L, Abu Hilal M, Edwin B, Troisi RI (2017) Evolution of laparoscopic liver surgery from innovation to implementation to mastery: perioperative and oncologic outcomes of 2,238 patients from 4 European Specialized Centers. J Am Coll Surg 225:639–649 - PubMed - DOI
    1. van der Poel MJ, Besselink MG, Cipriani F, Armstrong T, Takhar AS, van Dieren S, Primrose JN, Pearce NW, Abu Hilal M (2016) Outcome and learning curve in 159 consecutive patients undergoing total laparoscopic hemihepatectomy. JAMA Surg 151:923–928 - PubMed - DOI

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