Surgery最新文献

{"title":"Main versus segmental hepatic artery angioembolization in patients with traumatic liver injuries: A Western Trauma Association multicenter study","authors":"Peter D. Nguyen MD ,&nbsp;Jeffry Nahmias MD, MHPE ,&nbsp;Negaar Aryan MD ,&nbsp;Jason M. Samuels MD ,&nbsp;Michael Cripps MD ,&nbsp;Heather Carmichael MD ,&nbsp;Robert McIntyre Jr. MD ,&nbsp;Shane Urban BSN, RN ,&nbsp;Clay Cothren Burlew MD ,&nbsp;Catherine Velopulos MD ,&nbsp;Shana Ballow DO ,&nbsp;Rachel C. Dirks PhD ,&nbsp;Marchall Chance Spalding DO, PhD, FACS ,&nbsp;Aimee LaRiccia DO ,&nbsp;Michael S. Farrell MD, MS ,&nbsp;Deborah M. Stein MD, MPH ,&nbsp;Michael S. Truitt MD, FACS ,&nbsp;Heather M. Grossman Verner MS ,&nbsp;Caleb J. Mentzer DO ,&nbsp;T.J. Mack MSN, RN, TCRN, CEN ,&nbsp;Areg Grigorian MD","doi":"10.1016/j.surg.2024.10.002","DOIUrl":"10.1016/j.surg.2024.10.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Hepatic angioembolization is highly effective for hemorrhage control in hemodynamically stable patients with traumatic liver injuries and contrast extravasation. However, there is a paucity of data regarding the specific location of angioembolization within the hepatic arterial vasculature and its implications on patient outcomes.</div></div><div><h3>Methods</h3><div>A post-hoc analysis of a multicenter prospective observational study across 23 centers was performed. Adult patients undergoing main hepatic artery angioembolization or segmental hepatic artery angioembolization within 8 hours of arrival were included. The primary outcome was liver-related complications, defined as perihepatic fluid collection, bile leak/biloma, pseudoaneurysm, hepatic necrosis, and/or hepatic abscess. Secondary outcomes were liver-related complication interventions, length of stay, and mortality.</div></div><div><h3>Results</h3><div>A total of 55 patients underwent hepatic angioembolization, with 23 (41.8%) undergoing main hepatic artery angioembolization and 32 (58.2%) receiving segmental hepatic artery angioembolization. Both groups were comparable in age, vitals, mechanism of injury, liver injury grade distribution, and injury severity score (all <em>P</em> &gt; .05). The main hepatic artery angioembolization group had greater rates of overall liver-related complications (65.2% vs 31.2%, <em>P</em> = .039), specifically perihepatic fluid collection (26.1% vs 6.3%, <em>P</em> = .040) and bile-leak/biloma (34.8% vs 12.5%, <em>P</em> = .048). Main hepatic artery angioembolization had greater rates of 2 or more liver-related complications (47.8% vs 9.4%, <em>P</em> = .001) and readmission within 30 days (30.4% vs 9.4%, <em>P</em> = .046). No significant differences were observed in hospital length of stay and mortality (all <em>P</em> &gt; .05).</div></div><div><h3>Conclusions</h3><div>Main hepatic artery angioembolization is associated with increased rates of liver-related complications, multiple liver-related complications, and readmission within 30 days compared with segmental hepatic artery angioembolization. Thus, main hepatic artery angioembolization should be reserved for use only when segmental hepatic artery angioembolization is not feasible, albeit with significantly increased morbidity.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"178 ","pages":"Article 108909"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to letter to the editor on “Long-term lorazepam use may be associated with worse long-term outcomes among patients with pancreatic adenocarcinoma”","authors":"Diamantis I. Tsilimigras MD, PhD,&nbsp;Timothy M. Pawlik MD, PhD, MPH, MTS, MBA","doi":"10.1016/j.surg.2024.10.006","DOIUrl":"10.1016/j.surg.2024.10.006","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"178 ","pages":"Article 108915"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to letter to the editor: “Team member familiarity and team effectiveness in the operating room: The mediating effect of mutual trust and shared mental models”","authors":"Tessa L. Verhoeff MD,&nbsp;Jeroen J.H.M. Janssen PhD,&nbsp;Reinier G. Hoff MD, PhD","doi":"10.1016/j.surg.2024.10.005","DOIUrl":"10.1016/j.surg.2024.10.005","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"178 ","pages":"Article 108914"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bile acid in drainage fluid for early diagnosis of anastomotic leakage and safe discharge after minimally invasive rectal cancer resection: A prospective cohort study","authors":"Linfeng Gao MS ,&nbsp;Tao Zhang MS ,&nbsp;Xicheng Chen MS ,&nbsp;Sen Dong MS ,&nbsp;Donglin Chen MS ,&nbsp;Nanhui Liu MS ,&nbsp;Bo Tang MD, PhD","doi":"10.1016/j.surg.2024.10.032","DOIUrl":"10.1016/j.surg.2024.10.032","url":null,"abstract":"<div><h3>Background</h3><div>This study was designed to evaluate the diagnostic value of bile acid levels in drainage fluid for early prediction and exclusion of anastomotic leakage, and assess the performance in allowing a safe discharge.</div></div><div><h3>Methods</h3><div>This prospective single-center study was conducted in patients diagnosed with rectal cancer who had received minimally invasive anterior resection consecutively from December 2021 to March 2024. Bile acid in drainage fluid, C-reactive protein, and procalcitonin in serum were measured on the third and fifth day after surgery. Four criteria were considered in discharging patients: a C-reactive protein level below 100 mg/L, flatus with or without defecation, a restore of liquid diet, a bile acid level less than 2 μmol/L.</div></div><div><h3>Results</h3><div>A total of 419 patients were included and divided into an anastomotic leakage group (<em>n</em> = 37; 8.8%) and a nonanastomotic leakage group (<em>n</em> = 382; 91.2%). Of those patients, 384 accorded with the discharge criteria and 380 of them (99%) discharged safely. The rate of anastomotic leakage after discharge and readmission was 0.5% and 0.3%. Bile acid levels in drainage fluid in the anastomotic leakage group were significantly greater than that in the nonanastomotic leakage group on both postoperative days 3 and 5 (postoperative day 3: 3.00 [2.00–5.17] μmol/L vs 0.80 [0.40–1.30] μmol/L, <em>P</em> &lt; .001; and postoperative day 5: 5.17 [3.00–9.20] μmol/L vs 2.00 [1.40–3.50] μmol/L, <em>P</em> &lt; .001). The negative predictive value in ruling out an anastomotic leakage were 0.96 on postoperative day 3 and 0.97 on postoperative day 5 for bile acid alone.</div></div><div><h3>Conclusion</h3><div>Drainage bile acid has a high negative predictive value in the early diagnosis of anastomotic leakage and showed potential to allow for safe discharge.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"178 ","pages":"Article 108949"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is distal pancreatectomy the optimal surgical procedure for pancreatic neck cancer?","authors":"Satoshi Nomura MD ,&nbsp;Toshihiko Masui MD, PhD ,&nbsp;Jun Muto MD, PhD ,&nbsp;Kazuki Hashida MD ,&nbsp;Hirohisa Kitagawa MD, PhD ,&nbsp;Ibuki Fujinuma MD ,&nbsp;Kei Kitamura MD, PhD ,&nbsp;Toshiro Ogura MD, PhD ,&nbsp;Amane Takahashi MD, PhD ,&nbsp;Kazuyuki Kawamoto MD, PhD","doi":"10.1016/j.surg.2024.10.021","DOIUrl":"10.1016/j.surg.2024.10.021","url":null,"abstract":"<div><h3>Background</h3><div>The optimal resection for pancreatic neck cancer is challenging in clinical practice because we could dissect by pancreaticoduodenectomy or distal pancreatectomy. The purpose of this study was to evaluate the effectiveness of lymph node dissection and to help determine the optimal surgical treatment for pancreatic neck cancer.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated 462 patients with pancreatic cancer who underwent curative-intent pancreatectomy between 2012 and 2022, 35 of whom had pancreatic neck cancer without preoperative radiologic gastroduodenal artery contact. We analyzed the clinicopathological characteristics, lymph node metastasis stations, and the efficacy index of lymph node dissection, which was calculated by multiplying the frequency of lymph node metastasis to each station by the 5-year survival rate of patients with positive lymph nodes at each station.</div></div><div><h3>Results</h3><div>The lymph node station with the greatest rate of metastasis was #11p (28.6%), followed by #8 (17.1%), #14 (14.3%), #13 (14.3%), #17 (9.5%), and #6 (4.8%). The efficacy indices of lymph node dissection were 14.3 for #11, 4.76 for #13, and 8.57 for #14. There were no significant differences in 5-year recurrence-free survival and 5-year overall survival between patients undergoing pancreaticoduodenectomy and those undergoing distal pancreatectomy (23.7% vs 54.7%, <em>P</em> = .142; 29.9% vs 51.1%, <em>P</em> = .179, respectively). Univariate survival analysis showed that tumor size ≥2 cm was associated with poor prognosis (hazard ratio, 3.842, <em>P</em> = .009).</div></div><div><h3>Conclusions</h3><div>PD with #11p lymph node dissection is preferable to DP in terms of survival benefit for pancreatic neck cancer with lymph node metastasis.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"178 ","pages":"Article 108930"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of metachronous peritoneal metastases after surgery for obstructive colon cancer: Multivariate analysis from a series of 1,085 patients","authors":"Antoine Cazelles MD ,&nbsp;Ahmad Tarhini MD ,&nbsp;Charles Sabbagh MD, PhD ,&nbsp;Diane Mege MD, PhD ,&nbsp;Valérie Bridoux MD, PhD ,&nbsp;Zaher Lakkis MD, PhD ,&nbsp;Thibault Voron MD, PhD ,&nbsp;Solafah Abdalla MD ,&nbsp;Frederik Lecot MD ,&nbsp;Mehdi Karoui MD, PhD ,&nbsp;Gilles Manceau MD, PhD","doi":"10.1016/j.surg.2024.10.014","DOIUrl":"10.1016/j.surg.2024.10.014","url":null,"abstract":"<div><h3>Background</h3><div>Data in the literature suggest that obstruction is an independent predictor of poor prognosis in colon cancer. Of all possible sites of recurrence, peritoneal metastases are associated with worse survival. Our aim was to report the incidence of metachronous peritoneal metastases from a cohort of patients undergoing resection of obstructive colon cancer with curative intent and to identify predictive factors for metachronous peritoneal metastases.</div></div><div><h3>Methods</h3><div>From 2000 to 2015, a total of 2,325 patients were treated for obstructive colon cancer in French surgical centers, members of the French National Surgical Association (AFC). Patients with palliative management, synchronous metastatic disease, and with postoperative mortality were excluded. A multivariate analysis was performed to determine independent predictive factors of metachronous peritoneal metastases.</div></div><div><h3>Results</h3><div>The cohort included 1,085 patients. The median follow-up was 21.5 months. Metachronous peritoneal metastases occurred in 12% of patients and were diagnosed after a median interval of 13.5 months. The cumulative 3-year metachronous peritoneal metastasis rate was 10.9%. Three-year overall survival was 85% for patients who did not develop recurrence, 71% for those who develop recurrence without peritoneal metastases, and 56% for those with metachronous peritoneal metastases (<em>P</em> &lt; .0001). In multivariate analysis, 3 variables were identified as independent risk factors for metachronous peritoneal metastases: pT4 stage (odds ratio: 1.98; 95% confidence interval: 1.17–3.36; <em>P</em> = .011), pN2 stage (odds ratio: 2.57; 95% confidence interval: 1.89–4.45; <em>P</em> = .0007), and fewer than 12 lymph nodes examined (odds ratio: 2.01; 95% confidence interval: 1.08–3.74; <em>P</em> = .028).</div></div><div><h3>Conclusion</h3><div>This study showed a significant risk of metachronous peritoneal metastases after curative-intent resection of obstructive colon cancer. The awareness of factors predisposing to metachronous peritoneal metastases could improve the treatment strategy of these patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"178 ","pages":"Article 108923"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluorescence-guided pancreatic surgery: A scoping review","authors":"Thomas B. Piper MD ,&nbsp;Gustav H. Schaebel MD ,&nbsp;Charlotte Egeland MD, PhD ,&nbsp;Michael P. Achiam MD, PhD, DMSc ,&nbsp;Stefan K. Burgdorf MD, PhD ,&nbsp;Nikolaj Nerup MD, PhD","doi":"10.1016/j.surg.2024.10.022","DOIUrl":"10.1016/j.surg.2024.10.022","url":null,"abstract":"<div><h3>Background</h3><div>Although fluorescence guidance during various surgical procedures has been shown to be safe and have possible better clinical outcomes than without the guidance, the use of fluorophores in pancreatic surgery is novel and not yet well described. This scoping review involved a systematic methodology of the currently available literature and aimed to illuminate the use of fluorophores in pancreatic surgery from a clinical view.</div></div><div><h3>Methods</h3><div>The PRISMA and the PRISMA-ScR guidelines were used when appropriate and the following databases were searched: PubMed, Embase, Scopus, The Cochrane Collection, and Web of Science. Human original articles and case reports were included. Bias was assessed with the Newcastle-Ottawa Scale and the IDEAL framework was used for evaluation of surgical innovation.</div></div><div><h3>Results</h3><div>A total of 5,565 search hits were screened, and 23 original articles and 24 case reports consisting of 754 patients met the inclusion criteria. The use of indocyanine green was both the most prominent and the most promising method for securing sufficient perfusion of neighboring organs, enhancing the detection and distinguishing of neuroendocrine tumors, and assisting in the identification of hepatic micrometastases.</div></div><div><h3>Conclusion</h3><div>The included studies were generally heterogenic, exploratory, and small. Indocyanine green was used in several ways, and it may add clinical value in different settings during pancreatic surgery. Tumor-targeted probes are a rapidly developing and promising field of research.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"178 ","pages":"Article 108931"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional and inflammatory status dynamics reflect preoperative treatment response and predict prognosis in locally advanced rectal cancer: A retrospective multi-institutional analysis","authors":"Wen Zhao MD ,&nbsp;Dingchang Li MD ,&nbsp;Xianqiang Liu MM ,&nbsp;Wenxing Gao MM ,&nbsp;Zhengyao Chang MD ,&nbsp;Peng Chen MD ,&nbsp;Xu Sun MD ,&nbsp;Yingjie Zhao MD ,&nbsp;Hao Liu MM ,&nbsp;Di Wu MD ,&nbsp;Sizhe Wang MM ,&nbsp;Yinqi Zhang MM ,&nbsp;Hanqing Jiao MM ,&nbsp;Xiangbin Wan MD, PhD ,&nbsp;Guanglong Dong MD, PhD","doi":"10.1016/j.surg.2024.108965","DOIUrl":"10.1016/j.surg.2024.108965","url":null,"abstract":"<div><h3>Background</h3><div>Systemic inflammation, as an important host property, is the most representative tumor-host interactions in cancer, and the development of malignant neoplasms may contribute to impairment on nutritional status. This study aimed to investigate the potential ability of nutritional and inflammatory index in predicting neoadjuvant chemoradiotherapy efficacy and prognosis in locally advanced rectal cancer (LARC).</div></div><div><h3>Methods</h3><div>This study was conducted using multi-institutional data. A total of 507 patients (262 in the training and 245 in the validation cohort) with stage IIA-IIIC LARC fit for neoadjuvant chemoradiotherapy were recruited from 2012 to 2014 were included in this study. Advanced lung cancer inflammation index (ALI) reflected nutritional and inflammatory status. The ALI was calculated as body mass index (BMI) × albumin × neutrophil/lymphocyte. Logistic regression model was used to identify predictive factors for preoperative treatment response. Cox multivariate regression models were used to analyze the factors affecting disease-free survival (DFS) and overall survival (OS).</div></div><div><h3>Results</h3><div>In the training cohort, patients with high pretreatment ALI were observed to be associated with young patients, never smoked, relatively high BMI, and early-stage pathologic TNM staging. The receiver operating characteristic curve indicated that pretreatment ALI and its changing was the single most important factor determining outcomes than other inflammatory indicators. The 10-year DFS and OS rates of the whole group were 63.6% and 74.1% respectively. Patients with low pretreatment ALI and ALI change had significantly poorer 10-year DFS (<em>P</em> &lt; .001 and <em>P</em> = .001) and 10-year OS (<em>P</em> = .002 and <em>P</em> = .025) rates than those with high ALI and ALI change. Similar findings were observed in the validation cohort. Multivariate analysis revealed that pretreatment ALI (<em>P</em> = .047 and <em>P</em> = .006) and ALI change (<em>P</em> = .027 and <em>P</em> = .041) were identified as independent prognostic factors for DFS. Meanwhile, high pretreatment ALI (<em>P</em> = .020 and <em>P</em> = .010), high systemic immune-inflammation index (SII) change (<em>P</em> = .040 and <em>P</em> = .012) and clinical stage T2-T3 were independent protective factors for OS. Furthermore, multivariate logistic regression analyses revealed that pretreatment ALI, ALI change, and SII change could independently predict efficacy of neoadjuvant chemoradiotherapy.</div></div><div><h3>Conclusion</h3><div>Our results suggest that as a feasible indicator of nutritional and inflammatory status, the ALI shows better efficiency than other inflammatory indicators in predicting efficacy of neoadjuvant chemoradiotherapy and prognosis.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"178 ","pages":"Article 108965"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic compared with laparoscopic cholecystectomy: A National Surgical Quality Improvement Program comparative analysis","authors":"Felipe B. Maegawa MD, MS, FACS ,&nbsp;Jamil Stetler MD, FACS ,&nbsp;Dipan Patel MD, FACS ,&nbsp;Snehal Patel MD, FACS ,&nbsp;Federico J. Serrot MD, FACS ,&nbsp;Edward Lin DO, FACS ,&nbsp;Ankit D. Patel MD, FACS","doi":"10.1016/j.surg.2024.08.006","DOIUrl":"10.1016/j.surg.2024.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Data demonstrating the clinical benefit of robotic cholecystectomy over the laparoscopic approach are lacking. Herein, we aim to evaluate whether robotic cholecystectomy is associated with improved surgical outcomes compared with laparoscopic cholecystectomy.</div></div><div><h3>Study Design</h3><div>This is a retrospective cohort study that used the American College of Surgeons National Surgical Quality Improvement Program to compare the outcomes of patients who underwent robotic or laparoscopic cholecystectomy for benign indications in 2022.</div></div><div><h3>Results</h3><div>Of the 59,216 patients identified, 53,746 underwent laparoscopic cholecystectomy and 5,470 robotic. Compared with the robotic cohort, the patients in the laparoscopic cholecystectomy group were older (50.4 vs 49.7 years), were of the male sex (32.7% vs 29.7%), and comprised a greater percentage of other races than White, African American, and Asian (28.6% vs 14.8%). Multivariable logistic regression revealed that robotic cholecystectomy compared with the laparoscopic approach was independently associated with a lower risk of Clavien-Dindo complications grade 3 or 4 (odds ratio, 0.82; 95% confidence interval, 0.69–0.98), a lower rate of conversion to open (odds ratio, 0.44; 95% confidence interval, 0.32–0.61), and lower odds of requiring hospitalization ≥24 hours (odds ratio, 0.76; 95% confidence interval, 0.71–0.81). There were no significant differences between the 2 approaches in terms of reoperation (odds ratio, 0.69; 95% confidence interval, 0.47–1.00) and readmission (odds ratio, 0.94; 95% confidence interval, 0.82–1.10).</div></div><div><h3>Conclusion</h3><div>Robotic cholecystectomy was independently associated with a lower risk of serious complications, lower rate conversion to open, and hospitalization ≥24 hours compared with laparoscopic cholecystectomy. These findings suggest that new technologies might enhance the safety of minimally invasive surgery.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"178 ","pages":"Article 108772"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors and outcomes of conversions in robotic and laparoscopic liver resections: A nationwide analysis","authors":"Gabriela Pilz da Cunha MD ,&nbsp;Jasper P. Sijberden MD ,&nbsp;Paul Gobardhan MD, PhD ,&nbsp;Daan J. Lips MD, PhD ,&nbsp;Türkan Terkivatan MD, PhD ,&nbsp;Hendrik A. Marsman MD, PhD ,&nbsp;Gijs A. Patijn MD, PhD ,&nbsp;Wouter K.G. Leclercq MD, PhD ,&nbsp;Koop Bosscha MD, PhD ,&nbsp;J. Sven D. Mieog MD, PhD ,&nbsp;Peter B. van den Boezem MD, PhD ,&nbsp;Maarten Vermaas MD, PhD ,&nbsp;Niels F.M. Kok MD, PhD ,&nbsp;Eric J.T. Belt MD, PhD ,&nbsp;Marieke T. de Boer MD, PhD ,&nbsp;Wouter J.M. Derksen MD, PhD ,&nbsp;Hans Torrenga MD, PhD ,&nbsp;Paul M. Verheijen MD, PhD ,&nbsp;Steven J. Oosterling MD, PhD ,&nbsp;Michelle R. de Graaff MD ,&nbsp;Rutger-Jan Swijnenburg MD, PhD","doi":"10.1016/j.surg.2024.09.004","DOIUrl":"10.1016/j.surg.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Unfavorable intraoperative findings or incidents during minimally invasive liver surgery may necessitate conversion to open surgery. This study aimed to identify predictors for conversion in minimally invasive liver surgery and gain insight into outcomes following conversions.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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], <em>P</em> &lt; .001), major blood loss (≥500 mL, 58.8% vs 26.7%, <em>P</em> &lt; .001), intensive care admission (19.0% vs 8.4%, <em>P</em> = .005), overall morbidity (38.9% vs 21.0%, <em>P</em> &lt; .001), severe morbidity (17.9% vs 9.6%, <em>P</em> = .002), and a longer hospital stay (6 days [interquartile range 5–8] vs 4 days [interquartile range 2–5], <em>P</em> &lt; .001) but not mortality (2.2% vs 1.2%, <em>P</em> = .387). Emergency conversions had increased intraoperative blood loss (1,500 mL [interquartile range 700–2,800] vs 525 mL [interquartile range 208–1,000], <em>P</em> &lt; .001), major blood loss (87.5% vs 59.3%, <em>P</em> = .005), and intensive care admission (27.9% vs 10.6%, <em>P</em> = .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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"178 ","pages":"Article 108820"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}