Is operation time over the benchmark value a risk factor for worse short-term outcomes after laparoscopic liver resection?

Introduction
Laparoscopic liver resection is a challenging surgical procedure that may require prolonged operation time, particularly during the learning curve. Operation time significantly decreases with increasing experience; however, prolonged operation time may significantly increase the risk of postoperative complications.

Aim
To assess whether prolonged operation time over the benchmark value influences short-term postoperative outcomes after laparoscopic liver resection.

Material and methods
A retrospective cohort study based on data from the National Polish Registry of Minimally Invasive Liver Surgery was performed. A total of 197 cases consisting of left lateral sectionectomy (LLS), left hemihepatectomy (LH), and right hemihepatectomy (RH) with established benchmark values for operation time were included. Data about potential confounders for prolonged operation time and worse short-term outcomes were exported.

Results
Most cases (129; 65.5%) were performed during the learning curve, while the largest rate was observed in LLS (57; 78.1%). Median operation time exceeded the benchmark value in LLS (Me = 210 min) and LH (Me = 350 min), while in RH the benchmark value was exceeded in 39 (44.3%) cases. Textbook outcomes were achieved in 138 (70.1%) cases. Univariate analysis (OR = 1.11; 95% CI: 0.61–2.06; p = 0.720) and multivariate analysis (OR = 1.16; 95% CI: 0.50–2.68; p = 0.734) did not reveal a significant impact of prolonged surgery on failing to achieve a textbook outcome.

Conclusions
Prolonging the time of laparoscopic liver resection does not significantly impair postoperative results. There is no reason related to the patients’ safety to avoid prolonging the time of laparoscopic liver resection over the benchmark value.