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1. Laparoscopic versus open resection of intrahepatic cholangiocarcinoma: nationwide analysis

Author

Eric Vibert, C. Hobeika, Patrick Pessaux, Y.P. Le Treut, O Turini, B Menahem, M.-A. Allard, J Barbieux, F Jehaes, Julio Abba, J Ewald, J Hardwigsen, B Trechot, J.-M. Regimbeau, L Ferre, M Lesurtel, E Lermite, M. El Amrani, E Buc, C VanBrugghe, U Marchese, P. Balladur, F Muscari, René Adam, A. Sa Cunha, Emilie Gregoire, Takayuki Kawai, Brice Gayet, Daniel Cherqui, Olivier Farges, J Lubrano, T Hor, N Petrucciani, J Chauvat, François Paye, M Bougard, Emmanuel Boleslawski, F R Souche, Edouard Girard, L. Schwarz, S Okumura, M Tedeschi, Alexis Laurent, J.-M. Fabre, A Carmelo, Ephrem Salamé, P Leourier, T Codjia, Christian Letoublon, A Thobie, S Truant, G Millet, X Unterteiner, Lionel Rebibo, Z Cherkaoui, Riccardo Memeo, J Nunèz, Olivier Scatton, Petru Bucur, Takeo Nomi, H Fagot, Nicolas Golse, C Ratajczak, M Chirica, Shohei Komatsu, Louise Barbier, D Patrice, K Lecolle, François Cauchy, Claire Goumard, Olivier Soubrane, François-René Pruvot, Gabriella Pittau, Christian Ducerf, Guillaume Passot, Oriana Ciacio, Christophe Laurent, N Oudafal, David Fuks, Kayvan Mohkam, A.-R. Kianmanesh, B Suc, Jean-Yves Mabrut, A Mulliri, J Zemour, L Chiche, Université Paris Cité (UPCité), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Mutualiste de Montsouris (IMM), Université Paris Descartes - Paris 5 (UPD5), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Montpellier (UM), Hôpital Claude Huriez [Lille], CHU Lille, Chirurgie digestive [CHU Amiens], CHU Amiens-Picardie, Simplification des soins chez les patients complexes - UR UPJV 7518 (SSPC), Université de Picardie Jules Verne (UPJV), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), L'Institut hospitalo-universitaire de Strasbourg (IHU Strasbourg), Institut National de Recherche en Informatique et en Automatique (Inria)-l'Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD)-Les Hôpitaux Universitaires de Strasbourg (HUS)-La Fédération des Crédits Mutuels Centre Est (FCMCE)-L'Association pour la Recherche contre le Cancer (ARC)-La société Karl STORZ, Institut de Recherche Contre les Cancers de l'Appareil Digestif-European Institute of Telesurgery (IRCAD/EITS), CHU Strasbourg, CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Physiopathologie et traitement des maladies du foie, Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Paul Brousse, Centre de Recherche Saint-Antoine (CRSA), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)

Subjects
Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 030230 surgery, Cholangiocarcinoma, 03 medical and health sciences, 0302 clinical medicine, Open Resection, medicine, Humans, Laparoscopic resection, Blood Transfusion, Laparoscopy, Propensity Score, Lymph node, Intrahepatic Cholangiocarcinoma, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, Odds ratio, Length of Stay, Middle Aged, Survival Analysis, Surgery, Dissection, medicine.anatomical_structure, Treatment Outcome, Bile Duct Neoplasms, 030220 oncology & carcinogenesis, Propensity score matching, Lymph Node Excision, Female, Bile Ducts, France, business
Abstract

Background The relevance of laparoscopic resection of intrahepatic cholangiocarcinoma (ICC) remains debated. The aim of this study was to compare laparoscopic (LLR) and open (OLR) liver resection for ICC, with specific focus on textbook outcome and lymph node dissection (LND). Methods Patients undergoing LLR or OLR for ICC were included from two French, nationwide hepatopancreatobiliary surveys undertaken between 2000 and 2017. Patients with negative margins, and without transfusion, severe complications, prolonged hospital stay, readmission or death were considered to have a textbook outcome. Patients who achieved both a textbook outcome and LND were deemed to have an adjusted textbook outcome. OLR and LLR were compared after propensity score matching. Results In total, 548 patients with ICC (127 LLR, 421 OLR) were included. Textbook-outcome and LND completion rates were 22.1 and 48.2 per cent respectively. LLR was independently associated with a decreased rate of LND (odds ratio 0.37, 95 per cent c.i. 0.20 to 0.69). After matching, 109 patients remained in each group. LLR was associated with a decreased rate of transfusion (7.3 versus 21.1 per cent; P = 0.001) and shorter hospital stay (median 7 versus 14 days; P = 0.001), but lower rate of LND (33.9 versus 73.4 per cent; P = 0.001). Patients who underwent LLR had lower rate of adjusted TO completion than patients who had OLR (6.5 versus 17.4 per cent; P = 0.012). Conclusion The laparoscopic approach did not substantially improve quality of care of patients with resectable ICC.

Published
2020
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2. Benchmark performance of laparoscopic left lateral sectionectomy and right hepatectomy in expert centers

Author

F.-R. Pruvot, C. Hobeika, S Truant, Patrick Pessaux, M.-A. Allard, M Tedeschi, Kayvan Mohkam, A. Sa Cunha, Julio Abba, J Chauvat, Riccardo Memeo, Takayuki Kawai, Christian Ducerf, T Codjia, François Paye, N Oudafal, Alexis Laurent, J Nunèz, F Jehaes, Takeo Nomi, M Chirica, Jean-Yves Mabrut, A Mulliri, C VanBrugghe, David Fuks, J Barbieux, Ephrem Salamé, Eric Vibert, L Ferre, Y.P. Le Treut, Oriana Ciacio, F R Souche, Emmanuel Boleslawski, A Thobie, Z Cherkaoui, Daniel Cherqui, S Okumura, M Bougard, B Trechot, Shohei Komatsu, M. El Amrani, Olivier Soubrane, J.-M. Regimbeau, F Muscari, L Chiche, E Buc, J.-M. Fabre, M Lesurtel, B Suc, Brice Gayet, B Menahem, P. Balladur, O Turini, A.-R. Kianmanesh, Nicolas Golse, François Cauchy, Emilie Gregoire, J Ewald, J Hardwigsen, J.-Y. Mabrut, Claire Goumard, C Ratajczak, Edouard Girard, P Leourier, L. Schwarz, J Zemour, Christian Letoublon, Gabriella Pittau, Guillaume Passot, Christophe Laurent, E Lermite, Jean-Marc Regimbeau, A Carmelo, G Millet, X Unterteiner, D Patrice, U Marchese, A. Laurent, J Lubrano, Lionel Rebibo, H Fagot, K Lecolle, T Hor, Olivier Scatton, Petru Bucur, René Adam, N Petrucciani, and Louise Barbier

Subjects
0301 basic medicine, Male, Percentile, medicine.medical_specialty, medicine.medical_treatment, Patient Readmission, Resection, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, medicine, Hepatectomy, Humans, In patient, Blood Transfusion, Mortality, Severe complication, Quality Indicators, Health Care, Hepatology, business.industry, General surgery, Liver Neoplasms, Margins of Excision, Odds ratio, Composite indicator, Length of Stay, Hospitals, Benchmarking, 030104 developmental biology, Outcome and Process Assessment, Health Care, Health Care Surveys, 030211 gastroenterology & hepatology, Female, Laparoscopy, France, Benchmark, laparoscopic liver resection, left lateral sectionectomy, quality of care, right hepatectomy, textbook outcome, Complication, business
Abstract

Background & Aims Herein, we aimed to establish benchmark values – based on a composite indicator of healthcare quality – for the performance of laparoscopic left lateral sectionectomy (LLLS) and laparoscopic right hepatectomy (LRH) using data from expert centers. Methods Data from a nationwide multicenter survey including all patients undergoing LLLS and LRH between 2000 and 2017 were analyzed. Textbook outcome (TO) completion was considered in patients fulfilling all 6 of the following characteristics: negative margins, no transfusion, no complication, no prolonged hospital stay, no readmission and no mortality. For each procedure, a cut-off laparoscopic liver resection (LLR) volume by center was associated with TO on multivariable analysis. These cut-offs defined the expert centers. The benchmark values were set at the 75th percentile of median outcomes among these expert centers. Results Among 4,400 LLRs performed in 29 centers, 855 patients who underwent LLLS and 488 who underwent LRH were identified. The overall incidences of TO after LLLS and LRH were 43.7% and 23.8%, respectively. LLR volume cut-offs of 25 LLR/year (odds ratio [OR] 2.45; bootstrap 95% CI 1.65–3.69; p = 0.001) and 35 LLR/year (OR 2.55; bootstrap 95% CI 1.34–5.63; p = 0.003) were independently associated with completion of TO after LLLS and LRH, respectively. Eight centers for LLLS and 6 centers for LRH, including 516 and 346 patients undergoing LLLS/LRH respectively, reached these cut-offs and were identified as expert centers. After LLLS, benchmark values of severe complication, mortality and TO completion were defined as ≤5.3%, ≤1.2% and ≥46.6%, respectively. After LRH, benchmark values of severe complication, mortality and TO completion were ≤20.4%, ≤2.8% and ≥24.2%, respectively. Conclusions This study provides an up-to-date reference on the benchmark performance of LLLS and LRH in expert centers. Lay summary In a nationwide French survey of laparoscopic liver resection, expert centers were defined according to the completion of a textbook outcome, which is a composite indicator of healthcare quality. Benchmark values regarding intra-operative details and outcomes were established using data from 516 patients with laparoscopic left lateral sectionectiomy and 346 patients with laparoscopic right hepatectomy from expert centers. These values should be used as a reference point to improve the quality of laparoscopic resections.

Published
2020

3. Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey

Author

C. Hobeika, O Turini, J Barbieux, J Ewald, J Hardwigsen, Julio Abba, U Marchese, Patrick Pessaux, C Ratajczak, F Jehaes, J Lubrano, P Leourier, B Menahem, N Oudafal, M Tedeschi, M Lesurtel, B Trechot, J.-M. Regimbeau, Eric Vibert, A Carmelo, David Fuks, G Millet, X Unterteiner, T Codjia, J-M Fabre, Emilie Gregoire, D Patrice, C VanBrugghe, M-A Allard, Shohei Komatsu, M. El Amrani, Takeo Nomi, J Zemour, Lionel Rebibo, Kayvan Mohkam, J Nunèz, M Chirica, F Muscari, B Suc, Y-P le Treut, H Fagot, Riccardo Memeo, Brice Gayet, Olivier Scatton, Petru Bucur, K Lecolle, E Lermite, Edouard Girard, Emmanuel Boleslawski, L Ferre, F-R Pruvot, Louise Barbier, Christian Letoublon, Gabriella Pittau, Z Cherkaoui, Nicolas Golse, M Bougard, Guillaume Passot, Takayuki Kawai, Christophe Laurent, L Chiche, René Adam, Alexis Laurent, T Hor, N Petrucciani, A Thobie, P. Balladur, A-R Kianmanesh, F R Souche, A Mulliri, L. Schwarz, J-Y Mabrut, S Okumura, François Cauchy, S Truant, François Paye, Claire Goumard, E Salamé, Christian Ducerf, Oriana Ciacio, A. Sa Cunha, E Buc, Daniel Cherqui, J Chauvat, Oliver Soubrane, Institut de Recherche sur les Maladies Virales et Hépatiques (IVH), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), and AFC-LLR-2018 study group

Subjects
Liver Cirrhosis, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Cirrhosis, Aucun, Sciences du Vivant [q-bio]/Médecine humaine et pathologie, Gastroenterology, Disease-Free Survival, liver, cirrhosis, laparoscopic liver resection, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Carcinoma, Hepatectomy, Humans, Risk factor, Propensity Score, Aged, Retrospective Studies, Cause of death, business.industry, Mortality rate, Liver Neoplasms, Retrospective cohort study, Odds ratio, Middle Aged, medicine.disease, Population Surveillance, 030220 oncology & carcinogenesis, Propensity score matching, Female, Laparoscopy, 030211 gastroenterology & hepatology, Surgery, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study.This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection.Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010).Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres.El objetivo de este estudio fue analizar el impacto de la cirrosis en los resultados a corto plazo después de la resección hepática laparoscópica (laparoscopic liver resection, LLR) en un estudio de cohortes multicéntrico nacional. MÉTODOS: Este estudio retrospectivo incluyó todos los pacientes sometidos a LLR en 27 centros entre 2000 y 2017. La cirrosis se definió como fibrosis F4 en el examen histopatológico. Los resultados a corto plazo de los pacientes con hígado cirrótico (cirrhotic liver CL) (pacientes CL) y los pacientes con hígado no cirrótico (non-cirrhotic liver, NCL) (pacientes NCL) se compararon después de realizar un emparejamiento por puntaje de propension del volumen del centro, las características demográficas y del tumor, y la extensión de la resección.Del total de 3.150 pacientes incluidos, se realizó LLR en 774 (24,6%) pacientes CL y en 2.376 (75,4%) pacientes NCL. Las tasas de complicaciones graves y mortalidad en el grupo de pacientes CL fueron del 10,6% y 2,6%, respectivamente. La insuficiencia hepática posterior a la hepatectomía (post-hepatectomy liver failure, PHLF) fue la principal causa de mortalidad (55% de los casos) y se produjo en el 3,6% de los casos en pacientes CL. Después del emparejamiento, los pacientes CL tendieron a tener tasas más altas de complicaciones graves (razón de oportunidades, odds ratio, OR 1,74; i.c. del 95% 0,92-0,41; P = 0,096) y de PHLF (OR 7,13; i.c. del 95% 0,91-323,10; P = 0,068) en comparación con los pacientes NCL. Los pacientes CL estuvieron expuestos a un mayor riesgo de mortalidad (OR 5,13; i.c. del 95% 1,08-48,6; P = 0,039) en comparación con los pacientes NCL. Los pacientes CL presentaron tasas similares de complicaciones cardiorrespiratorias graves (P = 0,338), de fuga biliar (P = 0,286) y de reintervenciones (P = 0,352) que los pacientes NCL. Los pacientes CL tuvieron una estancia hospitalaria más larga (11 versus 8 días; P = 0,018) que los pacientes NCL. La experiencia del centro fue un factor protector independiente de PHLF (OR 0,33; i.c. del 95% 0,14-0,76; P = 0,010) pacientes CL. CONCLUSIÓN: La presencia de cirrosis subyacente sigue siendo un factor de riesgo independiente de peores resultados en pacientes sometidos a resección hepática laparoscópica, incluso en centros con experiencia.

Published
2020
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4. Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey.

Author

Hobeika C, Fuks D, Cauchy F, Goumard C, Soubrane O, Gayet B, Salamé E, Cherqui D, Vibert E, Scatton O, Nomi T, Oudafal N, Kawai T, Komatsu S, Okumura S, Petrucciani N, Laurent A, Bucur P, Barbier L, Trechot B, Nunèz J, Tedeschi M, Allard MA, Golse N, Ciacio O, Pittau G, Cunha AS, Adam R, Laurent C, Chiche L, Leourier P, Rebibo L, Regimbeau JM, Ferre L, Souche FR, Chauvat J, Fabre JM, Jehaes F, Mohkam K, Lesurtel M, Ducerf C, Mabrut JY, Hor T, Paye F, Balladur P, Suc B, Muscari F, Millet G, El Amrani M, Ratajczak C, Lecolle K, Boleslawski E, Truant S, Pruvot FR, Kianmanesh AR, Codjia T, Schwarz L, Girard E, Abba J, Letoublon C, Chirica M, Carmelo A, VanBrugghe C, Cherkaoui Z, Unterteiner X, Memeo R, Pessaux P, Buc E, Lermite E, Barbieux J, Bougard M, Marchese U, Ewald J, Turini O, Thobie A, Menahem B, Mulliri A, Lubrano J, Zemour J, Fagot H, Passot G, Gregoire E, Hardwigsen J, le Treut YP, and Patrice D

Subjects
Aged, Disease-Free Survival, Female, Humans, Liver Cirrhosis etiology, Male, Middle Aged, Population Surveillance, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Carcinoma, Hepatocellular surgery, Hepatectomy adverse effects, Laparoscopy adverse effects, Liver Cirrhosis diagnosis, Liver Neoplasms surgery, Postoperative Complications diagnosis, Propensity Score
Abstract

Background: The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study., Methods: This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection., Results: Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010)., Conclusion: Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres., (© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd.)

Published
2020
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