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أعرض في EDS

Modern trends in minimally invasive versus open hepatectomy for colorectal liver metastasis: an analysis of ACS-NSQIP.

التفاصيل البيبلوغرافية
العنوان: Modern trends in minimally invasive versus open hepatectomy for colorectal liver metastasis: an analysis of ACS-NSQIP.
المؤلفون: Carpenter EL; Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX, 78234, USA. elizabeth.lee.carpenter@gmail.com., Thomas KK; Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX, 78234, USA., Adams AM; Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX, 78234, USA., Valdera FA; Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX, 78234, USA., Chick RC; Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX, 78234, USA., Kemp Bohan PM; Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX, 78234, USA., Spitzer HV; Department of Surgery, William Beaumont Army Medical Center, 18511 Highlander Medics St, Fort Bliss, TX, 79918, USA., Clifton GT; Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX, 78234, USA., Bader JO; Department of Clinical Investigation, William Beaumont Army Medical Center, 18511 Highlander Medics St, Fort Bliss, TX, 79918, USA., Nelson DW; Department of Surgery, William Beaumont Army Medical Center, 18511 Highlander Medics St, Fort Bliss, TX, 79918, USA., Vreeland TJ; Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX, 78234, USA.
المصدر: Surgical endoscopy [Surg Endosc] 2023 Jul; Vol. 37 (7), pp. 5591-5602. Date of Electronic Publication: 2022 Nov 07.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Springer Country of Publication: Germany NLM ID: 8806653 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-2218 (Electronic) Linking ISSN: 09302794 NLM ISO Abbreviation: Surg Endosc Subsets: MEDLINE
أسماء مطبوعة: Publication: 1992- : New York : Springer
Original Publication: [Berlin] : Springer International, c1987-
مواضيع طبية MeSH: Liver Neoplasms*/secondary , Colorectal Neoplasms*/surgery , Colorectal Neoplasms*/pathology, Humans ; Hepatectomy/methods ; Quality Improvement ; Minimally Invasive Surgical Procedures ; Postoperative Complications/surgery ; Retrospective Studies
مستخلص: Background: Surgical resection of colorectal liver metastasis (CRLM) provides the best opportunity for prolonged survival. Eligibility for metastasectomy has expanded with technical advancements including parenchymal-sparing hepatectomy (PSH). Meanwhile, enthusiasm for minimally invasive surgery (MIS) has increased, though this approach may be preferentially utilized for technically straightforward cases. The purpose of this study is to characterize modern trends in open versus MIS approaches to partial hepatectomy and anatomic hepatectomy for CRLM within a nationwide cohort.
Methods: The American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) was used to investigate trends in MIS versus open hepatectomy for CRLM from 2015 to 2019. We examined baseline clinicopathologic and disease-related characteristics and compared trends in treatments over the study period.
Results: A total of 7457 patients undergoing hepatectomy for CRLM were identified (1367 MIS, 6090 open). Patients had similar clinicopathologic features between the two groups. Patients undergoing MIS resection less frequently received neoadjuvant therapy (51.1% vs 64.0%, p < 0.001) or concurrent intraoperative ablation (15.0% vs 21.3%, p < 0.001). Patients with tumors < 2 cm (34.9% vs 26.8%, p < 0.001) or only one to two tumors (82.8% vs 65.0%, p < 0.001) more commonly underwent MIS. MIS and open partial hepatectomies both significantly increased over the study period, but open partial hepatectomy increased at a greater rate than MIS (p < 0.001). Rates of anatomic resections have remained the same, with a greater proportion performed using an open approach (34.9% vs 16.4%, p < 0.001). Rates of operations consisting of > 1 concurrent partial hepatectomy are stable, but significantly more likely to be performed open (p < 0.001).
Conclusions: Hepatectomy for CRLM has increased from a rise in partial hepatectomy, potentially translating to increased use of PSH. Current trends suggest MIS approaches appear to be increasing, but selectively implemented for patients with less technically demanding disease characteristics. Educational efforts should be directed towards increased dissemination of parenchymal-sparing MIS techniques for more complex resections.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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فهرسة مساهمة: Keywords: Colorectal liver metastasis; Hepatectomy; Minimally invasive surgery; Parenchymal-sparing
تواريخ الأحداث: Date Created: 20221107 Date Completed: 20230707 Latest Revision: 20230718
رمز التحديث: 20231215
DOI: 10.1007/s00464-022-09749-y
PMID: 36344895
قاعدة البيانات: MEDLINE
الوصف
تدمد:1432-2218
DOI:10.1007/s00464-022-09749-y