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Erschienen in: Surgical Endoscopy 7/2016

20.10.2015

The learning curve of laparoscopic liver resection after the Louisville statement 2008: Will it be more effective and smooth?

verfasst von: Chung-Wei Lin, Tzu-Jung Tsai, Tsung-Yen Cheng, Hung-Kuang Wei, Chen-Fang Hung, Yin-Yin Chen, Chii-Ming Chen

Erschienen in: Surgical Endoscopy | Ausgabe 7/2016

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Abstract

Background

Laparoscopic liver resection (LLR) has been proven to be feasible and safe. However, it is a difficult and complex procedure with a steep learning curve. The aim of this study was to evaluate the learning curve of LLR at our institutions since 2008.

Methods

One hundred and twenty-six consecutive LLRs were included from May 2008 to December 2014. Patient characteristics, operative data, and surgical outcomes were collected prospectively and analyzed.

Results

The median tumor size was 25 mm (range 5–90 mm), and 96 % of the resected tumors were malignant. 41.3 % (52/126) of patients had pathologically proven liver cirrhosis. The median operation time was 216 min (range 40–602 min) with a median blood loss of 100 ml (range 20–2300 ml). The median length of hospital stay was 4 days (range 2–10 days). Six major postoperative complications occurred in this series, and there was no 90-day postoperative mortality. Regarding the incidence of major operative events including operation time longer than 300 min, perioperative blood loss above 500 ml, and major postoperative complications, the learning curve [as evaluated by the cumulative sum (CUSUM) technique] showed its first reverse after 22 cases. The indication of laparoscopic resection in this series extended after 60 cases to include tumors located in difficult locations (segments 4a, 7, 8) and major hepatectomy. CUSUM showed that the incidence of major operative events proceeded to increase again, and the second reverse was noted after an additional 40 cases of experience. Location of the tumor in a difficult area emerged as a significant predictor of major operative events.

Conclusions

In carefully selected patients, CUSUM analysis showed 22 cases were needed to overcome the learning curve for minor LLR.
Literatur
1.
Zurück zum Zitat Gagner M, Rheault M, Dubuc J (1992) Laparoscopic partial hepatectomy for liver tumor. Surg Endosc 6:97–98 Gagner M, Rheault M, Dubuc J (1992) Laparoscopic partial hepatectomy for liver tumor. Surg Endosc 6:97–98
2.
Zurück zum Zitat Cherqui D, Husson E, Hammoud R, Malassagne B, Stéphan F, Bensaid S, Rotman N, Fagniez P-L (2000) Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 232:753–762CrossRefPubMedPubMedCentral Cherqui D, Husson E, Hammoud R, Malassagne B, Stéphan F, Bensaid S, Rotman N, Fagniez P-L (2000) Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 232:753–762CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Cherqui D, Laurent A, Tayar C, Chang S, Van Nhieu JT, Loriau J, Karoui M, Duvoux C, Dhumeaux D, Fagniez PL (2006) Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg 243:499–506CrossRefPubMedPubMedCentral Cherqui D, Laurent A, Tayar C, Chang S, Van Nhieu JT, Loriau J, Karoui M, Duvoux C, Dhumeaux D, Fagniez PL (2006) Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg 243:499–506CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Dagher I, Belli G, Fantini C, Laurent A, Tayar C, Lainas P, Tranchart H, Franco D, Cherqui D (2010) Laparoscopic hepatectomy for hepatocellular carcinoma: a European experience. J Am Coll Surg 211:16–23CrossRefPubMed Dagher I, Belli G, Fantini C, Laurent A, Tayar C, Lainas P, Tranchart H, Franco D, Cherqui D (2010) Laparoscopic hepatectomy for hepatocellular carcinoma: a European experience. J Am Coll Surg 211:16–23CrossRefPubMed
5.
Zurück zum Zitat Vigano L, Tayar C, Laurent A, Cherqui D (2009) Laparoscopic liver resection: a systematic review. J Hepato-Biliary-Pancreat Surg 16:410–421CrossRef Vigano L, Tayar C, Laurent A, Cherqui D (2009) Laparoscopic liver resection: a systematic review. J Hepato-Biliary-Pancreat Surg 16:410–421CrossRef
6.
Zurück zum Zitat Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection—2,804 patients. Ann Surg 250:831–841CrossRefPubMed Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection—2,804 patients. Ann Surg 250:831–841CrossRefPubMed
7.
Zurück zum Zitat Koffron AJ, Auffenberg G, Kung R, Abecassis M (2007) Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg 246:385–392 (discussion 392–384) CrossRefPubMedPubMedCentral Koffron AJ, Auffenberg G, Kung R, Abecassis M (2007) Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg 246:385–392 (discussion 392–384) CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Buell JF, Thomas MT, Rudich S, Marvin M, Nagubandi R, Ravindra KV, Brock G, McMasters KM (2008) Experience with more than 500 minimally invasive hepatic procedures. Ann Surg 248:475–486PubMed Buell JF, Thomas MT, Rudich S, Marvin M, Nagubandi R, Ravindra KV, Brock G, McMasters KM (2008) Experience with more than 500 minimally invasive hepatic procedures. Ann Surg 248:475–486PubMed
9.
Zurück zum Zitat Chen HY, Juan CC, Ker CG (2008) Laparoscopic liver surgery for patients with hepatocellular carcinoma. Ann Surg Oncol 15:800–806CrossRefPubMed Chen HY, Juan CC, Ker CG (2008) Laparoscopic liver surgery for patients with hepatocellular carcinoma. Ann Surg Oncol 15:800–806CrossRefPubMed
10.
Zurück zum Zitat Vigano L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D (2009) The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg 250:772–782CrossRefPubMed Vigano L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D (2009) The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg 250:772–782CrossRefPubMed
11.
Zurück zum Zitat Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker C-G, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey J-N, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS (2009) The international position on laparoscopic liver surgery. Ann Surg 250:825–830CrossRefPubMed Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker C-G, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey J-N, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS (2009) The international position on laparoscopic liver surgery. Ann Surg 250:825–830CrossRefPubMed
12.
Zurück zum Zitat Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:83CrossRefPubMedPubMedCentral Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:83CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Bryant R, Laurent A, Tayar C, Cherqui D (2009) Laparoscopic liver resection-understanding its role in current practice: the Henri Mondor Hospital experience. Ann Surg 250:103–111CrossRefPubMed Bryant R, Laurent A, Tayar C, Cherqui D (2009) Laparoscopic liver resection-understanding its role in current practice: the Henri Mondor Hospital experience. Ann Surg 250:103–111CrossRefPubMed
14.
15.
Zurück zum Zitat Wohl H (1977) The cusum plot: its utility in the analysis of clinical data. N Engl J Med 296:1044–1045CrossRefPubMed Wohl H (1977) The cusum plot: its utility in the analysis of clinical data. N Engl J Med 296:1044–1045CrossRefPubMed
16.
Zurück zum Zitat Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Yap CH, Colson ME, Watters DA (2007) Cumulative sum techniques for surgeons: a brief review. ANZ J Surg 77:583–586CrossRefPubMed Yap CH, Colson ME, Watters DA (2007) Cumulative sum techniques for surgeons: a brief review. ANZ J Surg 77:583–586CrossRefPubMed
18.
Zurück zum Zitat Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ (2015) Recommendations for laparoscopic liver resection: a report from the second International Consensus Conference Held in Morioka. Ann Surg 261:619–629PubMed Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ (2015) Recommendations for laparoscopic liver resection: a report from the second International Consensus Conference Held in Morioka. Ann Surg 261:619–629PubMed
19.
Zurück zum Zitat Rao A, Rao G, Ahmed I (2012) Laparoscopic vs. open liver resection for malignant liver disease. A systematic review. Surgeon 10:194–201CrossRefPubMed Rao A, Rao G, Ahmed I (2012) Laparoscopic vs. open liver resection for malignant liver disease. A systematic review. Surgeon 10:194–201CrossRefPubMed
20.
Zurück zum Zitat Parks KR, Kuo YH, Davis JM, O’Brien B, Hagopian EJ (2014) Laparoscopic versus open liver resection: a meta-analysis of long-term outcome. HPB (Oxford) 16:109–118CrossRef Parks KR, Kuo YH, Davis JM, O’Brien B, Hagopian EJ (2014) Laparoscopic versus open liver resection: a meta-analysis of long-term outcome. HPB (Oxford) 16:109–118CrossRef
21.
Zurück zum Zitat Nguyen KT, Marsh JW, Tsung A, Steel JJ, Gamblin TC, Geller DA (2011) Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch Surg 146:348–356CrossRefPubMed Nguyen KT, Marsh JW, Tsung A, Steel JJ, Gamblin TC, Geller DA (2011) Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch Surg 146:348–356CrossRefPubMed
22.
Zurück zum Zitat Wakabayashi G, Cherqui D, Geller DA, Han HS, Kaneko H, Buell JF (2014) Laparoscopic hepatectomy is theoretically better than open hepatectomy: preparing for the 2nd International Consensus Conference on Laparoscopic Liver Resection. J Hepato-Biliary-Pancreat Surg 21:723–731CrossRef Wakabayashi G, Cherqui D, Geller DA, Han HS, Kaneko H, Buell JF (2014) Laparoscopic hepatectomy is theoretically better than open hepatectomy: preparing for the 2nd International Consensus Conference on Laparoscopic Liver Resection. J Hepato-Biliary-Pancreat Surg 21:723–731CrossRef
23.
Zurück zum Zitat Vanounou T, Steel JL, Nguyen KT, Tsung A, Marsh JW, Geller DA, Gamblin TC (2010) Comparing the clinical and economic impact of laparoscopic versus open liver resection. Ann Surg Oncol 17:998–1009CrossRefPubMed Vanounou T, Steel JL, Nguyen KT, Tsung A, Marsh JW, Geller DA, Gamblin TC (2010) Comparing the clinical and economic impact of laparoscopic versus open liver resection. Ann Surg Oncol 17:998–1009CrossRefPubMed
24.
Zurück zum Zitat Lin NC, Nitta H, Wakabayashi G (2013) Laparoscopic major hepatectomy: a systematic literature review and comparison of 3 techniques. Ann Surg 257:205–213CrossRefPubMed Lin NC, Nitta H, Wakabayashi G (2013) Laparoscopic major hepatectomy: a systematic literature review and comparison of 3 techniques. Ann Surg 257:205–213CrossRefPubMed
25.
Zurück zum Zitat Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC, Lainas P, Laurent A, Nguyen KT, Marvin MR, Thomas M, Ravindra K, Fielding G, Franco D, Buell JF (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250:856–860CrossRefPubMed Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC, Lainas P, Laurent A, Nguyen KT, Marvin MR, Thomas M, Ravindra K, Fielding G, Franco D, Buell JF (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250:856–860CrossRefPubMed
26.
Zurück zum Zitat Pearce NW, Di Fabio F, Teng MJ, Syed S, Primrose JN, Hilal MA (2011) Laparoscopic right hepatectomy: a challenging, but feasible, safe and efficient procedure. Am J Surg 202:e52–e58CrossRefPubMed Pearce NW, Di Fabio F, Teng MJ, Syed S, Primrose JN, Hilal MA (2011) Laparoscopic right hepatectomy: a challenging, but feasible, safe and efficient procedure. Am J Surg 202:e52–e58CrossRefPubMed
27.
Zurück zum Zitat Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, Hasegawa Y, Katagiri T, Takagi C, Itano O, Kaneko H, Wakabayashi G (2014) A novel difficulty scoring system for laparoscopic liver resection. J Hepato-Biliary-Pancreat Sci 21:745–753CrossRef Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, Hasegawa Y, Katagiri T, Takagi C, Itano O, Kaneko H, Wakabayashi G (2014) A novel difficulty scoring system for laparoscopic liver resection. J Hepato-Biliary-Pancreat Sci 21:745–753CrossRef
28.
Zurück zum Zitat Cho JY, Han H-S, Yoon Y-S, Shin S-H (2008) Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location. Surgery 144:32–38CrossRefPubMed Cho JY, Han H-S, Yoon Y-S, Shin S-H (2008) Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location. Surgery 144:32–38CrossRefPubMed
29.
Zurück zum Zitat Ishizawa T, Gumbs AA, Kokudo N, Gayet B (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256:959–964CrossRefPubMed Ishizawa T, Gumbs AA, Kokudo N, Gayet B (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256:959–964CrossRefPubMed
30.
Zurück zum Zitat Yoon Y-S, Han H-S, Cho JY, Ahn KS (2010) Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc 24:1630–1637CrossRefPubMed Yoon Y-S, Han H-S, Cho JY, Ahn KS (2010) Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc 24:1630–1637CrossRefPubMed
31.
Zurück zum Zitat Belghiti J, Clavien P, Gadzijev E, Garden J, Lau W, Makuuchi M, Strong R (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2:333–339 Belghiti J, Clavien P, Gadzijev E, Garden J, Lau W, Makuuchi M, Strong R (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2:333–339
Metadaten
Titel
The learning curve of laparoscopic liver resection after the Louisville statement 2008: Will it be more effective and smooth?
verfasst von
Chung-Wei Lin
Tzu-Jung Tsai
Tsung-Yen Cheng
Hung-Kuang Wei
Chen-Fang Hung
Yin-Yin Chen
Chii-Ming Chen
Publikationsdatum
20.10.2015
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 7/2016
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4575-1

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