- 作者：Faizal D. Bhojani ; MD ; FRCSC ; Adrian Fox ; MD ; Kristen Pitzul ; MSc ; Steven Gallinger ; MD ; MSc ; FRCSC ; Alice Wei ; MD ; MSc ; FRCSC ; FACS ; Carol-Anne Moulton ; MD ; MEd ; PhD ; FRACS ; Allan Okrainec ; MD ; MHPE ; FRCSC ; FACS ; Sean P. Cleary ; MD ; MSc ; MPH ; FRCSC ; Sean.Cleary@uhn.ca
- 关键词：ASA ; American Society of Anesthesiologists ; CCD ; Case Costing Department ; CVP ; central venous pressure ; HCC ; hepatocellular carcinoma ; LLR ; laparoscopic liver resection ; LOS ; length of stay ; MELD ; Model of End-Stage Liver Disease ; OLR ; open liver resectio
- 刊名：Journal of the American College of Surgeons
- 出版年：2012
- 出版时间：February 2012
- 年：2012
- 卷：214
- 期：2
- 页码：184-195
- 全文大小：431 K
Background
Surgical resection of hepatic lesions is associated with intraoperative and postoperative morbidity and mortality. Our center has introduced a laparoscopic liver resection (LLR) program over the past 3 years. Our objective is to describe the initial clinical experience with LLR, including a detailed cost analysis.Study Design
We evaluated all LLRs from 2006 to 2010. Each was matched to 2 open cases for number of segments removed, patient age, and background liver histology. Model for End-Stage Liver Disease (MELD) and the Charlson comorbidity index were calculated retrospectively. Nonparametric statistical analysis was used to compare surgical and economic outcomes. Analyses were performed including and excluding converted cases.
Results
Fifty-seven patients underwent attempted LLR. Demographic characteristics were similar between groups. Estimated blood loss was lower in the LLR vs the open liver resection (OLR) group, at 250 mL and 500 mL, respectively (p < 0.001). Median operating room times were 240 minutes and 270 minutes in the LLR and OLR groups, respectively (p = 0.14). Eight cases were converted to open (14 % ): 2 for bleeding, 2 for anatomic uncertainty, 1 for tumor size, 1 for margins, 1 for inability to localize the tumor, and 1 for adhesions. Median length of stay was lower for LLR at 5 days vs 6 days for OLR (p < 0.001). There was no difference in frequency of ICU admission, reoperation, 30-day emergency room visit, or 30-day readmission rates. Median overall cost for LLR was lower at $11,376 vs $12,523 for OLR (p = 0.077).
Conclusions
Our experience suggests that LLR confers the clinical advantages of reduced operating room time, estimated blood loss, and length of stay while decreasing overall cost. LLR, therefore, appears to be a clinically and fiscally advantageous approach in properly selected patients.