Ciria R, Padial A, Ayllón MD, García-Gaitan C, Briceño J. Fast-track protocols in laparoscopic liver surgery: Applicability and correlation with difficulty scoring systems. World J Gastrointest Surg 2022; 14(3): 211-220 [PMID: 35432762 DOI: 10.4240/wjgs.v14.i3.211]
Corresponding Author of This Article
Ruben Ciria, FEBS, MD, PhD, Surgeon, Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofia, Avenida Menéndez Pidal s/n, Cordoba 14004, Spain. rubenciria@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Mar 27, 2022; 14(3): 211-220 Published online Mar 27, 2022. doi: 10.4240/wjgs.v14.i3.211
Fast-track protocols in laparoscopic liver surgery: Applicability and correlation with difficulty scoring systems
Ruben Ciria, Ana Padial, María Dolores Ayllón, Carmen García-Gaitan, Javier Briceño
Ruben Ciria, Ana Padial, María Dolores Ayllón, Javier Briceño, Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofia, Cordoba 14004, Spain
Carmen García-Gaitan, Unit of Anesthesiology, University Hospital Reina Sofia, Cordoba 14004, Spain
Author contributions: Ciria R and Ayllón MD designed the research study; Ciria R, Ayllón MD, Padial A and García-Gaitan C performed the research; all authors analyzed the data and wrote the manuscript; All authors have read and approved the final manuscript; Ciria R and Padial A have equally contributed to the development of this manuscript and research.
Institutional review board statement: Approval number of the institutional review board of the University Hospital Reina Sofia was 4380 (Code 0000-0002).
Conflict-of-interest statement: The authors declare no conflict of interest in none of the contents within the development of the manuscript.
Data sharing statement: Technical appendix, statistical code and dataset available from the corresponding author at rubenciria@gmail.com. Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ruben Ciria, FEBS, MD, PhD, Surgeon, Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofia, Avenida Menéndez Pidal s/n, Cordoba 14004, Spain. rubenciria@gmail.com
Received: April 19, 2021 Peer-review started: April 19, 2021 First decision: June 13, 2021 Revised: July 25, 2021 Accepted: February 9, 2022 Article in press: February 9, 2022 Published online: March 27, 2022
Abstract
BACKGROUND
Few series have reported the utility of fast-track protocols (FTP) in minimally invasive liver surgery.
AIM
To report the applicability of FTP in minimally invasive liver surgery and to correlate with difficulty scores.
METHODS
The series of patients undergoing minimally invasive liver surgery from 2014 was analyzed. Iwate, Southampton and Gayet’s scores were compared as predictors of FTP adherence. Accomplishment of FTP was considered within 24-h, 48-h and 72-h. Multivariate models were performed to define discharge < 24 h, < 72 h, complications and readmissions.
RESULTS
From 160 cases, 78 were candidates for FTP, of which 22 (28.2%), 19 (24.4%) and 14 (17.9%) were discharged in < 24-h, 48-h and 72-h, respectively (total = 71.5%). Iwate, Southampton and Gayet’s scores achieved area under the receiver operating characteristic values for < 24-h stay of 0.780, 0.687 and 0.698, respectively. Sensitivity and specificity values for the best score (Iwate) were 87.7% and 66.7%, respectively (cutoff = 5.5). In multivariate models, < 72 h stay and complications revealed body mass index as a risk factor independent from difficulty scores.
CONCLUSION
The development of aggressive FTP is feasible and < 24-h stay can be achieved even in moderate and advanced complexity cases. Difficulty scores, including body mass index value, may be useful to predict which cases may adhere to these protocols.
Core Tip: The current manuscript shows how fast-track protocols on laparoscopic liver surgery can be accomplished according to difficulty scoring systems.
