The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

First Long-term Oncologic Results of the ALPPS Procedure in a Large Cohort of Patients With Colorectal Liver Metastases

OBJECTIVES: To analyze long-term oncological outcome along with prognostic risk factors in a large cohort of patients with colorectal liver metastases (CRLM) undergoing ALPPS. BACKGROUND: ALPPS is a two-stage hepatectomy variant that increases resection rates and R0 resection rates in patients with primarily unresectable CRLM as evidenced in a recent randomized controlled trial. Long-term oncologic results, however, are lacking. METHODS: Cases in- and outside the International ALPPS Registry were collected and completed by direct contacts to ALPPS centers to secure a comprehensive cohort. Overall, cancer-specific (CSS), and recurrence-free (RFS) survivals were analyzed along with independent risk factors using Cox-regression analysis. RESULTS: The cohort included 510 patients from 22 ALPPS centers over a 10-year period. Ninety-day mortality was 4.9% and median overall survival, CSS, and RFS were 39, 42, and 15 months, respectively. The median follow-up time was 38 months (95% confidence interval 32-43 months). Multivariate analysis identified tumor-characteristics (primary T4, right colon), biological features (K/N-RAS status), and response to chemotherapy (Response Evaluation Criteria in Solid Tumors) as independent predictors of CSS. Traditional factors such as size of metastases, uni versus bilobar involvement, and liver-first approach were not predictive. When hepatic recurrences after ALPPS was amenable to surgical/ablative treatment, median CSS was significantly superior compared to chemotherapy alone (56 vs 30 months, P < 0.001). CONCLUSIONS: This large cohort provides the first evidence that patients with primarily unresectable CRLM treated by ALPPS have not only low perioperative mortality, but achieve appealing long-term oncologic outcome especially those with favorable tumor biology and good response to chemotherapy

Improved Survival in Liver Transplant Patients Receiving Prolonged-release Tacrolimus-based Immunosuppression in the European Liver Transplant Registry (ELTR): An Extension Study.

none49sinoneAdam R, Karam V, Cailliez V, Trunečka P, Samuel D, Tisone G, Němec P, Soubrane O, Schneeberger S, Gridelli B, Bechstein WO, Risaliti A, Line PD, Vivarelli M, Rossi M, Pirenne J, Klempnauer JL, Rummo A, Di Benedetto F, Zieniewicz K, Troisi R, Paul A, Vali T, Kollmar O, Boudjema K, Hoti E, Colledan M, Pratschke J, Lang H, Popescu I, Ericzon BG, Strupas K, De Simone P, Kochs E, Heyd B, Gugenheim J, Pinna AD, Bennet W, Kazimi M, Bachellier P, Wigmore SJ, Rasmussen A, Clavien PA, Hidalgo E, O'Grady JG, Zamboni F, Kilic M, Duvoux C; all contributing centers (www.eltr.org) and the European Liver and Intestine Transplant Association (ELITA).Adam, R; Karam, V; Cailliez, V; Trunečka, P; Samuel, D; Tisone, G; Němec, P; Soubrane, O; Schneeberger, S; Gridelli, B; Bechstein, Wo; Risaliti, A; Line, Pd; Vivarelli, M; Rossi, M; Pirenne, J; Klempnauer, Jl; Rummo, A; Di Benedetto, F; Zieniewicz, K; Troisi, R; Paul, A; Vali, T; Kollmar, O; Boudjema, K; Hoti, E; Colledan, M; Pratschke, J; Lang, H; Popescu, I; Ericzon, Bg; Strupas, K; De Simone, P; Kochs, E; Heyd, B; Gugenheim, J; Pinna, Ad; Bennet, W; Kazimi, M; Bachellier, P; Wigmore, Sj; Rasmussen, A; Clavien, Pa; Hidalgo, E; O'Grady, Jg; Zamboni, F; Kilic, M; Duvoux, C; all contributing centers, (www. eltr. org) and the European Liver and Intestine Transplant Association (ELITA)