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Tesi etd-06282018-091348


Thesis type
Tesi di laurea magistrale LM6
Author
VACCA, PIER GIUSEPPE
URN
etd-06282018-091348
Title
Learning Curve della Chirurgia Epatica del Risparmio d'Organo per lesioni tumorali profonde: uno studio retrospettivo su 126 interventi consecutivi
Struttura
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Corso di studi
MEDICINA E CHIRURGIA
Commissione
relatore Dott. Buccianti, Piero
correlatore Dott. Urbani, Lucio
Parole chiave
  • Parenchyma-Sparing Hepatectomy
  • Learning Curve
  • Fegato
  • Risparmio d'Organo
Data inizio appello
17/07/2018;
Consultabilità
parziale
Data di rilascio
17/07/2021
Riassunto analitico
Introduction. Parenchyma sparing hepatectomy (PSH) assures adequate future <br>liver remnant (FLR) for deep located tumours, however, PSH requires complex <br>surgical procedures with a learning curve that has never been analysed. <br> <br>Methods. Data from 126 consecutive patients treated with a PSH during the first 9 <br>years of practice were registered in a prospective database. One patient with <br>preoperative total bilirubin &gt;5 mg/dl was excluded. The initial period (4y) of low <br>(&lt;14/y) and the later period (5y) of high (&gt;14/y) case volume were compared. <br> <br>Results. Low (n=24) and high (n=101) case volume groups were comparable <br>(P&gt;0.05) for patient’s baseline characteristics, PSH requiring HV exposure/resection <br>(92% vs 78%), PSH with vascular reconstruction (25% vs 25%), extrahepatic surgical <br>procedures (25% vs 28%), median blood loss (150 vs 150 ml), blood transfusion <br>(37% vs 27%), overall (50% vs 38%) and severe (8% vs 8%) postoperative <br>complications and median length of stay (8.5 vs 9 days). Overall 90-day mortality <br>was 1.6%. In high volume case period there was an increasing attitude in <br>first/second order glissonian pedicles exposure (33% vs 68%; P=0.001) and the <br>mean biggest lesion size was greater (41+24 cm vs 55+37 cm, P=0.034). <br>Furthermore the operative time was shorter (714+316 min vs 595+242 min, <br>P=0.048) and the resected liver surface per minute was larger (0.93+0.35 cm2/min <br>vs 1.44+0.69 cm2/min, P=0.001). <br> <br>Conclusions. The learning curve had significant impact on the operative time and <br>on the surface area resected per minute, in spite of an increased attitude in <br>first/second order glissonian pedicles exposure and increased mean biggest lesion <br>size.
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