An International Expert Delphi Consensus on Defining Textbook Outcome in Liver Surgery (TOLS)

被引：37

作者：

Gorgec, Burak ^{[1
,2
,3
,4
]}

Cacciaguerra, Andrea Benedetti ^{[1
,4
,5
]}

Pawlik, Timothy M. ^{[6
,7
]}

Aldrighetti, Luca A. ^{[8
]}

Alseidi, Adnan A. ^{[9
]}

Cillo, Umberto ^{[10
]}

Kokudo, Norihiro ^{[11
]}

Geller, David A. ^{[12
]}

Wakabayashi, Go ^{[13
]}

Asbun, Horacio J. ^{[14
]}

Besselink, Marc G. ^{[2
,3
]}

Cherqui, Daniel ^{[15
]}

Cheung, Tan To ^{[16
]}

Clavien, Pierre-Alain ^{[17
]}

Conrad, Claudius ^{[18
]}

D'Hondt, Mathieu ^{[19
]}

Dagher, Ibrahim ^{[20
]}

Dervenis, Christos ^{[21
]}

Devar, John ^{[22
,23
]}

Dixon, Elijah ^{[24
]}

Edwin, Bjorn ^{[25
,26
,27
]}

Efanov, Mikhail ^{[28
]}

Ettore, Giuseppe M. ^{[29
]}

Ferrero, Alessandro ^{[30
]}

Fondevilla, Constantino ^{[31
]}

Fuks, David ^{[32
]}

Giuliante, Felice ^{[33
]}

Han, Ho-Seong ^{[34
]}

Honda, Goro ^{[35
]}

Imventarza, Oscar ^{[36
,37
]}

Kooby, David A. ^{[38
]}

Lodge, Peter ^{[39
]}

Lopez-Ben, Santiago ^{[40
]}

Machado, Marcel A. ^{[41
]}

Marques, Hugo P. ^{[42
]}

O'Rourke, Nick ^{[43
]}

Pekolj, Juan ^{[44
]}

Pinna, Antonio D. ^{[45
]}

Portolani, Nazario ^{[46
]}

Primrose, John ^{[4
]}

Rotellar, Fernando ^{[47
]}

Ruzzenente, Andrea ^{[48
]}

Schadde, Erik ^{[49
,50
,51
]}

Siriwardena, Ajith K. ^{[52
]}

Smadi, Sameer ^{[53
]}

Soubrane, Olivier ^{[54
]}

Tanabe, Kenneth K. ^{[55
]}

Teh, Catherine S. C. ^{[56
]}

Torzilli, Guido ^{[57
]}

Van Gulik, Thomas M. ^{[2
,3
]}

机构：

[1] Poliambulanza Fdn Hosp, Dept Surg, Brescia, Italy

[2] Univ Amsterdam, AmsterdamUMC, Dept Surg, Amsterdam, Netherlands

[3] Canc Ctr Amsterdam, Amsterdam, Netherlands

[4] Univ Hosp Southampton NHS Fdn Trust, Dept Surg, Southampton, England

[5] Polytech Univ Marche, Riuniti Hosp, Dept Expt & Clin Med, Hepatobiliary & Abdominal Transplantat Surg, Ancona, Italy

[6] Ohio State Univ, Wexner Med Ctr, Dept Surg, Div Surg Oncol, Columbus, OH USA

[7] James Comprehens Canc Ctr, Columbus, OH USA

[8] IRCCS San Raffaele Hosp, Hepatobiliary Surg Div, Milan, Italy

[9] Univ Calif San Francisco, Dept Surg, San Francisco, CA USA

[10] Padova Univ Hosp, Dept Surg Oncol & Gastroenterol, Hepatobiliary Surg & Liver Transplantat Unit, Padua, Italy

[11] Natl Ctr Global Hlth & Med, Dept Surg, Hepatobiliary Pancreat Surg Div, Tokyo, Japan

[12] Univ Pittsburgh, Dept Surg, Med Ctr, Pittsburgh, PA USA

[13] Ageo Cent Gen Hosp, Ctr Adv Treatment Hepatobiliary & Pancreat Dis, Saitama, Japan

[14] Miami Canc Inst, Hepatobiliary & Pancreas Surg, Miami, FL USA

[15] Paul Brousse Univ Hosp, Dept Hepatobiliary Surg, Villejuif, France

[16] Univ Hong Kong, Dept Surg, Hong Kong, Peoples R China

[17] Univ Hosp Zurich, Dept Surg & Transplantat, Zurich, Switzerland

[18] Tufts Univ, Sch Med, St Elizabeths Med Ctr, Dept Surg, Boston, MA USA

[19] Groeninge Hosp, Dept Digest & Hepatobiliary Pancreat Surg, Kortrijk, Belgium

[20] Antoine Beclere Hosp, Dept Minimally Invas Digest Surg, Clamart, France

[21] Konstantopouleio Gen Hosp, Dept Surg, Athens, Greece

[22] Univ Witwatersrand, Fac Hlth Sci, Sch Clin Med, Dept Surg, Johannesburg, South Africa

[23] Chris Hani Baragwanath Acad Hosp, Dept Gen Surg, Hepatopancreat Biliary Unit, Johannesburg, South Africa

[24] Univ Calgary, Dept Surg, Calgary, AB, Canada

[25] Oslo Univ Hosp Oslo, Dept Hepatopancreatobiliary Surg, Oslo, Norway

[26] Oslo Univ Hosp Oslo, Intervent Ctr, Oslo, Norway

[27] Univ Oslo, Med Fac, Inst Clin Med, Oslo, Norway

[28] Moscow Clin Res Ctr, Dept Hepatopancreatobiliary Surg, Moscow, Russia

[29] San Camillo Hosp, Gen Surg & Transplantat Unit, Rome, Italy

[30] Umberto I Mauriziano Hosp, Dept Gen & Oncol Surg, Turin, Italy

[31] Hosp Univ La Paz, IdiPAZ, Gen & Digest Surg, Madrid, Spain

[32] Univ Paris 05, Inst Mutualiste Montsouris, Dept Digest Oncol & Metab Surg, Paris, France

[33] Univ Cattolica Sacro Cuore, IRCCS, Chirurg Epatobiliare, Rome, Italy

[34] Seoul Natl Univ, Bundang Hosp, Coll Med, Dept Surg, Seongnam Si, Gyeonggi Do, South Korea

[35] Tokyo Womens Med Univ, Inst Gastroenterol, Dept Surg, Tokyo, Japan

[36] Hosp Argerich, Dept Surg, Buenos Aires, Argentina

[37] Hosp Garrahan, Dept Surg, Buenos Aires, Argentina

[38] Emory Univ, Sch Med, Winship Canc Inst, Dept Surg, Atlanta, GA USA

[39] St James Univ Hosp, HPB & Transplant Unit, Leeds, England

[40] Hosp Univ Girona Dr Josep Trueta, Dept Gen & Digest Surg, HPB Unit, Girona, Spain

[41] Univ Sao Paulo, Dept Surg, Sao Paulo, Brazil

[42] Curry Cabral Hosp, Dept Surg, Lisbon, Portugal

[43] Royal Brisbane & Womens Hosp, Dept HPB Surg, Brisbane, Qld, Australia

[44] Hosp Italiano Buenos Aires, Dept Gen Surg, Div HPB Surg & Liver Transplant Unit, Buenos Aires, Argentina

[45] Cleveland Clin Florida, Abdominal Transplant & HPB Ctr, Weston, FL USA

[46] Univ Brescia, Dept Clin & Expt Sci, Surg Clin, Brescia, Italy

[47] Clin Univ Navarra, Dept Gen & Digest Surg, Pamplona, Spain

[48] Univ Verona, Dept Surg, Verona, Italy

[49] Univ Zurich, Inst Physiol, Zurich, Switzerland

[50] Cantonal Hosp Winterthur, Dept Surg, Zurich, Switzerland

来源：

ANNALS OF SURGERY | 2023年 / 277卷 / 05期

关键词：

composite measure; laparoscopic liver surgery; liver surgery; minimally invasive liver surgery; patient outcome; quality of care; robotic liver surgery; textbook outcome; COMPOSITE MEASURES; QUALITY; MORTALITY; RESECTION; METASTASES; CARE; COMPLICATIONS; 30-DAY;

D O I：

10.1097/SLA.0000000000005668

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Objective: To reach global expert consensus on the definition of TOLS in minimally invasive and open liver resection among renowned international expert liver surgeons using a modified Delphi method. Background: Textbook outcome is a novel composite measure combining the most desirable postoperative outcomes into one single measure and representing the ideal postoperative course. Despite a recently developed international definition of Textbook Outcome in Liver Surgery (TOLS), a standardized and expert consensus-based definition is lacking. Methods: This international, consensus-based, qualitative study used a Delphi process to achieve consensus on the definition of TOLS. The survey comprised 6 surgical domains with a total of 26 questions on individual surgical outcome variables. The process included 4 rounds of online questionnaires. Consensus was achieved when a threshold of at least 80% agreement was reached. The results from the Delphi rounds were used to establish an international definition of TOLS. Results: In total, 44 expert liver surgeons from 22 countries and all 3 major international hepato-pancreato-biliary associations completed round 1. Forty-two (96%), 41 (98%), and 41 (98%) of the experts participated in round 2, 3, and 4, respectively. The TOLS definition derived from the consensus process included the absence of intraoperative grade = 2 incidents, postoperative bile leakage grade B/C, postoperative liver failure grade B/C, 90-day major postoperative complications, 90-day readmission due to surgery-related major complications, 90-day/in-hospital mortality, and the presence of R0 resection margin. Conclusions: This is the first study providing an international expert consensus-based definition of TOLS for minimally invasive and open liver resections by the use of a formal Delphi consensus approach. TOLS may be useful in assessing patient-level hospital performance and carrying out international comparisons between centers with different clinical practices to further improve patient outcomes.

引用

页码：821 / 828

页数：8

共 49 条

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