Learning Curve of Ex Vivo Liver Resection and Autotransplantation in Treating End-Stage Hepatic Alveolar Echinococcosis: A RA-CUSUM Analysis

Background: This retrospective study aimed to evaluate the safety and learning curve of ex vivo liver resection and autotransplantation (ELRA).Methods: A total of 102 consecutive end-stage HAE patients who underwent ELRA between 2014 and 2020 in West China Hospital were enrolled. The primary endpoin...

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Auteurs principaux:	Yiwen Qiu, Xianwei Yang, Tao Wang, Shu Shen, Yi Yang, Bin Huang, Wentao Wang
Format:	article
Langue:	EN
Publié:	Frontiers Media S.A. 2021
Sujets:	risk-adjusted cumulative sum analysis autotransplantation liver transplantation living donor ex vivo resection alveolar echinococcosis Surgery RD1-811
Accès en ligne:	https://doaj.org/article/2b35d286daf2401fa1a3f0986c5a364b
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spelling	oai:doaj.org-article:2b35d286daf2401fa1a3f0986c5a364b2021-12-01T15:51:32ZLearning Curve of Ex Vivo Liver Resection and Autotransplantation in Treating End-Stage Hepatic Alveolar Echinococcosis: A RA-CUSUM Analysis2296-875X10.3389/fsurg.2021.753968https://doaj.org/article/2b35d286daf2401fa1a3f0986c5a364b2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fsurg.2021.753968/fullhttps://doaj.org/toc/2296-875XBackground: This retrospective study aimed to evaluate the safety and learning curve of ex vivo liver resection and autotransplantation (ELRA).Methods: A total of 102 consecutive end-stage HAE patients who underwent ELRA between 2014 and 2020 in West China Hospital were enrolled. The primary endpoint was major postoperative complications (comprehensive complication index, CCI > 26). The ELRA learning curve was evaluated using risk-adjusted cumulative sum (RA-CUSUM) methods. The learning phases were determined based on RA-CUSUM analysis and tested for their association with intra- and post-operative endpoints.Results: The median surgery time was 738 (659–818) min, with a median blood loss of 2,250 (1,600–3,000) ml. The overall incidence of major morbidity was 38.24% (39/102). Risk-adjusted cumulative sum analysis demonstrated a learning curve of 53 ELRAs for major postoperative complications. The learning phase showed a significant association with the hemodynamic unstable time (HR −30.29, 95% CI −43.32, −17.25, P < 0.0001), reimplantation time (HR −13.92, 95% CI −23.17, −4.67, P = 0.004), total postoperative stay (HR −6.87, 95% CI −11.33, −2.41, P = 0.0033), and postoperative major morbidity (HR 0.25, 95% CI 0.09, 0.68, p = 0.007) when adjusted for age, disease course, liver function, and remote metastasis.Discussion:Ex vivo liver resection and autotransplantation is feasible and safe with a learning curve of 53 cases for major postoperative complications.Yiwen QiuXianwei YangTao WangShu ShenYi YangBin HuangWentao WangFrontiers Media S.A.articlerisk-adjusted cumulative sum analysisautotransplantationliver transplantationliving donorex vivo resectionalveolar echinococcosisSurgeryRD1-811ENFrontiers in Surgery, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	risk-adjusted cumulative sum analysis autotransplantation liver transplantation living donor ex vivo resection alveolar echinococcosis Surgery RD1-811
spellingShingle	risk-adjusted cumulative sum analysis autotransplantation liver transplantation living donor ex vivo resection alveolar echinococcosis Surgery RD1-811 Yiwen Qiu Xianwei Yang Tao Wang Shu Shen Yi Yang Bin Huang Wentao Wang Learning Curve of Ex Vivo Liver Resection and Autotransplantation in Treating End-Stage Hepatic Alveolar Echinococcosis: A RA-CUSUM Analysis
description	Background: This retrospective study aimed to evaluate the safety and learning curve of ex vivo liver resection and autotransplantation (ELRA).Methods: A total of 102 consecutive end-stage HAE patients who underwent ELRA between 2014 and 2020 in West China Hospital were enrolled. The primary endpoint was major postoperative complications (comprehensive complication index, CCI > 26). The ELRA learning curve was evaluated using risk-adjusted cumulative sum (RA-CUSUM) methods. The learning phases were determined based on RA-CUSUM analysis and tested for their association with intra- and post-operative endpoints.Results: The median surgery time was 738 (659–818) min, with a median blood loss of 2,250 (1,600–3,000) ml. The overall incidence of major morbidity was 38.24% (39/102). Risk-adjusted cumulative sum analysis demonstrated a learning curve of 53 ELRAs for major postoperative complications. The learning phase showed a significant association with the hemodynamic unstable time (HR −30.29, 95% CI −43.32, −17.25, P < 0.0001), reimplantation time (HR −13.92, 95% CI −23.17, −4.67, P = 0.004), total postoperative stay (HR −6.87, 95% CI −11.33, −2.41, P = 0.0033), and postoperative major morbidity (HR 0.25, 95% CI 0.09, 0.68, p = 0.007) when adjusted for age, disease course, liver function, and remote metastasis.Discussion:Ex vivo liver resection and autotransplantation is feasible and safe with a learning curve of 53 cases for major postoperative complications.
format	article
author	Yiwen Qiu Xianwei Yang Tao Wang Shu Shen Yi Yang Bin Huang Wentao Wang
author_facet	Yiwen Qiu Xianwei Yang Tao Wang Shu Shen Yi Yang Bin Huang Wentao Wang
author_sort	Yiwen Qiu
title	Learning Curve of Ex Vivo Liver Resection and Autotransplantation in Treating End-Stage Hepatic Alveolar Echinococcosis: A RA-CUSUM Analysis
title_short	Learning Curve of Ex Vivo Liver Resection and Autotransplantation in Treating End-Stage Hepatic Alveolar Echinococcosis: A RA-CUSUM Analysis
title_full	Learning Curve of Ex Vivo Liver Resection and Autotransplantation in Treating End-Stage Hepatic Alveolar Echinococcosis: A RA-CUSUM Analysis
title_fullStr	Learning Curve of Ex Vivo Liver Resection and Autotransplantation in Treating End-Stage Hepatic Alveolar Echinococcosis: A RA-CUSUM Analysis
title_full_unstemmed	Learning Curve of Ex Vivo Liver Resection and Autotransplantation in Treating End-Stage Hepatic Alveolar Echinococcosis: A RA-CUSUM Analysis
title_sort	learning curve of ex vivo liver resection and autotransplantation in treating end-stage hepatic alveolar echinococcosis: a ra-cusum analysis
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/2b35d286daf2401fa1a3f0986c5a364b
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Learning Curve of Ex Vivo Liver Resection and Autotransplantation in Treating End-Stage Hepatic Alveolar Echinococcosis: A RA-CUSUM Analysis

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