ArticleSurgical endoscopy2024
Is prolonged operative time associated with postoperative complications in liver surgery? An international multicentre cohort study of 5424 patients.
Article in Surgical endoscopy, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.
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Who cites it
10 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Learning curves in robotic and laparoscopic colorectal surgery: a systematic review.Journal of robotic surgery · 2026Pooled it
- Postoperative Outcomes After Robotic Liver Resection of Caudate Lobe: A Systematic Review.Medicina (Kaunas, Lithuania) · 2024Pooled it
- Trial
- Development and validation of a model for predicting short-term complications after hepatectomy in patients with primary liver cancer.Journal of gastrointestinal oncology · 2026Article
- Prolonged surgical time and hypoalbuminemia as risk factors for adverse outcomes after esophagectomy: a multicenter study with age-stratified and spline-based analysis.Esophagus : official journal of the Japan Esophageal Society · 2026Observational
- An inflammation-nutrition-surgery-based INSEP model and a web-based clinical decision support system for predicting early postoperative infection in elderly patients with hepatocellular carcinoma: a multicenter retrospective study.Frontiers in nutrition · 2026Article
- Study - International multicentric minimally invasive liver resection (SIMMILR-4) : a comparison of conventional, digitally enhanced and collaborative robotic with Tele-robotic laparoscopic surgery for colorectal liver metastases.Journal of robotic surgery · 2025Article
- The impact of liver transection depth on surgical difficulty in robotic versus laparoscopic limited liver resection (TAKUMI-5).Langenbeck's archives of surgery · 2025Article
- Review
- Advanced approaches to loco-regional and surgical management for hepatocellular carcinoma.Journal of gastrointestinal oncology · 2024Article
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41 authors.
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Abstract
backgroundThe relation between operative time and postoperative complications in liver surgery is unclear. The aim of this study is to assess the impact of operative time on the development of postoperative complications in patients who underwent minimally invasive or open liver resections of various anatomical extent and technical difficulty levels.
methodsIn this retrospective cohort study, patients that underwent a right hemihepatectomy (RH), technically major resection (anatomically minor resection in segment 1, 4a, 7 or 8; TMR) or left lateral sectionectomy (LLS) between 2000 and 2022 were extracted from a multicenter database comprising the prospectively maintained databases of 31 centers in 13 countries. Minimally invasive procedures performed during the learning curve were omitted. Logistic regression models, performed separately for 9 different groups based on stratification by procedure type and allocated surgical approach, were used to assess the association between the fourth quartile of operative time (25% of patients with the longest operative time) and postoperative complications.
resultsOverall, 5424 patients were included: 1351 underwent RH (865 open, 373 laparoscopic and 113 robotic), 2821 TMR (1398 open, 1225 laparoscopic and 198 robotic), and 1252 LLS (241 open, 822 laparoscopic and 189 robotic). After adjusting for potential confounders (age, BMI, gender, ASA grade, previous abdominal surgery, disease type and extent, blood loss, Pringle, intraoperative transfusions and incidents), the fourth quartile of operative time, compared to the first three quartiles, was associated with an increased risk of postoperative complications after open, laparoscopic and robotic TMR (aOR 1.35, p = 0.031; aOR 1.74, p = 0.001 and aOR 3.11, p = 0.014, respectively), laparoscopic and robotic RH (aOR 1.98, p = 0.018 and aOR 3.28, p = 0.055, respectively) and solely laparoscopic LLS (aOR 1.69, p = 0.019).
conclusionsA prolonged operative time is associated with an increased risk of postoperative complications, although it remains to be defined if this is a causal relationship.
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