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Updated: Jul 29, 2025
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Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy
Published on: March 10, 2023
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Assessing textbook outcome after single large hepatocellular carcinoma resection
Rémy Sindayigaya1, Stylianos Tzedakis1, Ecoline Tribillon2
1Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (APHP), 75014, Paris, France; Université Paris Cité, Faculté de Médecine, 75006, Paris, France.
Summary
Achieving ideal surgical care, measured by textbook outcome (TO), significantly improves survival after liver cancer resection. Laparoscopic surgery is a key predictor of achieving TO, especially in non-cirrhotic patients.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Medical Informatics
Background:
- Surgical care quality is crucial for outcomes in liver cancer.
- Identifying predictors of ideal surgical care is essential for improving patient results.
- Textbook Outcome (TO) serves as a quality metric in hepatobiliary surgery.
Purpose of the Study:
- To investigate the impact of ideal surgical care on oncological outcomes.
- To identify predictors of achieving Textbook Outcome (TO) after liver cancer resection.
- To assess the role of TO as a surrogate marker for improved oncological care.
Main Methods:
- Retrospective analysis of 103 patients undergoing liver cancer resection (2000-2021).
- Surgical care quality assessed using Textbook Outcome (TO).
- Multivariate analysis and Cox regressions used to determine predictors and impact of TO on overall survival (OS).
Main Results:
- Ideal surgical care (TO) was achieved in 52.4% of patients.
- Laparoscopic approach was independently associated with achieving TO (OR 2.57, p=0.045).
- Patients achieving TO demonstrated significantly better overall survival (5-year OS: 83.4% vs. 37.0%, p<0.0001).
Conclusions:
- Textbook Outcome (TO) is a significant predictor of improved survival after liver cancer resection.
- Laparoscopic approach is a key factor in achieving ideal surgical care.
- TO may serve as a valuable surrogate marker for enhanced oncological care, particularly in non-cirrhotic patients.
