Abstract：
BACKGROUND: Despite evidence of benefits on postoperative outcomes, minimally invasive liver surgery (MILS) had a very low diffusion up to 2014, and recent evolution is unknown. Our aim was to analyze the recent diffusion and adoption of MILS and compare the trends in indications, extent of resection, and institutional practice with open liver surgery (OLS).
METHODS: We analyzed the French nationwide, exhaustive cohort of all patients undergoing a liver resection in France between January 1, 2013 and December 31, 2022. Average annual percentage changes (AAPC) in the incidence of MILS and OLS were compared using mixed-effects log-linear regression models. Time trends were analyzed in terms of extent of resection, indication, and institutional practice.
RESULTS: MILS represented 25.2% of 74,671 liver resections and year incidence doubled from 16.5% in 2013 to 35.4% in 2022. The highest AAPC were observed among major liver resections [+ 22.2% (19.5; 24.9) per year], primary [+ 10.2% (8.5; 12.0) per year], and secondary malignant tumors [+ 9.9% (8.2; 11.6) per year]. The highest increase in MILS was observed in university hospitals [+ 14.7% (7.7; 22.2) per year] performing 48.8% of MILS and in very high-volume (> 150 procedures/year) hospitals [+ 12.1% (9.0; 15.3) per year] performing 19.7% of MILS. OLS AAPC decreased for all indications and institutions and accelerated over time from - 1.8% (- 3.9; - 0.3) per year in 2013-2018 to - 5.9% (- 7.9; - 3.9) per year in 2018-2022 (p = 0.013).
CONCLUSIONS: This is the first reported trend reversal between MILS and OLS. MILS has considerably increased at a national scale, crossing the 20% tipping point of adoption rate as defined by the IDEAL framework.
METHODS: We analyzed the French nationwide, exhaustive cohort of all patients undergoing a liver resection in France between January 1, 2013 and December 31, 2022. Average annual percentage changes (AAPC) in the incidence of MILS and OLS were compared using mixed-effects log-linear regression models. Time trends were analyzed in terms of extent of resection, indication, and institutional practice.
RESULTS: MILS represented 25.2% of 74,671 liver resections and year incidence doubled from 16.5% in 2013 to 35.4% in 2022. The highest AAPC were observed among major liver resections [+ 22.2% (19.5; 24.9) per year], primary [+ 10.2% (8.5; 12.0) per year], and secondary malignant tumors [+ 9.9% (8.2; 11.6) per year]. The highest increase in MILS was observed in university hospitals [+ 14.7% (7.7; 22.2) per year] performing 48.8% of MILS and in very high-volume (> 150 procedures/year) hospitals [+ 12.1% (9.0; 15.3) per year] performing 19.7% of MILS. OLS AAPC decreased for all indications and institutions and accelerated over time from - 1.8% (- 3.9; - 0.3) per year in 2013-2018 to - 5.9% (- 7.9; - 3.9) per year in 2018-2022 (p = 0.013).
CONCLUSIONS: This is the first reported trend reversal between MILS and OLS. MILS has considerably increased at a national scale, crossing the 20% tipping point of adoption rate as defined by the IDEAL framework.
摘要：
背景：尽管有证据表明对术后结局有益，到2014年,微创肝脏手术(MILS)的扩散率非常低,最近的演变尚不清楚.我们的目的是分析MILS的近期扩散和采用，并比较适应症的趋势，切除范围,以及开放式肝脏手术（OLS）的机构实践。
方法：我们分析了法国全国，2013年1月1日至2022年12月31日在法国接受肝切除术的所有患者的详尽队列。使用混合效应对数线性回归模型比较了MILS和OLS发病率的平均年度百分比变化（AAPC）。根据切除程度分析了时间趋势，指示,和制度实践。
结果：MILS占74,671例肝脏切除术的25.2％，年发病率从2013年的16.5％增加到2022年的35.4％。在主要的肝切除术中观察到最高的AAPC[每年22.2％（19.5;24.9）]，主要[每年增加10.2%（8.5；12.0）]，和继发性恶性肿瘤[每年增加9.9％（8.2;11.6）]。MILS的增幅最高的是大学医院[每年14.7％（7.7;22.2）]，占MILS的48.8％，而非常大量（每年>150次手术）的医院[每年12.1%（9.0;15.3）]，占MILS的19.7％。所有适应症和机构的OLSAAPC下降，并随着时间的推移从2013-2018年的每年-1.8％（-3.9;-0.3）加速到2018-2022年的每年-5.9％（-7.9;-3.9）（p=0.013）。
结论：这是MILS和OLS之间首次报道的趋势逆转。MILS在全国范围内大幅增加，跨越理想框架定义的20%的采用率临界点。
方法：我们分析了法国全国，2013年1月1日至2022年12月31日在法国接受肝切除术的所有患者的详尽队列。使用混合效应对数线性回归模型比较了MILS和OLS发病率的平均年度百分比变化（AAPC）。根据切除程度分析了时间趋势，指示,和制度实践。
结果：MILS占74,671例肝脏切除术的25.2％，年发病率从2013年的16.5％增加到2022年的35.4％。在主要的肝切除术中观察到最高的AAPC[每年22.2％（19.5;24.9）]，主要[每年增加10.2%（8.5；12.0）]，和继发性恶性肿瘤[每年增加9.9％（8.2;11.6）]。MILS的增幅最高的是大学医院[每年14.7％（7.7;22.2）]，占MILS的48.8％，而非常大量（每年>150次手术）的医院[每年12.1%（9.0;15.3）]，占MILS的19.7％。所有适应症和机构的OLSAAPC下降，并随着时间的推移从2013-2018年的每年-1.8％（-3.9;-0.3）加速到2018-2022年的每年-5.9％（-7.9;-3.9）（p=0.013）。
结论：这是MILS和OLS之间首次报道的趋势逆转。MILS在全国范围内大幅增加，跨越理想框架定义的20%的采用率临界点。
