Utilizing the Concept of Textbook Outcome for Evaluating Quality Control in the Transition From Open Hepatectomy to Laparoscopic Hepatectomy for Hepatocellular Carcinoma

Yi-Hsuan Lee; Hsiu-Hsien Lin; Tsai-Ling Kuo; Yen-Cheng Chen

doi:10.1016/j.gassur.2025.102130

Utilizing the Concept of Textbook Outcome for Evaluating Quality Control in the Transition From Open Hepatectomy to Laparoscopic Hepatectomy for Hepatocellular Carcinoma

J Gastrointest Surg. 2025 Jun 24:102130. doi: 10.1016/j.gassur.2025.102130. Online ahead of print.

Authors

Yi-Hsuan Lee¹, Hsiu-Hsien Lin¹, Tsai-Ling Kuo², Yen-Cheng Chen³

Affiliations

¹ Division of General Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
² Division of General Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
³ Division of General Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan. Electronic address: yccmdsurg@gmail.com.

PMID: 40571250
DOI: 10.1016/j.gassur.2025.102130

Abstract

Background: The learning curve has traditionally been utilized to evaluate the development of surgical techniques. However, no studies have yet explored the use of the "textbook outcome" (TO), a composite metric originally designed for assessing surgical and postoperative care quality, in monitoring the evolution of surgical techniques. Therefore, this study aims to evaluate the quality control during the transition from open hepatectomy to laparoscopic hepatectomy for hepatocellular carcinoma (HCC) using TO as a standardized metric.

Methods: The retrospective study enrolled patients newly diagnosed with HCC who underwent hepatectomy from January 2013 to June 2021. Patient were divided into open hepatectomy (OH) and laparoscopic hepatectomy (LH) groups. A subgroup analysis was conducted within the LH group, dividing patients into those who achieved a TO and those who did not. Data on demographic characteristics, perioperative variables, and surgical complications were prospectively collected.

Results: The proportion of laparoscopic interventions steadily increased over the years, surpassing 50% after 2017. Overall, 81.4% and 86.9% of patients in the OH and LH groups, respectively, achieved TO (p = 0.337). Among those who achieved TO, no significant difference was observed between the LH and OH groups (p = 0.415); the 12-, 24-, and 36-month overall survival rates were 91.5%, 83.7%, and 83.7% in the LH group and 88.1%, 83.8%, and 80.7% in the OH group.

Conclusions: Under the TO concept, the implementation of LH did not compromise perioperative or oncological outcomes during its developmental phase. Moreover, TO serves as a robust evaluative tool for systematically monitoring the quality control of surgical procedures and postoperative care in the context of advancing laparoscopic surgical techniques.

Keywords: hepatocellular carcinoma; laparoscopic surgery; textbook outcome.