肝癌根治性切除术“教科书式结局”研究进展

Research progress on“textbook outcome”of radical hepatectomy for liver cancer

教科书式结局(TO)是一种全新的综合测量体系,其由多个结果参数组成,仅在全部参数都达到标准,该手术才符合TO。TO既代表手术后的最佳疗效,符合患者对“最佳”医疗的期望,亦用于评估不同团队对同一类疾病的手术治疗的质量、效果,甚至医院的水平、医疗保健成本等,是一个全新的质量评价指标体系。2022年国际肝胆胰外科协会(IHPBA)刊发了关于专门定义肝切除术的教科书式结局(TOLS)的国际专家共识,包括微创肝切除(MILR)和开放肝切除(OLR)。本文将从传统肝癌手术切除的评价标准及其不足之处、TO概念的产生、TO在肝胆胰外科领域的初步应用、TOLS最新国际专家共识、TOLS的优势与不足等方面阐述TO在肝癌手术切除方面的应用及其前景。

Textbook outcome(TO)is a novel comprehensive measurement system consisting of multiple outcome parameters.Only when all parameters meet the standards,the surgery is considered to achieve TO.TO represents the optimal therapeutic effect after surgery,meeting patients′expectations for the“best”medical care.It is also used to evaluate the quality and effectiveness of surgical treatments for the same disease by different teams,as well as the level of hospitals and healthcare costs.It is a new quality evaluation index system.In 2022,the International Hepato-Pancreato-Biliary Association(IHPBA)published an international expert consensus on the specifically defined textbook outcomes of liver surgery(TOLS),including minimally invasive liver resection(MILR)and open liver resection(OLR).This article discusses the evaluation criteria and limitations of traditional liver cancer surgery,the concept of TO,the initial application of TO in the field of hepato-pancreato-biliary surgery,the latest international expert consensus on TOLS,and the advantages and limitations of TOLS.It elaborates on the application and prospects of TO in liver cancer surgery.