Abbass Mohammad Ali, Slezak Jeffery M, DiFronzo L Andrew
Department of Surgery, Kaiser Permanente, Los Angeles, California, USA.
Am Surg. 2013 Oct;79(10):961-7.
Although the safety of hepatic resection has improved, it is still a highly morbid procedure. A retrospective cohort of 375 patients undergoing hepatectomy (2004 to 2012) was done. All procedures were performed by a single surgeon at a tertiary center. To help identify trends over time, two subgroups were identified: Group 1 (n = 195 from October 2004 to December 2010) and Group 2 (n = 180 from January 2011 to November 2012). The two study groups had similar patient characteristics except there were more patients with cirrhosis in Group 2 (10 vs 17%, P = 0.04). A similar number of major hepatectomies was noted. Median estimated blood loss was 400 mL versus 300 mL (P = 0.04) in Group 2. Overall complications were more common in Group 1 (54 vs 45%). Fewer Grade 3 or greater Clavien complications (22 vs 13%, P = 0.04) and fewer hospital readmissions were noted in Group 2 (20 vs 8%, P = 0.002). Morbidity was associated with worse Eastern Cooperative Oncology Group (ECOG) performance status, age older than 60 years, and open surgery. Grade 3 or greater Clavien complications were also associated with age older than 60 years, higher American Society of Anesthesiologists class, and worse ECOG status and median estimated blood less greater than 400 mL. Higher Model for End-stage Liver Disease score and advanced ECOG status were correlated with mortality. Outcomes of hepatic resection improved time despite more complex patient characteristics and an equal number of major hepatectomies being performed. However, worse ECOG performance status was a major predictor of postoperative complications and increased mortality.
尽管肝切除术的安全性有所提高，但它仍然是一种具有高发病率的手术。对375例行肝切除术的患者（2004年至2012年）进行了一项回顾性队列研究。所有手术均由一家三级中心的一名外科医生完成。为了帮助确定随时间的趋势，确定了两个亚组：第1组（2004年10月至2010年12月，n = 195）和第2组（2011年1月至2012年11月，n = 180）。两个研究组的患者特征相似，只是第2组中肝硬化患者更多（10%对17%，P = 0.04）。主要肝切除术的数量相似。第2组的中位估计失血量为400 mL，而第1组为300 mL（P = 0.04）。总体并发症在第1组中更常见（54%对45%）。第2组中3级或更高级别的Clavien并发症较少（22%对13%，P = 0.04），再次入院的患者也较少（20%对8%，P = 0.002）。发病率与东部肿瘤协作组（ECOG）的较差体能状态、年龄大于60岁以及开放手术有关。3级或更高级别的Clavien并发症也与年龄大于60岁、美国麻醉医师协会分级较高、ECOG状态较差以及中位估计失血量大于400 mL有关。终末期肝病模型评分较高和ECOG状态较差与死亡率相关。尽管患者特征更复杂且主要肝切除术的数量相同，但肝切除术的结果随时间有所改善。然而，ECOG较差的体能状态是术后并发症和死亡率增加的主要预测因素。
