Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton, Southampton, UK.
Department of General and Hepatobiliary Surgery, Liver Transplantation, Ghent University Hospital Medical School, Ghent, Belgium.
Br J Surg. 2018 Aug;105(9):1182-1191. doi: 10.1002/bjs.10821. Epub 2018 May 8.
Previous studies have demonstrated that patient, surgical, tumour and operative variables affect the complexity of laparoscopic liver resections. However, current difficulty scoring systems address only tumour factors. The aim of this study was to develop and validate a predictive model for the risk of intraoperative complications during laparoscopic liver resections.
The prospectively maintained databases of seven European tertiary referral liver centres were compiled. Data from two-thirds of the patients were used for development and one-third for validation of the model. Intraoperative complications were based on a modified Satava classification. Using the methodology of the Framingham Heart Study, developed to identify risk factors that contribute to the development of cardiovascular disease, factors found to predict intraoperative complications independently were assigned points, and grouped into low-, moderate-, high- and extremely high-risk groups based on the likelihood of intraoperative complications.
A total of 2856 patients were included. Neoadjuvant chemotherapy, lesion type and size, classification of resection and previous open liver resection were found to be independent predictors of intraoperative complications. Patients with intraoperative complications had a longer duration of hospital stay (5 versus 4 days; P < 0·001), higher complication rates (32·5 versus 15·5 per cent; P < 0·001), and higher 30-day (3·0 versus 0·3 per cent; P < 0·001) and 90-day (3·8 versus 0·8 per cent; P < 0·001) mortality rates than those who did not. The model was able to predict intraoperative complications (area under the receiver operating characteristic (ROC) curve (AUC) 0·677, 95 per cent c.i. 0·647 to 0·706) as well as postoperative 90-day mortality (AUC 0·769, 0·681 to 0·858).
This comprehensive scoring system, based on patient, surgical and tumour factors, and developed and validated using a large multicentre European database, helped estimate the risk of intraoperative complications.
先前的研究已经表明，患者、手术、肿瘤和手术操作变量会影响腹腔镜肝切除术的复杂性。然而，当前的困难评分系统仅考虑肿瘤因素。本研究旨在开发和验证一种预测腹腔镜肝切除术术中并发症风险的模型。
汇集了七个欧洲三级转诊肝脏中心的前瞻性维护数据库。将三分之二的患者的数据用于模型的开发，三分之一的数据用于验证。术中并发症基于改良的 Satava 分类。采用 Framingham 心脏研究的方法，该方法用于确定导致心血管疾病发展的危险因素，将独立预测术中并发症的因素赋予分值，并根据术中并发症的可能性将其分为低、中、高和极高风险组。
共纳入 2856 例患者。新辅助化疗、病变类型和大小、切除分类和先前的开放性肝切除术被发现是术中并发症的独立预测因素。发生术中并发症的患者住院时间更长（5 天与 4 天；P＜0·001）、并发症发生率更高（32·5 与 15·5 ％；P＜0·001）、30 天（3·0 与 0·3 ％；P＜0·001）和 90 天（3·8 与 0·8 ％；P＜0·001）死亡率更高。该模型能够预测术中并发症（受试者工作特征曲线下面积（AUC）0·677，95％置信区间 0·647 至 0·706）以及术后 90 天死亡率（AUC 0·769，0·681 至 0·858）。
该综合评分系统基于患者、手术和肿瘤因素，使用大型多中心欧洲数据库进行开发和验证，有助于评估术中并发症的风险。
