3707 例连续肝切除术的综合并发症指数验证了尽管复杂性增加但随着时间的推移结局仍改善。
Comprehensive Complication Index Validates Improved Outcomes Over Time Despite Increased Complexity in 3707 Consecutive Hepatectomies.
机构信息
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
出版信息
Ann Surg. 2020 Apr;271(4):724-731. doi: 10.1097/SLA.0000000000003043.
OBJECTIVE
The aim of this study was to evaluate trends over time in perioperative outcomes for patients undergoing hepatectomy.
BACKGROUND
As perioperative care and surgical technique for hepatectomy have improved, the indications for and complexity of liver resections have evolved. However, the resulting effect on the short-term outcomes over time has not been well described.
METHODS
Consecutive patients undergoing hepatectomy during 1998 to 2015 at 1 institution were analyzed. Perioperative outcomes, including the comprehensive complication index (CCI), were compared between patients who underwent hepatectomy in the eras 1998 to 2003, 2004 to 2009, and 2010 to 2015.
RESULTS
The study included 3707 hepatic resections. The number of hepatectomies increased in each era (794 in 1998 to 2003, 1402 in 2004 to 2009, and 1511 in 2010 to 2015). Technical complexity increased over time as evidenced by increases in the rates of major hepatectomy (20%, 23%, 30%, P < 0.0001), 2-stage hepatectomy (0%, 3%, 4%, P < 0.001), need for portal vein embolization (5%, 9%, 9%, P = 0.001), preoperative chemotherapy for colorectal liver metastases (70%, 82%, 89%, P < 0.001) and median operative time (180, 175, 225 minutes, P < 0.001). Significant decreases over time were observed in median blood loss (300, 250, 200 mL, P < 0.001), transfusion rate (19%, 15%, 5%, P < 0.001), median length of hospitalization (7, 7, 6 days, P < 0.001), rates of CCI ≥26.2 (20%, 22%, 16%, P < 0.001) and 90-day mortality (3.1%, 2.6%, 1.3%, P < 0.01). On multivariable analysis, hepatectomy in the most recent era 2010 to 2015 was associated with a lower incidence of CCI ≥26.2 (odds ratio 0.7, 95% confidence interval 0.6-0.8, P < 0.0001).
CONCLUSION
Despite increases in complexity over an 18-year period, continued improvements in surgical technique and perioperative outcomes yielded a resultant decrease in CCI in the most current era.
目的
本研究旨在评估患者行肝切除术的围手术期结局随时间的变化趋势。
背景
随着围手术期护理和肝切除术技术的提高，肝切除术的适应证和复杂性也发生了变化。然而，其对随时间推移的短期结局的影响尚未得到很好的描述。
方法
分析 1998 年至 2015 年期间在 1 家机构接受肝切除术的连续患者。比较了 1998 年至 2003 年、2004 年至 2009 年和 2010 年至 2015 年期间行肝切除术的患者的围手术期结局，包括综合并发症指数（CCI）。
结果
该研究纳入了 3707 例肝切除术。每个时期的肝切除术数量都有所增加（1998 年至 2003 年为 794 例，2004 年至 2009 年为 1402 例，2010 年至 2015 年为 1511 例）。随着时间的推移，技术复杂性增加，主要肝切除术（20%、23%、30%，P < 0.0001）、2 期肝切除术（0%、3%、4%，P < 0.001）、门静脉栓塞术（5%、9%、9%，P = 0.001）、结直肠癌肝转移术前化疗（70%、82%、89%，P < 0.001）和中位手术时间（180、175、225 分钟，P < 0.001）的比例均有所增加。随着时间的推移，中位出血量（300、250、200 毫升，P < 0.001）、输血率（19%、15%、5%，P < 0.001）、中位住院时间（7、7、6 天，P < 0.001）、CCI ≥26.2（20%、22%、16%，P < 0.001）和 90 天死亡率（3.1%、2.6%、1.3%，P < 0.01）均显著降低。多变量分析显示，2010 年至 2015 年行肝切除术与 CCI ≥26.2 的发生率较低相关（比值比 0.7，95%置信区间 0.6-0.8，P < 0.0001）。
结论
尽管在 18 年期间复杂性增加，但手术技术和围手术期结局的持续改善导致了最近时期 CCI 的降低。
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