微创肝切除术治疗肝细胞癌的早期发病率和死亡率：与开放性切除术的倾向评分匹配比较。

Early Morbidity and Mortality after Minimally Invasive Liver Resection for Hepatocellular Carcinoma: a Propensity-Score Matched Comparison with Open Resection.

机构信息

Department of Surgery, Wexner Medical Center at the Ohio State University, Columbus, OH, USA.

Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave, N-907 Doan Hall, Columbus, OH, 43210, USA.

出版信息

J Gastrointest Surg. 2019 Jul;23(7):1435-1442. doi: 10.1007/s11605-018-4016-2. Epub 2018 Oct 30.

DOI:10.1007/s11605-018-4016-2

PMID:30377911

Abstract

BACKGROUND

The impact of minimally invasive surgery on the short-term outcomes of patients with hepatocellular carcinoma (HCC) undergoing liver resection remains poorly defined.

METHODS

The ACS-NSQIP-targeted hepatectomy database was used to identify patients who underwent liver resection for HCC during 2014-2016. A 1:1 propensity score matching was created between patients who underwent open (OLR) vs. minimally invasive liver resection (MILR) based on age, ASA score, liver resection type, liver texture, and stage of disease. The short-term outcomes of patients undergoing OLR vs. MILR were compared.

RESULTS

Among a total cohort of 1816 patients, propensity score matching resulted in 728 liver resections: 364 (50%) OLR and 364 (50%) MILR. Overall morbidity (29% vs. 23%, P = 0.04) was greater among patients undergoing OLR compared with MILR, whereas mortality did not differ between the two approaches (2% vs 1%, P = 0.57). MILR was associated with significant reductions in hospital LOS (6 vs. 4 days, P < 0.0001) but no difference in operative time (188 vs. 171 min, P = 0.13). On multivariate logistic regression analysis, age ≥ 65 (OR:1.6, 95%CI: 1.1-2.3, P = 0.0065), ASA class ≥ 3 (OR:2.7, 95%CI: 1.5-4.7, P = 0.0003), preoperative blood transfusion (OR:9.7, 95%CI: 1.06-90.3, P = 0.04), T ≥ 3 (OR:1.9, 95%CI: 1.09-3.4, P = 0.02), operative time > 200 min (OR:1.8, 95%CI: 1.2-2.5, P = 0.0011), and OLR (OR:1.4, 95%CI: 1.002-2.03, P = 0.04) were associated with increased odds of overall morbidity.

CONCLUSIONS

MILR for HCC is associated with a shorter hospital LOS and reduced postoperative complication rates, even after controlling for important patient and clinicopathologic confounders, compared to OLR. Efforts to expand the use of MILR for hepatobiliary surgery are warranted.

摘要

背景

微创外科手术对接受肝切除术的肝细胞癌（HCC）患者的短期结局的影响仍不清楚。

方法

使用 ACS-NSQIP 靶向肝切除术数据库，确定 2014 年至 2016 年间接受 HCC 肝切除术的患者。根据年龄、ASA 评分、肝切除术类型、肝质地和疾病分期，对接受开放肝切除术（OLR）与微创肝切除术（MILR）的患者进行 1:1 倾向评分匹配。比较 OLR 与 MILR 患者的短期结局。

结果

在总共 1816 例患者中，进行了倾向评分匹配，共进行了 728 例肝切除术：364 例（50%）OLR 和 364 例（50%）MILR。与 MILR 相比，OLR 患者的总体发病率（29% vs. 23%，P=0.04）更高，而两种方法的死亡率无差异（2% vs. 1%，P=0.57）。MILR 与住院 LOS 显著缩短相关（6 天 vs. 4 天，P<0.0001），但手术时间无差异（188 分钟 vs. 171 分钟，P=0.13）。多变量逻辑回归分析显示，年龄≥65 岁（OR：1.6，95%CI：1.1-2.3，P=0.0065）、ASA 分级≥3（OR：2.7，95%CI：1.5-4.7，P=0.0003）、术前输血（OR：9.7，95%CI：1.06-90.3，P=0.04）、T 期≥3（OR：1.9，95%CI：1.09-3.4，P=0.02）、手术时间>200 分钟（OR：1.8，95%CI：1.2-2.5，P=0.0011）和 OLR（OR：1.4，95%CI：1.002-2.03，P=0.04）与总体发病率增加相关。