改良三级分类在预测开腹肝切除手术复杂性和术后发病率方面的性能。

Performance of a modified three-level classification in stratifying open liver resection procedures in terms of complexity and postoperative morbidity.

机构信息

Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.

出版信息

Br J Surg. 2020 Feb;107(3):258-267. doi: 10.1002/bjs.11351. Epub 2019 Oct 11.

DOI:10.1002/bjs.11351

PMID:31603540

Abstract

BACKGROUND

Traditional classifications for open liver resection are not always associated with surgical complexity and postoperative morbidity. The aim of this study was to test whether a three-level classification for stratifying surgical complexity based on surgical and postoperative outcomes, originally devised for laparoscopic liver resection, is superior to classifications based on a previously reported survey for stratifying surgical complexity of open liver resections, minor/major nomenclature or number of resected segments.

METHODS

Patients undergoing a first open liver resection without simultaneous procedures at MD Anderson Cancer Center (Houston cohort) or the University of Tokyo (Tokyo cohort) were studied. Surgical and postoperative outcomes were compared among three grades: I (wedge resection for anterolateral or posterosuperior segment and left lateral sectionectomy); II (anterolateral segmentectomy and left hepatectomy); III (posterosuperior segmentectomy, right posterior sectionectomy, right hepatectomy, central hepatectomy and extended left/right hepatectomy).

RESULTS

In both the Houston (1878 patients) and Tokyo (1202) cohorts, duration of operation, estimated blood loss and comprehensive complication index score differed between the three grades (all P < 0·050) and increased in stepwise fashion from grades I to III (all P < 0·001). Left hepatectomy was associated with better surgical and postoperative outcomes than right hepatectomy, extended right hepatectomy and right posterior sectionectomy, although these four procedures were categorized as being of medium complexity in the survey-based classification. Surgical outcomes of minor open liver resections also differed between the three grades (all P < 0·050). For duration of operation and blood loss, the area under the curve was higher for the three-level classification than for the minor/major or segment-based classification.

CONCLUSION

The three-level classification may be useful in studies analysing open liver resection at Western and Eastern centres.

摘要

背景

传统的开腹肝切除术分类法并不总是与手术复杂性和术后发病率相关。本研究旨在检验一种基于手术和术后结果对手术复杂性进行分层的三级分类法是否优于基于先前报道的调查对开腹肝切除术的手术复杂性进行分层的分类法、小/大命名法或切除的节段数。

方法

研究对象为在 MD 安德森癌症中心（休斯顿队列）或东京大学（东京队列）接受首次开腹肝切除术且无同期手术的患者。在三个等级（I 级：前外侧或后上叶楔形切除术和左外侧叶切除术；II 级：前外侧叶切除术和左半肝切除术；III 级：后上叶切除术、右后叶切除术、右半肝切除术、中央肝切除术和扩大的左/右半肝切除术）之间比较手术和术后结果。

结果

在休斯顿（1878 例）和东京（1202 例）队列中，三个等级之间手术持续时间、估计失血量和综合并发症指数评分均有差异（均 P<0·050），且从 I 级到 III 级呈阶梯式增加（均 P<0·001）。左半肝切除术与右半肝切除术、扩大的右半肝切除术和右后叶切除术相比，具有更好的手术和术后结果，尽管这四种手术在基于调查的分类法中被归类为中度复杂。三种类型的小开腹肝切除术的手术结果也有差异（均 P<0·050）。对于手术持续时间和失血量，三级分类的曲线下面积高于小/大或节段分类。